Primena preparata gloga u terapiji srčane insuficijencije

Hawthorn is a proven, established remedy for heart ailments. Therapeutic efficacy has been most reliably documented for hawthorn leaves and flowers, and a fixed combination of hawthorn flowers, leaves, and fruits. The updated 1994 Commission E monograph of hawthorn leaves and flowers states that the extract is indicated for declining cardiac performance consistent with stage II failure according to NYHA criteria. Standardized hawthorn extracts exerted positive inotropic effect, positive dromotropic effect, negative bathmotropic effect, increased coronary and myocardial circulatory perfusion, and reducted peripheral vascular resistance. The recommended dosage is 160-900 mg/day of the crude water-alcohol extract (ethanol 45% V/V or methanol 70% V/V, drug/extract ratio = 4-7:1, with defined flavonoid or oligomeric procyanidin content), corresponding to 30-168,7 mg oligomeric procyanidins, calculated as epicatechin, or 3,5-19,8 mg flavonoids, calculated as hyperoside. Based on the results of the treatment studies that used objective criteria, however, the recommended dose should be toward the upper end of the relatively broad range stated in the monograph, i.e., 600-900 mg of extract per day.Fitopreparati na bazi Crataegus vrsta su ispitani i potvrđeni biljni lekovi za dopunsku terapiju srčane insuficijencije. Terapijska efikasnost potvrđena je za listove i cvetove i za fiksnu kombinaciju cvetova, listova i plodova gloga. Prema revidiranoj monografiji Komisije E iz 1994. godine, standardizovani ekstrakti listova i cvetova gloga, Crataegi folium cum flore, koriste se kod oslabljene srčane funkcije koja odgovara stadijumu II prema NYHA klasifikaciji. Standardizovani ekstrakti gloga ispoljavaju pozitivno inotropno, pozitivno dromotropno i negativno batmotropno delovanje, poboljšavaju protok kroz koronarne krvne sudove, povećavaju prokrvljenost miokarda i snižavaju periferni otpor. Preporučena dnevna doza je 160-900 mg vodeno-alkoholnog ekstrakta (etanol 45% V/V ili metanol 70% V/V) sa odnosom droga/ekstrakt 4-7:1 i definisanim sadržajem flavonoida ili procijanidina: 30-168,7 mg oligomernih procijanidina (OPC), računato kao epikatehin ili 3,5-19,8 mg flavonoida, računato kao hiperozid. Međutim, na osnovu rezultata kliničkih istraživanja, preporučena dnevna doza trebala bi da bude veća i da iznosi npr. 600-900 mg

Biljne droge u terapiji plućnih bolesti

Plant drugs can be used as supplementary medicines in the symptomatic treatment of pulmonary diseases. Expectorant drugs are used in the treatment of mucostasis in bronchial asthma and chronic bronchitis. Certain drugs are administered in cases of respiratory tract diseases with mild bronchospasm. In cases of viral infections, patients are recommended to take drugs, which increase protection strenghts of organism. Certain plant bronchospasmolitic ingredients were used as source for semisynthetic or as a model for synthetic production of medicines in the treatment of bronchial asthma and other obstructive pulmonary diseases (ipratropium bromide is atropine derivative, disodium cromoglycate is khellin derivative). Today, ephedrine is only partly being produced synthetically, while it is still being isolated from plant material (various Ephedra species)

