Relief Formula [Discontinued] by Pharmanex

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Abdominal pain. Although there has been interest in using oral atractylodes for abdominal pain, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Anorexia nervosa. Although there has been interest in using oral atractylodes for anorexia nervosa, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Cachexia. It is unclear if oral atractylodes is beneficial in patients with cachexia. Details: Preliminary clinical research in people with gastric cancer-related cachexia shows that taking an isolated constituent of atractylodes, atractylenolide I, 1.32 grams orally daily for 7 weeks moderately improves appetite scores and functional ability scores when compared with fish oil 0.45 grams (15706).
• Common cold. Although there has been interest in using oral atractylodes for the common cold, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Diarrhea. Although there has been interest in using oral atractylodes for diarrhea, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Gastroesophageal reflux disease (GERD). Although there has been interest in using oral atractylodes for GERD, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Influenza. Although there has been interest in using oral atractylodes for Influenza, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Intracranial hemorrhage. Atractylodes has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with chronic subdural hematoma (CSDH) who underwent burr hole surgery shows that taking atractylodes rhizome as part of traditional Japanese medicine products also containing Asian water plantain, mushrooms, and cinnamon for 3 months reduces postoperative recurrence of CSDH when compared with usual care. Subgroup analysis suggests the combination treatment containing atractylodes may be most effective for the acute on chronic CSDH subtype (112827). It is unclear whether these effects are due to atractylodes, other ingredients, or the combination.
• Lung cancer. Although there has been interest in using oral atractylodes for lung cancer, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Obesity. Although there has been interest in using oral atractylodes for obesity, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Peritoneal dialysis. Although there has been interest in using oral atractylodes for peritoneal dialysis, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral atractylodes for RA, there is insufficient reliable information about the clinical effects of atractylodes for this purpose. More evidence is needed to rate atractylodes for these uses.

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POSSIBLY EFFECTIVE

• Gingivitis. Magnolia bark extract might modestly reduce gum bleeding and inflammation when added to gum or toothpaste. Details: One clinical study shows that chewing gum containing magnolia bark extract plus xylitol for 5 minutes three times daily for 30 days reduces gingival bleeding by 33%, compared with 24% after chewing gum containing xylitol alone (92459). Another clinical study in adults with gingivitis shows that using a fluoride toothpaste containing magnolia extract 0.3% twice daily reduces gingivitis severity by about 0.27 points on the gingival index after 3 months, compared to 0.15 points for patients using the toothpaste without magnolia extract (92464).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. Although there is interest in using topical magnolia for aging skin, there is insufficient reliable information about the clinical effects of magnolia for this purpose.
• Allergic rhinitis (hay fever). Although there is interest in using oral magnolia for hay fever, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Anxiety. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy females with mild anxiety shows that taking a proprietary blend of magnolia and phellodendron bark extract (Relora, Next Pharmaceuticals), standardized to 1.5% honokiol and 0.1% berberine, 250 mg three times daily for 6 weeks reduces temporary feelings of stress-induced anxiety almost 2-fold when compared with placebo. However, taking this product does not seem to improve long-standing feelings of stress-induced anxiety (34246). It is unclear if this effect is due to magnolia, other ingredients, or the combination. Additionally, this study was funded by the supplement manufacturer.
• Dental plaque. It is unclear if oral magnolia is beneficial in patients with dental plaque. Details: Clinical research in adults with gingivitis shows that using a toothpaste containing 0.3% magnolia extract twice daily modestly reduces plaque severity by about 0.41 points on the mean plaque index after 3 months, compared to a 0.27 point reduction for patients using the toothpaste without magnolia extract (92464). While statistically significant, this improvement might not be clinically meaningful.
• Diabetes. Although there is interest in using oral magnolia for diabetes, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Headache. Although there is interest in using oral magnolia for headache, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Menopausal symptoms. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized clinical study in postmenopausal patients shows that taking a specific combination of magnolia, Vitex agnus-castus, soy isoflavones, vitamin D, and lactobacillus (Estromineral Serena Plus, Meda Pharma SpA) daily for one year decreases the frequency and intensity of hot flashes and improves sleep quality and the ability to fall asleep when compared with soy isoflavones alone (95031). Additionally, a small clinical study shows that taking this same product daily for one year improves vasomotor symptoms, mood disorders, somatic symptoms, sleep disorders, blood pressure, and glycemic control when compared to baseline (110708). However, the validity of these findings is limited by a lack of control group. Overall, it is unclear if the effects of this magnolia-containing product in postmenopausal patients are due to magnolia, other ingredients, or the combination.
• Obesity. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in overweight females who report stress eating shows that taking a specific product containing a combination of bark extracts of magnolia plus phellodendron (Relora, Next Pharmaceuticals, Inc.) 250 mg three times daily for 6 weeks seems to prevent weight gain, compared with a 1.5 kg weight gain in those taking placebo (14349). This finding is limited because differences between groups were not statistically compared. Furthermore, it's unclear if this product induces weight loss.
• Postpartum depression. It is unclear if oral magnolia tea is beneficial for preventing postpartum depression. Details: A small clinical study in healthy postpartum patients shows that drinking 1 cup of magnolia tea daily for 3 weeks may improve depressive symptoms and sleep efficiency when compared with usual care alone. Magnolia tea (plant part unspecified) was steeped in 300 mL of hot water for 12 minutes prior to consumption (105089).
• Stress. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small low-quality clinical trial in moderately stressed healthy adults shows that taking a proprietary blend of magnolia and phellodendron bark extract (Relora, Next Pharmaceuticals) 250 mg twice daily for 4 weeks improves overall mood and decreases stress when compared with placebo (94904). It is unclear if this effect is due to magnolia, other ingredients, or the combination. Additionally, this study was funded by the supplement manufacturer. More evidence is needed to rate magnolia for these uses.

