SAFETY AND EFFICACY OF PANAX GINSENG DURING PREGNANCY AND LACTATION

Main Article Content

Dugald Seely
Jean-Jacques Dugoua
Daniel Perri
Edward Mills Mills
Gideon Koren

Keywords

Panax ginseng, asian ginseng, ginseng, pregnancy, lactation, breastfeeding, systematic review

Abstract

Background


There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and the safety of herbs used by women during pregnancy and lactation. This is one article in a series that systematically reviews the evidence for herbs commonly used during pregnancy and lactation.


 Objectives


To systematically review the literature for evidence on the use, safety and pharmacology of Panax ginseng, focusing on issues pertaining to pregnancy and lactation.


 Methods


We searched 7 electronic databases and compiled data according to the grade of evidence that was found.


 Results


Based on strong scientific evidence from a cohort study, Panax ginseng was not associated with adverse effects when used during pregnancy. Panax ginseng was misreported in the literature as causing androgenization, when, in fact, the case reported was due to an adulterant. There is in vitro evidence of teratogenicity with exposure to ginsenosides; however, this evidence is derived from animal embryos and is based on exposure to isolated ginsenosides at much higher levels than achievable through normal consumption in humans. There is also conflicting evidence as to whether or not Panax ginseng has estrogenic properties. In lactation, there are no human studies on the safety of Panax ginseng, only in vitro evidence based on three animal studies reporting minimal risk.


 Conclusions


Panax ginseng should be consumed with caution during pregnancy, especially during the first trimester,and during lactation.

