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Dear User:
The Natural Medicines Comprehensive Database took two years to create and was released in
September 1999. Since its release, our research and editorial team continues to update the Database daily.
The editorial staff at Therapeutic Research Center decided to create the Natural Medicines Comprehensive
Database in the mid-1990's. The team had been researching and publishing objective drug information about
prescription and non-prescription drugs for many years and maintained a practice of answering drug
therapy-related questions for pharmacists and physicians throughout the United States and Canada.
In the mid-1990's, the staff started receiving a tremendous amount of questions related to natural medicines.
Our research team quickly discovered that there were no reliable resources that could be used to answer
questions in this subject area. Often times different resources would contain conflicting information or
had unreliable references. Several resources contained questionable information, some were outdated, and
many were based on anecdotal evidence or author opinions.
The research and editorial team at Therapeutic Research Center put their drug information and literature
evaluation skills to work to produce a highly objective, evidence-based resource designed for healthcare professionals.
Since that time, the Natural Medicines Comprehensive Database has grown in recognition. It is now recognized
as the scientific gold standard for evidence-based information on this topic. Leaders in conventional medicine
as well as complementary, alternative, and integrative medicine recognize the Database as the go-to resource
for the most complete and practical information.
The Database provides all of the clinically relevant information in an easy-to-use format.
You can do a product search from any page...you can click a button to get a patient handout for each
product...you can click references to see abstracts of articles. You'll always find all of your options on
the left hand side of the page.
We continually add valuable new information. Hundreds of monographs have been updated and thousands of
new references are added each year. We also add new interactions as soon as they are recognized, and new
safety concerns. Several effectiveness ratings have been raised or lowered based on new scientific findings.
This Database provides the most comprehensive listing of brand name product ingredients available. We encourage
users to let our editorial staff know any time that a brand name product cannot be found, so that our team can go
to work to find the information and add it to the Database. A special benefit to using this Database is that the
ingredients of brand name products are hot linked to a monograph on the particular ingredient.
Our research team continues to update the Web site every day. Research is now booming in this subject area.
We continue to add new data daily.
We have also created a brand new database and web site specifically for patients. This gives patients
reliable information in patient-friendly wording based on Natural Medicines Comprehensive Database.
The content of the patient-oriented web site is integrated into the professional Web site so health professionals
who use www.NaturalDatabase.com instantly have access to all of the patient education info and can print them for
a patient at any time.
Several exciting new projects related to this Database have recently been completed. All of the documented interactions
related to natural products are in this Database, and users will now find a very user-friendly interface in
order to check for interactions between all natural and regular products including all the ingredients. Users
will also find an enhanced interface to determine which natural products may be appropriate for various ailments.
If you are a new user of the Natural Medicines Comprehensive Database, please take a moment to read the
following pages. They explain how each monograph is laid out and how you can use each section to answer your questions.
PLUS, as a subscriber, you get the Natural Database eUPDATE and eCE sent to you monthly
to keep you abreast of new developments...and give you continuing education units --
accredited for physicians, pharmacists, nurse practitioners, physician assistants, and dietitians.
We hope you find this Database extremely useful. If you have suggestions, comments, or inquiries,
please don't hesitate to contact us: e-mail; phone: (209) 472-2244.
Sincerely,
Jeff M. Jellin, Pharm.D.,
Editor
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Getting the most out of Natural Medicines Comprehensive Database:
| | Monograph Name |  |
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Every one of the 1000 plus monographs in the Natural Medicines Comprehensive Database is given a name
based on the most widely used or most recognized name. These appear in ALL CAPS at the top of every monograph.
| | Also Known As | |
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Most herbal and non-herbal natural medicines go by a variety of names. The most common name is chosen as the
name of the monograph. Other colloquial, non-scientific names are included in this section and indexed at the
end of the book. This makes finding a natural medicine by any of its names quick and easy.
In many cases, different natural medicines may have similar sounding names. For example, there are
numerous varieties of ginseng: Siberian ginseng, American ginseng, Panax ginseng, and others.
The Database has a separate monograph for each of these. This section will alert you when there are other
monographs that have similar names.
| | Scientific Names | |
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This section contains all botanical, chemical, or other scientific names. Often times there is not just
one botanical name for a plant. In these cases, we have provided as many botanical names as are known.