(Read more about MAGNOLIA)

There is insufficient reliable information available about the safety of atractylodes.

PREGNANCY: POSSIBLY UNSAFE
when used orally. In animals, atractylodes has caused reproductive toxicity, including fetal death, as well as changes in gestation, growth, and skeletal formation (94304).

LACTATION:
There is insufficient reliable information available about the safety of atractylodes when used during breast-feeding.

(Read more about ATRACTYLODES)

POSSIBLY SAFE ...when used orally and appropriately, short-term. A specific product containing magnolia extract and phellodendron extract (Relora, Next Pharmaceuticals, Inc.) has been used with apparent safety in clinical trials at a dose of 250 mg two to three times daily for up to 6 weeks (14349,34246,94904). ...when used topically in a toothpaste for up to 6 months (92464).

PREGNANCY: UNSAFE
when the magnolia flower bud is used orally due to reports of uterine stimulant activity (11953). There is insufficient reliable information available about the safety of using magnolia bark during pregnancy; avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about MAGNOLIA)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes might increase the risk of bleeding when used concomitantly with anticoagulant and antiplatelet drugs.  Details Laboratory research suggests that atractylenolides II and III, constituents of atractylodes, reduce platelet activation (94299). So far, this has not been shown in humans.

AROMATASE INHIBITORS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes may have an additive effect when used with other aromatase inhibitors.  Details Laboratory research suggests that atractylodes and its constituents exhibit aromatase inhibitor effects (94302).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes might decrease the levels of CYP1A2 substrates.  Details In animals, atractylodes administered at high doses has been shown to induce CYP1A2 activity (112828). This effect has not been shown in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes might increase the levels of CYP3A4 substrates.  Details In animals, atractylodes administered at high doses has been shown to inhibit CYP3A1 activity, which is a homolog to the human CYP3A4 enzyme (112828). This effect has not been shown in humans.

HEXOBARBITAL Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking atractylodes may prolong the therapeutic and adverse effects of hexobarbital.  Details In animals, atractylodes has been shown to prolong the effects of hexobarbital (94303). These effects have not been shown in humans.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, magnolia might have additive effects and increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.  Details In vitro research shows that the chemicals magnolol and honokiol, isolated from magnolia bark, inhibit platelet aggregation that is experimentally induced by collagen and arachidonic acid. However, they do not inhibit platelet aggregation that is induced by adenosine diphosphate, platelet-activating factor, or thrombin (18273). This interaction has not been reported in humans.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of large doses of magnolia bark and CNS depressants might have additive effects.  Details In vitro and animal research shows that constituents extracted from magnolia bark, especially honokiol and magnolol, have sedative effects. These effects may be due to the inhibition of catecholamine release and modulation of gamma-aminobutyric acid-A (GABA-A) receptors (11946,11952).

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General ...There is currently a limited amount of information on the adverse effects of atractylodes. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Allergic reaction, dry mouth, nausea.

Gastrointestinal ...Orally, atractylenolide I, an isolated constituent of atractylodes, can cause bad taste, nausea, and dry mouth (15706).

Immunologic ...Atractylodes can cause an allergic reaction in people sensitive to the Asteraceae/Compositae family (12450). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

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General ...Orally, magnolia seems to be well tolerated.
Most Common Adverse Effects:
Topically: Contact dermatitis.

Dermatologic ...Topically, magnolia bark has been associated with reports of allergic contact dermatitis (92463,92468,95030,110709). In several cases, the use of anti-aging facial creams containing magnolia bark extract was associated with allergic contact dermatitis of the face (92463,92468,95030). In one case, the use of a vaginal gel containing magnolia bark extract was associated with allergic contact dermatitis of the vulva (110709). Symptoms typically resolve with the use of topical corticosteroids and discontinuation of magnolia bark extract (95030,110709). Patch testing suggests that the magnolia bark extract constituents magnolol and honokiol are responsible for this adverse effect (110709).

Endocrine ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported thyroid dysfunction (14349). However, it's not known if this side effect is related to magnolia or some other factor.

Gastrointestinal ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported heartburn (14349). However, it's not known if this side effect is related to magnolia or some other factor.

Neurologic/CNS ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported shaking hands and perilabial numbness. Another patient reported fatigue and headache (14349). However, it's not known if these side effects are related to magnolia or some other factor.

Psychiatric ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported sexual dysfunction (14349). However, it's not known if this side effect is related to magnolia or some other factor.

(Read more about MAGNOLIA)