Primena biljnih lekovitih proizvoda u terapiji depresije

For dry hydroalcoholic extracts of St. John's wort herb, Hyperici herba (Hypericum perforatum, Hypericaceae), it was demonstrated in clinical trials that in the treatment of mild to moderate (but not severe) major depression, they are more effective than placebo, and as effective as some standard antidepressants. These extracts represent complex mixtures of structurally diverse constituents with various mechanisms of action. The quantity of active components can vary among different extracts. The Committee on Herbal Medicinal Products of the European Medicines Agency (EMA/HMPC) published monograph on St. John's wort herb, Hyperici herba, according to which these extracts are the components of herbal medicinal products with well-established medicinal use of the active substance, intended for the treatment of mild to moderate depressive episodes and for the short term treatment of symptoms in mild depressive disorders. These herbal drugs are characterized by good tolerability. Compared to synthetic antidepressants, they cause less undesirable effects. However, they exhibit interactions with the large number of drugs, due to the induction of the isoenzymes of cytochrome P450 system (CYP, primarily CYP3A4) and P-glycoprotein, as well as the potentiation of serotonergic effects. Because of mentioned interactions, for these herbal drugs appropriate contraindications, special warnings and precautions for use were established.Za suve vodenoalkoholne ekstrakte herbe kantariona, Hyperici herba (Hypericum perforatum, Hypericaceae), u kliničkim studijama je pokazano da su u slučaju blage i umerene (ali ne i teške) velike depresije značajno efikasniji od placeba, i da je njihova efikasnost uporediva sa nekim sintetskim antidepresivima. Ovi ekstrakti predstavljaju složene smeše hemijski različitih sastojaka koji deluju različitim mehanizmima. Količina aktivnih sastojaka među različitim ekstraktima može da varira. Komitet za biljne lekovite proizvode Evropske agencije za lekove (EMA/HMPC) izdao je monografiju za herbu kantariona, Hyperici herba, prema kojoj se na bazi ovih ekstrakata izrađuju biljni lekovi sa dobro dokumentovanom upotrebom aktivne supstance (eng. well-established medicinal use), namenjeni za terapiju blagih do umerenih depresivnih epizoda i kratkotrajnu terapiju blagih depresivnih poremećaja. Ove biljne lekove karakteriše dobra podnošljivost. U odnosu na sintetske antidepresive izazivaju manje neželjenih dejstava. Međutim, biljni lekovi na bazi suvih vodenoalkoholnih ekstrakata herbe kantariona ispoljavaju interakcije sa velikim brojem lekova zahvaljujući indukciji izoenzima sistema citohrom P450 (CYP, prvenstveno CYP3A4) i P-glikoproteina, kao i potenciranju serotoninskih efekata. Zbog navedenih interakcija ustanovljene su odgovarajuće kontraindikacije i posebna upozorenja i mere opreza vezane za primenu ovih biljnih lekova

Herbal and Traditional Herbal Medicinal Products, EU Herbal Monographs and EU List

Prema zakonskim aktima EU i zakonskim aktima naše zemlje, biljni lekovi (BL) i tradicionalni biljni lekovi (TBL) predstavljaju vrste lekova. Kao aktivne sastojke sadrže biljne droge (supstance biljnog porekla) i/ili preparate biljnih droga (biljne preparate). BL se stavljaju u promet na osnovu potvrđenog kvaliteta, kliničke efikasnosti i bezbednosti. TBL se registruju na osnovu potvrđenog kvaliteta i dovoljno podataka o tradicionalnoj upotrebi kojima se dokazuje da imaju prihvatljiv stepen bezbednosti i očekivanu efikasnost. Komitet za biljne lekovite proizvode (HMPC) Evropske agencije za lekove (EMA) izdaje monografije EU za biljne droge, preparate biljnih droga i njihove kombinacije u kojima se nalaze pretklinički i klinički podaci za BL sa dobro poznatom upotrebom (WEU) i podaci o tradicionalnoj upotrebi (TU) za TBL. HMPC priprema i nacrte unosa u listu EU za TBL, koje usvaja i objavljuje Evropska komisija. Zaključno sa julom 2019. god., HMPC je izdao 160 finalnih monografija, koje su dostupne na web-sajtu EMA (157 monografija za 156 biljnih droga i preparata, dve monografije za dve kombinacije biljnih droga i jednu monografiju za čaj, tj. čajne mešavine); za 13 biljnih droga i preparata objavljeni su unosi u listu EU. U radu je dat prikaz terapijskih oblasti i indikacija koje su odobrene u navedenim finalnim monografijama EU. Takođe, dat je pregled BL i TBL koji imaju dozvole za stavljanje u promet/upisani su u Registar tradicionalnih biljnih lekova u Republici Srbiji.According to legislation of EU, as well as of our country, herbal medicinal products (HMPs) and traditional herbal medicinal products (THMPs) are categories of medicinal products. As active ingredients, they contain herbal drugs (herbal substances) and/or herbal drug preparations (herbal preparations). HMPs are authorized based on proved quality, clinical efficacy and safety. THMPs are registered based on proved quality and sufficient data on traditional use (acceptable safety level and plausible efficacy). The Committee on Herbal Medicinal Products (HMPC) of the European Medicines Agency (EMA) publishes EU herbal monographs, which comprise preclinical and clinical data on HMPs with well-established use (WEU), as well as data on traditional use (TU) for THMPs. HMPC also develops drafts of EU list entries for THMPs, which are adopted and their final versions are published by the European Commission. By the end of July 2019, HMPC issued 160 final monographs, which are available on the EMA website (157 monographs for 156 herbal drugs and herbal drug preparations, two monographs for two herbal drug combinations, and monograph for herbal tea combinations); EU list entries on 13 herbal drugs and preparations were finalized. This paper provides an overview of the therapeutic areas and indications approved in these final EU monographs. In addition, overview of HMPs and THMPs, which are authorized/registered in the Republic of Serbia is given