We have also included any synonyms. For plants, a family name is also listed.
| | People Use This For | |
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There are a wide variety of uses for most natural medicines. However, not all uses have been validated through
clinical study. In this field, ALL known uses are listed without regard for effectiveness. A use listing in
this section does NOT mean the product is effective for that use. Efficacy is discussed in the Effectiveness
section (see below).
| | Safety | |
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For each natural medicine in the Database you get an evidence-based safety rating.
These are PRACTICAL ratings that are STANDARDIZED throughout the Natural Medicines Comprehensive Database.
You will see that different uses of a product often get different safety ratings. For example, camphor
is rated "LIKELY SAFE" when used topically, but it is rated "UNSAFE" when used orally.
Questions often come up about using products during pregnancy or lactation, or in children. If there are
safety considerations that apply specifically to children, a special mention in the safety field will address
the concern. Every listing includes a rating for safety in PREGNANCY and LACTATION.
Our team has been very meticulous in analyzing the medical literature to assign the safety ratings.
Each rating is assigned according to specific criteria:
LIKELY SAFE = The product has undergone a rigorous scientific evaluation equivalent to a review by the
FDA, Health Canada, or other governmental authority and has been found to be safe when used appropriately.
Or reputable references generally agree that the product is safe when used appropriately based on two or
more randomized, controlled, clinical trials involving several hundred to several thousand patients and
published in refereed journals; or based on large-scale post-marketing surveillance showing a low incidence
of significant adverse effects.
POSSIBLY SAFE = Reputable references agree that the product might be safe when used appropriately, and
there are human studies reporting no serious adverse effects.
POSSIBLY UNSAFE = There is some evidence suggesting that use of the product might be unsafe.
LIKELY UNSAFE = Reputable references agree that the product can be harmful, based on human studies or
reliable case reports of significant adverse effects.
UNSAFE = The product has undergone a rigorous scientific evaluation or a review by a reliable regulatory
agency and found to often cause clinically significant harm to humans. Or large-scale post-marketing surveillance
shows a high incidence of significant adverse effects.
| | Effectiveness | |
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For each natural medicine in the Database you get an evidence-based effectiveness rating.
These are PRACTICAL ratings that are STANDARDIZED throughout the Natural Medicines Comprehensive Database.
The "effectiveness" rating differs depending on the use, so you will often see more than one rating for a product.
Our team has been very meticulous in analyzing the medical literature to assign the efficacy ratings.
Each product is rated by the following scale:
EFFECTIVE = The product has passed a rigorous scientific review equivalent to a review by the FDA,
Health Canada, or other governmental authority and has been found to be effective for a specific indication
as an OTC drug, orphan drug, or prescription drug product.
LIKELY EFFECTIVE = Reputable references generally agree that the product is effective for the given indication,
based on two or more randomized, controlled, clinical trials involving several hundred to several thousand
patients, giving positive results for clinically relevant end-points and published in established, refereed journals.
POSSIBLY EFFECTIVE = Reputable references suggest that the product might work for the given indication based
on one or more clinical trials giving positive results for clinically relevant end-points.
POSSIBLY INEFFECTIVE = Reputable references suggest that the product might not work for the given indication
based on one human study giving negative results for clinically relevant end-points.
LIKELY INEFFECTIVE = Reputable references generally agree that the product is not effective for the given
indication, based on two or more randomized, controlled, clinical trials giving negative results for
clinically relevant end-points and published in established, refereed journals.
INEFFECTIVE = Most reputable references agree that the product is not effective for the given indication,
or multiple high-quality studies resulted in negative results; there are no equally reliable human studies
offering convincing contradictory data.
When possible, we have included one very useful bit of information in this Effectiveness section...the
SPECIFIC FORMULA OR EXTRACT that was used in studies that found the product to be effective or ineffective.
This information is not easily found elsewhere, but it is very important.
For example, a significant study was published in the Journal of the American Medical Association providing
evidence that ginkgo has a positive role in delaying the progression of Alzheimer's disease. Its effects
have been likened to Aricept. Many published works, and many ginkgo manufacturers have since stated ginkgo's
effectiveness in this area.
But this information is not useful without knowing what formulation of ginkgo was shown to have a positive effect.
The Natural Medicines Comprehensive Database states that the formulations of ginkgo that contain
Egb 761 (Tanakan) or LI 1370 (Lichtwer Pharma), consisting of 24-25% flavone glycosides and 6% terpene lactones,
are the formulations in the prominent studies that were shown to have beneficial effect.