Abstract 2811 | PDF Downloads 433

References

1. Radad K, et al. Use of ginseng in medicine with emphasis on neurodegenerative disorders. J Pharmacol Sci 2006;100(3):175- 86.
2. Bahrke MS, Morgan WR. Evaluation of the ergogenic properties of ginseng: an update. Sports Med 2000;29(2):113-33.
3. Boon H, Smith M. The complete natural medicine guide to the 50 most common medicinal herbs. 2004, Toronto: Robert Rose.
4. Blumenthal M. Asian ginseng: potential therapeutic uses. Adv Nurse Pract 2001;9(2):26-8,33.
5. Coon JT, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions. Drug Saf 2002;25(5):323-44.
6. Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin Pharmacol
1999;55(8):567-75.
7. Jellin JM, Batz F, Hitchens K. Natural medicines comprehensive database 3rd Edition. 2002, Stockton, CA: Therapeutic Research Faculty.1530.
8. Moon J, et al. Induction of G(1) cell cycle arrest and p27(KIP1) increase by panaxydol isolated from Panax ginseng. Biochem Pharmacol 2000;59:1109-16.
9. Ng TB, Wang H. Panaxagin, a new protein from Chinese ginseng possesses anti -fungal, anti- viral, translation -inhibiting and ribonuclease activities. Life Sci 2001;68:739- 49.
10. Foster S. Panax ginseng. American Botanical Council, 1996.
11. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. 1996, New York, NY: John Wiley & Sons. 649.
12. Hong B, et al. A double -blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol 2002;168(5):2070 -3
13. Choi HK, et al. Clinical study of SS-Cream in patients with lifelong premature ejaculation. Urology 2000;55:257-61.
14. Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non- insulin dependent diabetic patients. Diabetes Care 1995;18:1373-5.
15. Scaglione F, et al. Efficacy and safety of the standardised Ginseng extract G115 for potentiating vaccination against the influenza syndrome and protection against the common cold [corrected]. Drugs Exp Clin Res 1996;22(2):65-72.
16. Wesnes KA, et al. The memory enhancing effects of a Ginkgo biloba/Panax ginseng combination in healthy middle-aged volunteers. Psychopharmacology (Berl) 2000;152(4)353-61.
17. Scholey AB, Kennedy DO. Acute, dose-dependent cognitive effects of Ginkgo biloba, Panax ginseng and their combination in healthy young volunteers: differential interactions with cognitive demand. Hum Psychopharmacol 2002;17(1):35-44.
18. The Review of Natural Products by Facts and Comparisons. 1999, St. Louis, MO: Wolters Kluwer Co.
19. Sorensen H, Sonne J. A double-masked study of the effects of ginseng on cognitive functions. Curr Ther Res Clin Exp 1996;57:959- 68.
20. D'Angelo L, et al. A double-blind, placebo-controlled clinical study on the effect of a standardized ginseng extract on psychomotor performance in healthy volunteers. J Ethnopharmacol 1986;16(1):15- 22.
21. Reay JL, Kennedy D, Scholey A. Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained 'mentally demanding' tasks. J Psychopharmacol 2006;20(6):771- 781.
22. Reay JL, Kennedy DO, Scholey AB. Single doses of Panax ginseng (G115) reduce blood glucose levels and improve cognitive performance during sustained mental activity. J Psychopharmacol 2005;19(4):357-65.
23. Kim SH, et al. Effects of Panax ginseng extract on exercise- induced oxidative stress. J Sports Med Phys Fitness 2005;45(2):178-82.
24. Scaglione F, Weiser K, Alessandria M. Effects of the standardized ginseng extract G115 (Reg.) in patients with chronic bronchitis: A nonblinded, randomized, comparative pilot study. Clin Drug Invest 2001;21:41-5.
25. Yun TK, Choi SY. Non-organ specific cancer prevention of ginseng: a prospective study in Korea. Int J Epidemiol 1998;27(3):359- 64.
26. Shin HR, et al. The cancer- preventive potential of Panax ginseng: a review of human and experimental evidence. Cancer Causes Control 2000;11:565-76.
27. Van Kampen JM, Robertson HA. A possible role for dopamine D3 receptor stimulation in the induction of neurogenesis in the adult rat substantia nigra. Neuroscience 2005;136(2):381 -6.
28. Wiklund IK, et al. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Int J Clin Pharmacol Res 1999;19:89 -99.
29. Zhang WY, Teng H, Zheng Y. [Ginseng saponin treatment for intrauterine growth retardation]. Zhonghua Yi Xue Za Zhi 1994;74(10):608-10, 646.
30. Farnsworth NR, et al. Potential value of plants as sources of new antifertility agents II. J. Pharm Sci. 1975;64(5):717 -753.
31. Awang DV. Maternal use of ginseng and neonatal androgenization. JAMA 1991;266(3):363.
32. Koren G, et al. Maternal ginseng use associated with neonatal androgenization. JAMA 1990;264:2866.
33. Okamu ra N, et al. Protective effect of ginseng saponins against impaired brain growth in neonatal rats exposed to ethanol.Biol Pharm Bull 1994;17(2):270 -4.
34. Chan LY, Chiu PY, Lau TK. An in -vitro study of ginsenoside Rb1 -induced teratogenicity using a whole rat embryo culture model. Hum Reprod
2003;18(10):2166 -8.
