Robin Brain asked:




Native Americans used golden seal as an eye wash and to relieve stomach problems. Today, it’s used to treat menstrual disorders, minor sciatica pain, rheumatic or muscle pain, and as an antispasmodic. It’s said to enhance the potency of other herbs as well. The useful portions are de rived from the rhizome and roots of Hydrastis canadensis. Its principal chemical constituents are the alkaloids hydrastine and berberine; it also contains other alkaloids, volatile oils, chlorogenic acid, phytosterols, and resins.

Golden seal may have anti-inflammatory, antihemorrhagic, immunomodulatory, and muscle relaxant properties. It exhibits inconsistent uterine hemostatic properties. Hydrastine causes peripheral vasoconstriction. Berberine can decrease the anticoagulant effect of heparin. It stimulates bile secretion and exhibits some antineoplastic and antibacterial activity. Berberine can stimulate cardiac function in lower doses or inhibit it at higher doses.

Golden seal is available as capsules, dried ground root and rhizome powder, tablets, tea, tincture, and water ethanol extracts. Common trade names include Golden Seal Power, Nu Veg Golden Seal Herb, and Nu Veg Golden Seal Root.

Reported uses

Golden seal is used to treat postpartum hemorrhage and to improve bile secretion. It’s also used as a digestive aid and xpectorant. Golden seal is used topically on wounds and herpes labialis lesions.

Administration

Alcohol and water extract: 250 mg by mouth three times a day

Dried rhizome: 0.5 to 1 g in 1 cup of water three times a day

Expectorant: 250 to 500 mg by mouth three times a day

For symptomatic relief of mouth sores and sore throat: 2 to 4 ml of tincture (1:10 in 60% ethanol), swished or gargled three times a day

Topical use (cream, ointment, or powder): Applied to wound once a day.

Hazards

Adverse effects associated with golden seal include sedation, reduced mental alertness, hallucinations, delirium, paresthesia, paralysis, hypotension or hypertension, mouth ulderation, nausea, vomiting, diarrhea, GI cramping, contact dermatitis, and megaloblastic anemia from decreased vitamin B absorption.

Golden seal may reduce anticoagulant effect of anticoagulant medications. Increased hypoglycemic effects may be seen with hypoglycemics and insulin. It may reduce or enhance hypotensive effect of antihypertensives. Golden seal may interfere or enhance cardiac effects when given with beta blockers, calcium channel blockers or digoxin. It may enhance sedative effects of central nervous system (CNS) depressants such as benzodiazepines. Disulfiram-like reaction may result when liquid preparations are combined with disulfiram, metronidazole, or cephalosporins.

Patients with hypertension, heart failure, or arrhythmias should avoid use. Pregnant and breast-feeding patients and those with severe renal or hepatic disease should also avoid use. Berberine increases bilirubin levels in infants and shouldn’t be given to them.

Safety Risk Life-threatening adverse effects of golden seal include aystole, heart block, leukopenia, and respiratory depression. High doses may lead to vomiting, bradycardia, hypertension, respiratory depression, exaggerated reflexes, seizures, and death.

Clinical considerations

German Commission E has not endorsed the use of golden seal for any condition because of the potential toxicity and lack of well-documented efficacy.

Monitor patient for signs and symptoms of vitamin B deficiency such as megaloblastic anemia, paresthesia, seizures, cheilosis, glossitis, and seborrheic dermatitis.

Monitor patient for adverse cardiovascular, respiratory, and neurologic effects. If patient has a toxic reaction, induce vomiting and perform gastric lavage. After lavage, instill activated charcoal and treat symptomatically.

Advise patient not to use golden seal because of its toxicity and lack of documented efficacy, especially if the patient has cardiovascular disease.

Warn patient to avoid driving until he knows how golden seal will affect CNS.

Tell patient to notify pharmacist of any herbal or dietary supplement that he’s taking when obtaining a new prescription.

Advise patient to consult his health care provider before using an herbal preparation because a conventional treatment with proven efficacy may be available.

Research summary

The topical use of golden seal extracts in sterile eye washes persists although there is little clinical evidence for its effectiveness. The plant possesses astringent and weak antiseptic properties that may be effective in treating minor oral problems. While small amounts of the plant can be ingested with no adverse effects as a component of bitter tonics, large doses can be toxic. The effects of the plant and its extracts in pregnant women are inconclusive. Golden seal is less effective than ergot alkaloids in treating postpartum hemorrhage. Berberine can decrease the duration of diarrhea caused by pathogens such as Vibrio cholerae, Shigella, Salmonella, Giardia, and some Enterobacteriaceae.

Carisoprodol, Fioricet, Tramadol