alfalfa

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

REMS

Hypercholesterolemia

Action ⬆ ⬇

Alfalfa leaf contains saponins which bind serum cholesterol and decrease its absorption. Alfalfa also contains manganese which may be responsible for hypoglycemic effects and isoflavonoids which have estrogenic properties.

Therapeutic effects:

Decreased cholesterol levels.
Decreased blood glucose levels.

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	Unknown	Unknown	Unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to alfalfa, clover, grass;
Systemic lupus erythematosus (seeds and sprouts only, not stems or leaves);
OB: Pregnancy and lactation.

Use Cautiously in:

Diabetes;
Renal impairment;
Hormone sensitive cancers/conditions due to possible estrogenic effects.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: dermatitis

Endo: hypoglycemia

F and E: hypokalemia

GI: GI upset, diarrhea, flatulence

Hemat: pancytopenia

Misc: lupus-like syndrome, photosensitivity

Interactions ⬆ ⬇

Natural-Drug Products:

May reduce the anticoagulant effects of warfarin.
May interfere with the effectiveness of oral contraceptivesandestrogens.
May have additive hypoglycemic effects withantidiabetics.
May potentiate drug-induced photosensitivity.
May counteract the immunosuppressant effects of cyclosporine.

Natural-Natural Products:

May increase the risk of clotting when taken with parsleynettleand plantain.
May increase the risk of hypoglycemia when taken with bitter melonor other herbs that lower blood sugar.
May interfere with the absorption of vitamin E.

Route/Dosage ⬆ ⬇

PO (Adults ): Dried herb: 5–10 grams 3 times daily. High cholesterol: 40 grams of heated seeds 3 times daily with food. Tablets: 2 grams 3 times daily for up to 2 mo, then 1 gram 3 times daily.Extract: 5–10 mL 3 times a day.

Availability ⬆ ⬇

Cholestaid (esterin processed alfalfa) tablets: 1 gram
Dried herb:
Liquid extract (1:1 in 25% alcohol):

Assessment ⬆ ⬇

Obtain a diet history, especially with regard to fat consumption.

Lab Test Considerations:

Monitor serum lipids before therapy to determine consistent elevations, then monitor periodically during therapy.
- Monitor PT and INR closely in patients taking warfarin; adjust dose if necessary.
- Monitor serum glucose; may cause hypoglycemia.
- Monitor serum antinuclear antibodies.

Implementation ⬆ ⬇

PO: Administer with meals.

Patient/Family Teaching ⬆ ⬇

Instruct patient to use alfalfa with meals as directed.
Caution patient that alfalfa seeds and sprouts can be contaminated with pathogens such as Salmonella enterica and Escherichia coli. Children, the elderly, and people with compromised immune systems should avoid eating alfalfa sprouts.
Advise female patients that alfalfa may decrease effectiveness or oral contraceptives; use a nonhormonal form of contraception during therapy. Advise patient to notify health care professional if pregnancy is planned or suspected; alfalfa should be avoided during pregnancy and breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