PDR for Herbal Medicines

422 /INDIAN SQUILL PDR FOR HERBAL MEDICINES

Steroids: sterols, including beta-sitosterol, campesterol,

stigmasterol

EFFECTS

The drug's content levels of cardioactive glycosides explain

the administration in the presence of cardiac insufficiency

and cardio-conditioned edema formation. The expectorant

may be due the drug's effect as a mild irritant of the

gastrointestinal tract combined with an increase in secretions

of the bronchial system. The drug's administration as an

antirheumatic appears plausible, due to the skin-irritating

effect of the oxalate raphides it contains.

INDICATIONS AND USAGE

Unproven Uses: For chronic bronchitis, asthma and cardiac

insufficiency as a treatment of second choice in the case of

hypersensitivity to digitalis.

Indian Medicine: For edema, digestion disturbances, menstr-

uation disorders, worm infestation, chronic bronchitis, asth-

ma, rheumatism and skin conditions.

CONTRAINDICATIONS

Neither the drug nor pure glycosides should be administered

in the presence of first- and second-degree AV-Block,

hypercalcemia, hypokalemia, hypertrophic cardiomyopathy,

carotid sinus syndrome, ventricle tachycardia, thoracic aortic

aneurysm, WPW syndrome.

PRECAUTIONS AND ADVERSE REACTIONS

General: No health hazards are known in conjunction with

the proper administration of designated therapeutic dosages.

Because of the limited therapeutic range of the cardioactive

steroid glycosides, a number of patients receiving no more

than therapeutic dosages might experience the following side

effects: hypertonia in gastrointestinal area, loss of appetite,

vomiting, diarrhea, headache and irregular pulse.

Drug Interactions: The simultaneous administration of

arrhythmogenic substances (sympathomimetics, methyl xan-

thines, phosphodiesterase inhibitors, quinidine) increases the

risk of cardiac arrhythmias. Contact witii the latex of the

fresh bulbs can lead to skin inflammation (Scilla dermatitis).

OVERDOSAGE

Overdose could lead to hypertonia in gastrointestinal area,

loss of appetite, vomiting, diarrhea, headache and irregular

pulse along with the following:

• heart: cardiac rhythm disorders as serious as life-threaten-
  ing ventricular tachycardias, atrial tachycardias with atrio-
  ventricular block.


• CNS: dizziness, vision disorders, depressions, states of
  confusion, hallucinations, psychoses.

Lethal dosages lead to cardiac arrest or to asphyxiation.
Because of the difficulties involved in standardizing the

drug, the administration of pure glycosides is to be preferred

(proscillaridin A).

The first-aid measures to be taken with poisonings are gastric

lavage and instillation of activated charcoal. All other

measures proceed according to the symptoms: careful

potassium replacement for potassium loss; phenytoin as an

antiarrhythmic for ectopic stimulation formation in the

ventricle; lidocaine for ventricular extrasystole; atropine or

orciprenaline for pronounced bradycardia. The prophylactic

insertion of a cardiac pacemaker is recommended. Hemoper-

fusion for the elimination of the glycosides or cholestyra-

mine administration for the interruption of the enterohepatic

circulation are possible.

DOSAGE

Mode of Administration: Whole herb, cut drug, powdered

drug and other galenic preparations for internal and external

use.

Preparation: Liquid extract: 100 g drug are percolated with

70% ethanol and then evaporated to 850 ml; the rest is filled

to 1000 ml again with 70% ethanol and filtered (BPC79).

Tincture: 100 gm drug is macerated with 1000 ml 60%

ethanol (BPC79).

Acetic acid maceration: 100 gm drug is macerated with 1000

ml acetic acid in a closed vessel and then filtered. Finally the

filtrate is heated and re-filtered after 7 days (BPC79).

Daily Dosage:

Drug: single dose: 60 to 200 mg; Tincture: 0.3 to 2 ml;

Liquid extract: 0.06 to 0.2 ml; Acetic acid essence: 0.6 to 2

ml.

Storage: Store in a dry place and below 25°C.

LITERATURE

Hansel R, Keller K. Rimpler H, Schneider G (Ed), Hagers

Handbuch der Pharmazeutischen Praxis, 5. Aufl., Bde 4-6

(Drogen), Springer Verlag Berlin, Heidelberg, New York, 1992-

1994

Inula britannica

See British Elecampane

(Xuan-Fu-Hua)

Inula helenium

See Elecampane