Depresija i anksioznost - mogućnosti primene biljnih lekova

Herbal medicinal products based on hydroalcoholic extracts of St. John's wort herb, Hyperici herba, could be used for treatment of mild to moderate (but not severe) depression. These products should not be taken concomitantly with synthetic antidepressants and with photosensitising drugs. St. John's wort herb extracts (hyperforin) could low down effective concentration of many drugs in blood and reduce their therapeutic effects, especially imunosupressors (cyclosporin), antiretroviral drugs (protease-1 and transcriptase inhibitors), theophylline, digoxin, anticoagulants (warfarin) and oral contraceptives. Their co-administration should be therefore avoided. Abruptly stopping of taking St. John's wort herbal medicinal products could cause increase of these drugs blood levels, which enhances further risks of adverse effects. Herbal medicinal products containing extracts of valerian root, Valerianae radix, could be used for mild nervous tensions and difficulty in falling asleep (non-organic insomnia). Continuous usage over 2-4 weeks is recommended for optimal treatment effect (not suitable for acute interventional treatment). For similar conditions, but only traditionally, products of hops strobiles, Lupuli strobuli, passionflower herb, Passiflorae herba, lemon balm leaf, Melissae folium, and lavender flower, Lavandulae flos, are used. Kava rhizome, Piperis methystici rhizoma, is the only herbal anxiolytic, whose products have an effect size comparable to standard anxiolytic treatments. Sadly kava products are banned in many countries, due to a suspicion that they can cause liver damage.Biljni lekovi na bazi vodeno-alkoholnih ekstrakata herbe kantariona, Hyperici herba mogu se koristiti kod blagih i umerenih (ali ne i teških) depresija. Ne treba ih uzimati istovremeno sa sintetskim antidepresivima, kao ni sa lekovima koji mogu da dovedu do fotosenzibilizacije. Ekstrakti kantariona (hiperforin) mogu da snize efektivnu koncentraciju mnogih lekova u plazmi i umanje njihovo terapijsko dejstvo, naročito imunosupresora (ciklosporin), antivirusnih lekova (inhibitori proteaze-1, transkriptaze), teofilina, digoksina, antikoagulanasa (varfarin) i oralnih kontraceptiva. Zbog toga treba izbegavati njihovu istovremenu primenu, utoliko pre što u slučaju naglog prekida uzimanja ekstrakata kantariona može doći do porasta nivoa sintetskih lekova u plazmi i povećanja rizika od pojave neželjenih efekata. Biljni lekovi na bazi ekstrakata korena odoljena, Valerianae radix, mogu se primenjivati kod blage uznemirenosti i za olakšavanje nastupanja sna (insomnia koja nije izazvana organskim poremećajima). Za postizanje optimalnog terapijskog efekta preporučuje se kontinuirana primena tokom 2-4 nedelje (nisu podesni za tretman akutnih stanja). Kod blage uznemirenosti i nesanice koriste se, ali za sada isključivo tradicionalno, i lekoviti proizvodi na bazi šišarica hmelja, Lupuli strobuli, herbe Hristovog cveća, Passiflorae herba, lista matičnjaka, Melissae folium i cveta lavande, Lavandulae flos. Lekoviti proizvodi na bazi rizoma kave, Piperis methystici rhizoma, su jedini biljni anksiolitici čiji je efekat uporediv sa efektima standardnih anksiolitika. Međutim, u mnogim zemljama ovi proizvodi su zabranjeni, zbog sumnje da mogu da deluju hepatotoksično