It cannot be inferred from this that other formulations of ginkgo will also have the same effect.
| | Mechanism of Action and Active Ingredients | |
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In this field you will find a description of the known constituents...and pharmacological actions
that might be attributable to these constituents. Keep in mind that most of the natural products are
used because people have observed, or think they observed, some benefit to using the product. In many
cases there has been relatively little scientific inquiry into the active ingredients and the exact mechanism
of action. Also recognize that most herbal medicines are combinations of many constituents. It is quite possible
that herbal medicines work by the combined effects of multiple constituents, and the concept of identifying
a single specific active ingredient is flawed. Even when a single, specific active ingredient is identified,
it is possible that other active ingredients may be discovered later. For example, authorities used to
think that St. John's wort exerted its effect due to hypericin content. More recent findings suggest
that maybe hyperforin exerts significant activity.
| | Adverse Reactions | |
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In this field you get information about all the known adverse reactions and side effects associated
with the product. These are typically derived from the side effects reported in clinical trials
and from reliable case reports regarding adverse effects.
In some cases, certain adverse reactions are suspected based on pharmacological properties of the product.
Information about suspected adverse reactions and document adverse reactions is clearly distinguished.
Known allergies are also listed. This can help you anticipate potential problems. For example,
people who are allergic to one herb coming from the asteraceae family might also be allergic to
other herbs in the same family.
| | Interactions | |
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There are five separate fields listing different categories of possible interactions. For each product,
this Database lists Possible Interactions with...
Herbs and Other Dietary Supplements
Drugs
Foods
Lab Tests
Diseases and Conditions
This is a very important part of the Database. There are hundreds of potential interactions...and
many practitioners are not on the look-out for them. The usual computerized checking systems do
not have all this info in their systems...and patients do not recognize the potential problems like
they do with regular drugs. To use the information in these interaction fields, it is important to
understand the origin of the data. In some cases, it comes from documented reports. In other cases,
the data are theoretical, based on the pharmacological profile of the natural medicine. For example,
horse chestnut seed contains coumarin derivatives and theoretically increases bleeding time. At this
point in time there are very few well-documented interactions. Much of the information regarding potential
interactions is theoretical. A synopsis of documented reports and theoretical predictions appears in
this field. We have also prepared a separate pair of charts in the back of the book to give you a
listing of the potential interactions between drugs and natural medicines.
| | Drug Influences on Nutrient Levels and Depletion | |
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Some nutrients are thought to be depleted from the body by certain drugs. Data about nutrient depletion
appear in this field. This is the only field in the Database that appears ONLY for those natural medicines
that are involved in nutrient depletion interactions. Most of these include vitamins and minerals.
The natural medicines listed in this Database are typically the substances that are being depleted, and
are not the entities causing the depletion. For this reason, the editors have chosen to only list this
field when there are important data to present.
| | Dosage and Administration | |
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The dosages in this field are not necessarily recommended doses, safe doses, or efficacious doses.
If clinical trials have been conducted then the doses used in the studies are listed. Other doses
listed are the common or traditional doses or those typically used in supplements. Many products
included in this Database may not be safe or effective. This needs to be considered even when a typical dose is listed.
| | Comments | |
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This field presents a potpourri of info. For example, the comments on Siberian ginseng point out that
it is a completely different herb than American or Panax ginseng. American or Panax ginseng is considerably
more expensive. It is said that the Soviet Union wanted to provide its athletes with any advantage offered by
ginseng but wanted a less expensive version. Therefore, Siberian ginseng became popular, and this is why most
studies on Siberian ginseng are written in Russian.
Scattered throughout the Database you will see statements like, "Insufficient reliable information available."
This means that data do not exist, or the literature is too contradictory, or the studies are not of high
enough quality. This information is valuable because it is important for practitioners to know what is NOT known.
Many references state that certain products are effective, or safe, etc. when data do not exist to support
this conclusion. This Database states when there is insufficient information to meet the reliability
standards of this Database.
| | References | |
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This Database is thoroughly referenced with thousands of reference citations. In each monograph you
will see numbers in parenthesis appearing at the end of statements. These refer to reference citations.
Click on any reference number to see the complete citation...or click on the "references" link to see a
complete list of references used to create a monograph.
For each citation that is indexed on MEDLINE, the Web version of the Database links directly to the original abstract.
