ginseng

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

Improving physical and mental stamina
General tonic to energize during times of fatigue and inability to concentrate
Sedative, sleep aid, antidepressant
Diabetes
Enhanced sexual performance/aphrodisiac
Increased longevity
Adjunctive treatment of cancer
Increased immune response
Increased appetite

Action ⬆ ⬇

Main active ingredient is ginsenoside from the dried root.
Serves as CNS stimulant and depressant.
Enhances immune function.
Interferes with platelet aggregation and coagulation.
Has analgesic, anti-inflammatory, and estrogen-like effects.

Therapeutic effects:

Improves mental and physical ability.
May improve appetite, memory, sleep pattern.
May reduce fasting blood glucose level in diabetic patients.

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:

Pregnancy (androgenization of fetus);
Lactation;
Children;
Manic-depressive disorders and psychosis;
Hypertension;
Asthma;
Infection;
Organ transplant recipients (can interfere with immunosuppressive therapy);
Hormone-sensitive cancers.

Use Cautiously in:

Autoimmune diseases;
Cardiovascular disease;
Diabetes (may have hypoglycemic effects);
Patients receiving anticoagulants;
Bleeding disorders;
Schizophrenia (may cause agitation).

Adv. Reactions/Side Effects ⬆ ⬇

CNS: insomnia, agitation, depression, dizziness, euphoria, headaches, nervousness

CV: hypertension, tachycardia

GI: diarrhea

GU: amenorrhea, vaginal bleeding

Derm: skin eruptions

Endo: estrogen-like effects

Misc: fever, mastalgia, STEVENS-JOHNSON SYNDROME

Interactions ⬆ ⬇

Natural-Drug Products:

May ↓ anticoagulant activity of warfarin.
May interfere with MAO inhibitors treatment and cause headache, tremulousness, and manic episodes.
May enhance blood glucose lowering effects of oral hypoglycemics and insulin.
May interfere with immunosuppressant therapy.
Use with caution when taking estrogens.

Natural-Natural Products:

May ↑ risk of bleeding when used with herbs that have antiplatelet or anticoagulant activities.
May prolong the QT interval when used with bitter orange, country mallow, and ephedra and ↑ risk of life-threatening arrhythmias.
May ↑ risk of hypoglycemia when used with herbs with hypoglycemic potential.

May potentiate effects of caffeine in coffee or tea and CNS stimulant effects of mate.

Route/Dosage ⬆ ⬇

PO (Adults ): Capsule: 200–600 mg/day; extract: 100–300 mg 3 times daily; crude root: 1–2 g/day; infusion: tea: 1–2 g root daily (½ tbsp/cup water) up to 3 times daily (P. ginseng tea bag usually contains 1500 mg of ginseng root). Do not use for longer than 3 mo. Cold/flu prevention: 100 mg daily 4 wk prior to influenza vaccination and continued for 8 wk; Chronic bronchitis: 100 mg BID for 9 days combined with antibiotic therapy; Erectile dysfunction: 900 mg TID; Type 2 diabetes: 200 mg daily.

Availability ⬆ ⬇

(Generic available)

Root powder: OTC
Extract in alcohol: OTC
Capsules: OTC
Tea bags: OTC

Assessment ⬆ ⬇

Assess level of energy, attention span, and fatigue person is experiencing prior to initiating and periodically during therapy.
Assess appetite; sleep duration; and perceived quality, emotional lability, and work efficiency prior to and during therapy.
Patients with chronic medical problems should not use this herb without the advice of health care professional.
Assess for ginseng toxicity (nervousness, insomnia, palpitations, and diarrhea).
Monitor patients with diabetes more frequently for hypoglycemia until response to the agent is ascertained.
Assess for the development of ginseng abuse syndrome (occurs when large doses of the herb are taken concomitantly with other psychomotor stimulants such as coffee and tea. May present as diarrhea, hypertension, restlessness, insomnia, skin eruptions, depression, appetite suppression, euphoria, and edema).

Implementation ⬆ ⬇

May be taken without regard to food.
Take at the same time daily and do not increase dose above the recommended amount because of potential toxic effects.

Patient/Family Teaching ⬆ ⬇

Caution patients with cardiovascular disease, hypertension or hypotension, or on steroid therapy to avoid the use of this herb.
Instruct patient in the symptoms of ginseng toxicity and to reduce dose or stop use of the herb if they occur.
Advise patient to limit the amount of caffeine consumed.
Advise patients with diabetes to monitor blood sugar levels until response to this agent is known.
Teach patient about the signs and symptoms of hepatitis (yellow skin or whites of eyes, dark urine, light-colored stools, lack of appetite for several days or longer, nausea, abdominal pain) and to stop use of the herb and promptly contact health care professional if they occur. (This herb is hepatoprotectant at low doses, but hepatodestructive at high doses.)
Caution patient not to exceed recommended doses because of potential side effects and toxicity.
Instruct patient to discontinue ginseng if diarrhea develops.
Instruct patient to consult health care professional before taking any Rx or OTC medications concurrently with ginseng.
Rep: Advise females of reproductive potential to avoid use of ginseng if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes ⬆ ⬇

Improved energy level and sense of well-being.
Improved quality of sleep.
Improved concentration and work efficiency.
Improved appetite.
May need to take for several wk before seeing results.
Recommended course of therapy is 3 wk. A repeated course is feasible. Do not use for longer than 3 mo.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