Biljni lekovi za respiratorna oboljenja kod dece

Herbal medicines are frequently used for prophylaxis and adjuvant therapy of respiratory ailments in paediatric practice. In medical treatment of inflammation of respiratory mucosa, essential oils with antiseptic and anti-inflammatory properties are frequently used and applied externally (ointments, baths), or internally (inhalations). In the same indication field, herbal preparations based upon the extracts of dalmatian sage leaves (Salviae folium) and plantain leaves or herb (Plantaginis lanceolatae folium/herba) are also commonly used. In the treatment of productive cough, the use of preparations derived from certain saponin-containing and aromatic herbal medicines, as well as the essential oils with secretolytic and secretomotoric action is justified. For relief of unproductive cough, phytopreparations containing mucilage (mucilaginosa) are useful. In paediatric practice, only the use of plant-derived diaphoretics is recommended for the treatment of feverish conditions (willow bark, Salicis cortex, as a herbal antipyretic, is contraindicated because of high salicylate content). For prophylaxis and adjuvant therapy of recurrent infections of the upper respiratory tract (common cold), the use of herbal preparations based on the extracts of certain Echinacea species is advised.Biljni lekovi se često koriste za profilaksu i adjuvantnu terapiju respiratornih oboljenja kod dece. Za tretman inflamacije sluzokože disajnih puteva obično se koriste etarska ulja sa antiseptičnim i antiinflamatornim delovanjem i primenjuju u obliku preparata za spoljašnju (masti, kupke) ili unutrašnju upotrebu (inhalacije). U ovom indikacionom području često se primenjuju i preparati na bazi ekstrakata lista dalmatinske žalfije (Salviae folium) i lista ili herbe bokvice (Plantaginis lanceolatae folium/herba). Za terapiju produktivnog kašlja opravdana je upotreba preparata nekih saponinskih, aromatičnih droga i etarskih ulja sa sekretolitičkim i sekretomotoričkim delovanjem. Za umirivanje neproduktivnog kašlja koriste se biljni lekovi koji sadrže sluzi (mucilagonosa). Za snižavanje povišene telesne temperature, u pedijatriji se preporučuje samo upotreba biljnih dijaforetika (kora vrbe, Salicis cortex, kao biljni antipiretik, kontraindikovana je zbog visokog sadržaja salicilata). Za profilaksu i adjuvantnu terapiju rekurentnih infekcija gornjeg respiratornog trakta savetuje se upotreba preparata na bazi ekstrakata nekih Echinacea vrsta

Bezbedna primena biljnih lekova u trudnoći i tokom perioda dojenja

Pregnancy is very specific period in which special warnings in drug use, including herbal drugs are recommended. This is related on period of lactation, too, since all drugs distributed and excreted into human milk potentially producing effects on nursing babies. There are no limits for use during pregnancy and lactation only for few herbal drugs. Some herbal drugs are contraindicated for use in these conditions due to their known adverse effects on fetus and newborns. However, for most herbal drugs there are no data, or they are very scarce, on the use during pregnancy and lactation. According to general recommendations in these cases, such herbal drugs should only be used after consulting a physician or under his supervision. However, for safety reasons, their use should be avoided every time if it is possible, especially in the first trimester when a fetus is the most vulnerable. Some herbal drugs can be used for therapy of pregnancy-related conditions (e.g. ginger for nausea and vomiting, and Lini semen, Plantaginis ovatae semen/testa and Psyilii semen for constipation). The use of herbal drugs for stimulation of lactation is traditional, and for none of them a clinical confirmation on efficacy and safety exist.Trudnoća je veoma specifičan period u kome treba biti posebno oprezan pri primeni lekova, uključujući i biljne. Ovo se odnosi i na period dojenja, budući da se svi lekovi, u većem ili manjem stepenu, raspodeljuju i izlučuju mlekom s mogućim ispoljavanjem dejstava na odojče. Za manji broj biljnih lekova ne postoji ograničenje za primenu u ovim stanjima, neki su kontraindikovani zbog poznatih neželjenih efekata na plod i odojče, dok za najveći broj biljnih lekova podaci o primeni u trudnoći i tokom perioda dojenja ne postoje ili su nepotpuni. U skladu sa opštom medicinskom praksom, oni se ne smeju koristiti bez savetovanja i nadzora lekara. Međutim, iz bezbednosnih razloga, najbolje je izbegavati ih tokom trudnoće i dojenja, kada god je to moguće, naročito u prvom trimestru kada je fetus najosetljiviji. Izvesne biljne droge mogu da se koriste za terapiju propratnih tegoba u trudnoći (npr. rizom đumbira, Zingiberis rhizoma kod mučnine i povraćanja, seme lana, Lini semen, seme i semenjača ispagule, Plantaginis ovatae semen/testa i seme indijske bokvice, Psyllii semen kod opstipacije). Primena biljnih droga za stimulaciju laktacije isključivo je tradicionalna, tj. ni za jednu ne postoji klinička potvrda efikasnosti i bezbednosti ovakve primene