The fact that so many references were used to create this Database allows this Database to be both a
scientific consensus of clinical information and a comprehensive collection of data on natural medicines.
| | Research Abstracts | |
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The Natural Medicines Comprehensive Database is a great clinical tool. It's also an efficient research tool.
The Database is completely referenced with several thousand reference citations. For each citation that
is indexed on MEDLINE, the Web version of the Database links directly to the original abstract.
| | Brand Names Listing | |
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There are really two separate databases of natural products within the Natural Medicines Comprehensive Database.
There is a compilation of over 1000 monographs on natural medicines or ingredients. There is another
database consisting of several thousand brand name products and their ingredients. Each brand name listing
provides the name of the manufacturer and all of the ingredients. The databases are linked to together to
allow you to search for products and brand names in any way you need.
Within the Brand Name listing, you will sometimes find the term "Editor's Comment" In these instances there
will be some important commentary from the editors related to the particular brand name product. For example,
the listing of all the ingredients in a brand name product may serve to answer some questions about the
product, but the use of all these ingredients in COMBINATION form may require additional commentary.
Or, there may be some data related to this particular brand that the editors wish for you to know about.
For example, some brand name products contain substances derived from animal organs.
Since there is some theoretical risk of contamination with diseased animal tissue (e.g., mad cow disease),
our editors have included an "Editor's Comment" about this risk.
Keep in mind that manufacturers can change the ingredients of their brand name products at anytime.
This has been creating problems for years. Remember when Ex-Lax contained phenolphthalein? Some people
did not realize that it was changed to contain sennosides and docusate sodium. The same thing happens
frequently with natural medicines.
| | "Tell The Editors" form | |
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It is unrealistic to believe that all clinicians, researchers, and other experts will always agree
with every statement in this Database. The Editors recognize that new information is surfacing all
the time and new interpretations develop all the time. A team of researchers and editors work full-time
to constantly update this Database. These editors respect intelligent differences of opinion, and in fact,
invite and encourage any professional user of this Database to share new knowledge, or new interpretations
with us. If you recommend a change to any statement in this Database, please use the "Tell The Editors"
form...you'll find a link to the form on each monograph page. Please include the reference citation.
The Editors review all suggestions. We thank you for helping to make this the best resource possible.
| | Updates | |
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The Web version of the Database is updated daily. Our team of editors and researchers work full-time
to constantly add new, practical data. This allows users to quickly find answers to all the questions
their patients are asking about the latest products and latest hype. The info on the Web version is
periodically downloaded to create the Book version.
| | Searchability | |
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Users of the Web version can quickly search the entire Database for whatever they are looking for.
The keyword search helps you quickly answer questions about drug interactions, side effects,
Effectiveness Ratings for specific diseases, precautions for certain conditions, etc.
| | Patient Education | |
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The Web version provides a full set of patient education handouts covering all of our monographs.
For each of the 1000+ monographs written for professionals, there is a corresponding patient
education handout. This allows you to provide patient-friendly information to all of your patients
interested in these products. The patient information is updated right along with the professional
monographs so your patients get the most up-to-date information.
| | Colleagues Interact | |
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Connect with your colleagues. Colleagues Interact is an online discussion group that allows users
to post questions and discuss interesting cases. Our editors routinely monitor Colleagues Interact
and frequently provide answers to subscriber's questions. All subscribers have access.
| | Book Version | |
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Our goal is to provide data that is accurate, timely, clinically practical, and easy to get to.
That's why fields are filled in with short concise data. And that's why we offer the data in both
printed and Web versions. We want practitioners to have access by whichever format serves them best.
The printed version is handy, easy-to-use, and usable anytime anywhere. The book version is over 1500 pages long.
The book is printed from the Web version and is accurate as of the date it is taken out of the Web. Updates
to the Web version continue daily, and each new edition of the book version contains the latest updates as
of the date it is printed. There are fewer brand names in the brand name listing in the book version, because
including all of them would consume hundreds of pages.
Whether you get the Book version, the Web version, or both depends on your specific needs.
The Book version allows you to quickly flip through a few pages to find the answers you need.
Some practitioners like to keep a copy handy so they can go over the info face-to-face with their patients.
The Web version offers the same great content with some additional capabilities that can only be made
available in the dynamic online format.
Many practitioners choose to get BOTH the Book and Web versions...the best of both worlds.
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