35. Liu P, et al. Developmental toxicity research of ginsenoside Rb1 using a whole mouse embryo culture model. Birth Defects Res B Dev Reprod Toxicol 2005;74(2):207-9.
36. Liu P, et al. Effects of ginsenoside Rg1 on postimplantation rat and mouse embryos cultured in vitro. Toxicol In Vitro 2006;20(2):234-8.
37. Chan LY, Chiu PY, Lau TK. Embryotoxicity study of ginsenoside Rc and Re in in vitro rat whole embryo culture. Reprod Toxicol 2004;19(1):131-4.
38. Cho SW, Cho EH, Choi SY. Ginsenosides activate DNA polymerase delta from bovine placenta. Life Sci 1995;57(14):1359-65.
39. Wong HB. Effects of herbs and drugs during pregnancy and lactation. J Singapore Paediatr Soc 1979;21(3 -4):169-78.
40. Palmer BV, et al. Gin Seng and mastalgia [letter]. BMJ 1978;1:1284.
41. Hopkins MP, Androff L, Benninghoff AS. Ginseng face cream and unexplained vaginal bleeding. Am J Obstet Gynecol 1988;159:1121- 2.
42. Greenspan EM. Ginseng and vaginal bleeding [letter]. JAMA 1983;249:2018.
43. Hammond TG, Whitworth JA. Adverse reactions to ginseng [letter]. Med J Aust 1981;1:492.
44. Punnonen R, Lukola A. Oestrogen-like effect of ginseng. Br Med J 1980;281:1110.
45. Eagon PK, et al. Medicinal herbs: modulation of estrogen action. in Era of Hope Mtg, Dept Defense. 2000. Atlanta, GA: Breast Cancer Res Prog.
46. Lee YJ, et al. Ginsenoside-Rb1 acts as a weak phytoestrogen in MCF-7 human breast cancer cells. Arch Pharm Res 2003;26:58-63.
47. Hu S, et al. Effect of subcutaneous injection of ginseng on cows with subclinical Staphylococcus aureus mastitis. J Vet Med B Infect Dis Vet Public Health 2001;48(7):519-28.
48. Concha C, Hu S, Holmberg O. The proliferative responses of cow stripping milk and blood lymphocytes to pokeweed mitogen and ginseng in vitro. Vet Res 1996;27(2):107-15.
49. Hu S, et al. Ginseng-enhanced oxidative and phagocytic activities of polymorphonuclear leucocytes from bovine peripheral blood and stripping milk. Vet Res 1995;26(3):155-61.
50. Chang YS, et al. Panax ginseng: a role in cancer therapy? Integr Cancer Ther 2003;2(1):13- 33.
51. Siegel RK. Ginseng abuse syndrome. Problems with the panacea. JAMA 1979;241(15):1614-5.
52. Attele AS, Wu JA, Yuan CS. Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol 1999;58(11):1685-93.
53. Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997;54:692-3.
54. Cheng TO. Ginseng- warfarin interaction. ACC Current Journal Review 2000;9(1):84.
55. Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non- insulin dependent diabetic patients. Diabetes Care 1993;Jan;16(1):8- 15, 1995;18:1373-5.
56. Newall CA, Anderson LA, Phillipson JD. Herbal medicines: a guide for health-care professionals. 1996, London, UK: Pharmaceutical Press 296.
57. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. 1998, Sandy, OR: Eclectic Medical Publications.
58. Becker BN. Ginseng- induced diuretic resistance. JAMA 1996;276(8):606-7.
59. Shader RI, Greenblatt DJ. Phenylzine and the dream machine-ramblings and reflections. J Clin Psychopharmacol 1985;5:65.
60. Jones BD, Runikis AM. Interaction of ginseng with phenelzine. J Clin Psychopharmacol 1987;7:201-2.
61. McGuffin M, et al. American Herbal Products Association's Botanical Safety Handbook. 1997, Boca Raton, FL: CRC Press. 231.
62. Zhu M, et al. Possible influences of ginseng on the pharmacodynamics of warfarin in rats. J Pharm Pharmacol 1999;51:175-80
63. Steiner M. Untersuchungen zur odemvermindernden und odemportektiven wirking von ro kastaniensamenextrakt. Phlebol Prokto 1990;19:239-42.
64. Vutyavanich T, Kraisarin T, Ruangsri R. Ging er for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97(4):577 -82.
65. Tode T, et al. Effect of Korean red ginseng on psychological functions in patients with severe climacteric syndromes. Int J Gynaecol Obstet 1999;67:169-74.
66. Hiai S, et al. Stimulation of pituitary-adrenocortical system by ginseng saponin. Endocrinol Jpn 1979;26:661- 5.
67. Kase Y, et al. Mechanisms by which Hange- shashin- to reduces prostaglandin E2 levels. Biol Pharm Bull 1998;21:1277- 81.
68. Robbers JE, Speedie MK, Tyler VE. Pharmacognosy and Pharmacobiotechnology. 1996, Baltimore, MD: Williams & Wilkins.
69. Belogortseva NI, Yoon JY, Kim KH. Inhibition of Helicobacter pylori hemagglutination by polysaccharide fractions from roots of Panax ginseng. Planta Med 2000;66:217- 20.
70. Schulz V, et al. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. 3rd ed. 1998, Berlin, GER: Springer.
71. Lewis R, et al. Non -ginsenoside nicotinic activity in ginseng species. Phytother Res 1999;13:59 -64.
72. Tamaoki J, Nakata J, Kawatani K. Ginsenoside-induced relaxation of human bronchial smooth muscle via release of nitric oxide. Br J Pharmacol 2000;130:1859-64.
73. Pan SJ, Ding Z, Ivy JL. Ginseng's effects on glucose tolerance and mRNA profiles in an animal model of Type II diabetes. Alt Ther 2001;7:S26.

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>