Evaluation of safety profile of the essential oils of Heracleum L. taxa (Apiaceae) related to determined furanocoumarin content

Za etarska ulja izolovana iz različitih biljnih organa osam taksona roda Heracleum L. (H. sphondylium L., H. sibiricum L., H. montanum Schleich. ex Gaudin, H. ternatum Velen., H. pyrenaicum subsp. pollinianum (Bertol.) F. Pedrotti & Pignatti, H. pyrenaicum subsp. orsinii (Guss.) F. Pedrotti & Pignatti, H. verticillatum Pančić i H. orphanidis Boiss.), u prethodnim ispitivanjima pokazana je antimikrobna, citotoksična i antioksidantna aktivnost. S obzirom da je u pojedinim od ovih etarskih ulja utvrđeno prisustvo potencijalno fototoksičnih furanokumarina (bergaptena, izobergaptena, pimpinelina i/ili izopimpinelina), cilj rada bio je da se izvrši kvantifikacija ukupnih furanokumarina i ustanovi maksimalni dozvoljeni dnevni unos ispitivanih ulja u skladu sa preporukama u odgovarajućem dokumentu Evropske agencije za lekove (Doc. Ref. EMEA/HMPC/317913/2006). Furanokumarini su kvantifikovani gasnom hromatografijom, metodom eksternog standarda, na osnovu površina pikova detektovanih plameno‐jonizacionim detektorom (FID). U skladu sa preporukom EMA, sadržaj ukupnih furanokumarina izražen je kao ksantotoksin (8‐metoksipsoralen, 8‐MOP). Prema navedenom dokumentu EMA, smatra se da dnevni unos 1,5 mg furanokumarina izraženih kao 8‐MOP putem biljnih lekovitih proizvoda ne doprinosi značajno ukupnom riziku, a da dnevni unos 15 μg ne predstavlja nikakav rizik. U skladu sa tim, dnevni unos ispitivanih etarskih ulja koji ne doprinosi značajno ukupnom riziku kreće se u opsegu 1,94‐5,23 mL za 15 etarskih ulja korena, 5,23‐15,68 mL za 14 ulja plodova i 2,90‐15,68 mL za tri ulja listova ili cvasti, a unos koji ne predstavlja nikakav rizik kreće se u opsegu 0,02‐0,05 mL za navedena etarska ulja korena, 0,05‐0,16 mL za ulja plodova i 0,03‐0,16 mL za ulja listova ili cvasti. U četiri ulja plodova i 24 ulja listova ili cvasti ispitivanih taksona roda Heracleum furanokumarini nisu detektovani. Ovaj rad demonstrira praktičnu primenu aktuelnih preporuka EMA koje se odnose na maksimalni dozvoljeni dnevni unos furanokumarina u cilju utvrđivanja bezbednosnog profila biljnih preparata u kojima su ovi sastojci detektovani.Essential oils of different plant parts of eight Heracleum L. taxa (H. sphondylium L., H. sibiricum L., H. montanum Schleich. ex Gaudin, H. ternatum Velen., H. pyrenaicum subsp. pollinianum (Bertol.) F. Pedrotti & Pignatti, H. pyrenaicum subsp. orsinii (Guss.) F. Pedrotti & Pignatti, H. verticillatum Pančić and H. orphanidis Boiss.) previously exhibited antimicrobial, cytotoxic and antioxidant activities. Considering that in some of these oils potentially phototoxic furanocoumarins were detected (bergapten, isobergapten, pimpinellin and/or isopimpinellin), the aim of this work was to quantify total furanocoumarins and estimate maximum daily intake of investigated oils, according to recommendations in corresponding document of European Medicines Agency (Doc. Ref. EMEA/HMPC/317913/2006). Furanocoumarins were quantified using gas chromatography, by external standard method, based on peak areas obtained by flame ionization detector (FID). As proposed by EMA, the sum of furanocoumarins equivalent to xanthotoxin (8‐methoxypsoralen, 8‐MOP) was calculated. According to noted EMA document, daily exposure of 1.5 mg furanocoumarins expressed as 8‐MOP through herbal medicinal products is not considered to contribute significantly to overall risk, and the intake of 15 μg is not considered to pose any unacceptable risk. Thus, daily intake of investigated essential oils, not contributing significantly to overall risk is in the range of 1.94‐5.23 mL for 15 root essential oils, 5.23‐15.68 mL for 14 fruit oils and 2.90‐15.68 mL for three leaf or flower oils, and the intake, not posing any unacceptable risk is in the range of 0.02‐0.05 mL for mentioned root oils, 0.05‐0.16 mL for fruit oils and 0.03‐0.16 mL for leaf or flower oils. In four fruit, and 24 leaf or flower oils of investigated Heracleum taxa furanocoumarins were not detected. This work demonstrates practical application of current EMA recommendations, which refer to maximum daily intake of furanocoumarins in order to establish safety profile of herbal preparations containing these compounds.VII Kongres farmaceuta Srbije sa međunarodnim učešćem, Beograd, Srbija, 10-14. 10. 2018.Saopštenje sa skupa nacionalnog značaja štampano u izvod

Opstipacija i dijareja - samomedikacija biljnim lekovima

Herbal drugs and herbal drug preparations are active constituents of many different dietary supplements, probiotics and herbal medicinal products, which can be used preventively or for the treatment of constipation and diarrhea. For prevention and for treatment of chronicle constipation diet with high content of dietary fibre and more liquids has to be applied. Today, the most important herbal remedies for treatment of acute constipation are those containing as active constituents bulk-forming herbal drugs or athranoid-containing herbal drugs (single dose corresponded to 20 mg of hydroxyantracene derivatives; daily dose 40-60 mg). For the symptomatic treatment of acute diarrhea tannin containing drugs, pectins or live dried yeast (Saccharomyces boulardii) can be used. Besides, different products with liophylisate of Lactobacillus and Bifidobacillus are available. For the chronicle diarrheal condition diet with pectins and with carob bean (Ceartonia siliqua) can be suggested. Natural products are mainly used trough the self-medication. Because of that, detail information about dosage, mode of administration, contraindications, precautions and adverse reaction, as well as about interaction with others drugs have to be given to patients. Second part of this paper deals with information about gastrointestinal disorders caused by the therapeutically doses of some approved herbal drugs and herbal medicinal products.Za prevenciju i lečenje hronične opstipacije, pacijentima treba preporučiti različite higijensko-dijetetske mere; više namirnica koje sadrže vlakna, više tečnosti, odgovarajuću fizičku aktivnost... Kada se radi o terapiji opstipacija, danas su najvažnije dve grupe biljnih proizvoda: zapreminski laksansi (sadrže sluzi, gume ili derivate celuloze) i stimulativni biljni lasansi (biljne droge i ekstrakti droga koje sadrže antranoide). Najviše se koristi list sene, ekstrakti i senozidi: doza je 20 - 40(60) mg ukupnih dihidroksiantranoidnih derivata. Zbog moguće preosetljivosti, doziranje bi trebalo da bude individualno, a zbog mogućeg “navikavanja” i pojave “lenjosti creva”, antranoide ne treba koristiti, neprekidno, tokom dužeg vremenskog perioda. Za simptomatsku terapiju akutne dijareje primenjuju se biljne droge koje sadrže tanine, pektine ili određene sluzi. Danas je interesantna primena liofilizata medicinskog kvasca (Saccharomyces boulardii), a i dalje su značajni preparati liofiliziranih određenih sojeva Lactobacillus, Bifidobacillus (pojedinačna doza je 108-109 bakterija). Za stanja hronične dijareje treba kombinovati specifičnu ishranu sa preparatima pektina i semena rogača (Ceartonia siliqua), npr. Svi biljni lekovi se koriste kroz proces samomedikacije. Zato pacijentu treba pružiti detaljne informacije o dozama, načinu primene, kontraindikacijama, neželjenim delovanjima i potencijalnim interakcijama sa drugim lekovima. U okviru drugog dela rada, izdvojene su informacije o biljnim drogama kod kojih se kao neželjena delovanja, prilikom primene terapijskih doza, javljaju određeni gastrointestinalni problemi