Research Opportunities

Medicinal Plant TRAMIL Survey Safety

Jamaican contribution to Screen key plants for the Caribbean potential drug herb Pharmacopeia interactions Medicinal Plant Safety

Herb-drug interactions are a key aspect of medicinal plant safety (Cohall, Griffiths et al., 2010)

Potential risk of Adverse Drug Reactions (ADR’s)

Limited Pharmacokinetic screening of Jamaican plants

Medicinal Plant Use

Yes 73%

Medicinal plant use continues to be highly prevalent in Jamaica Treatment & Health Maintenance

78% 53% 30% 16% 14% 13% 10% 10% 6% 5% 4% 4% 3% 2% Commonly Used Medicinal Plants

Common Name Scientific Name n %

Cerasee Mormodica charantia 114 42.2 Leaf of Life Bryophyllum pinnatum 93 34.4 Sinkle Bible Aloe vera 68 25.2 Jack-in-the-Bush Eupatorium odoratum 61 22.6 Soursop Annona muricata 41 15.2 Ginger Zingiber officinale 37 13.7 Susumber Solanum torvum 35 13.0 116Garlic medicinalAllium plants sativum ID’d by respondents34 12.6 Maranga Gliricidia sepium 27 10.0 Pepper Elder Peperomia pellucida 26 9.6 Vervine Stachytarpheta jamaicensis 26 9.6 Rice & Peas Clerodendrum thomsoniae 25 9.3 Rice Bitters Andrographis paniculata 24 8.9 Dogblood Rivina humilis 22 8.2 Noni Morinda citrifolia 21 7.8 Tuna Opuntia tuna 20 7.4 Aralia Polyscia guilfoylei 19 7.0 Fever Grass Cymbopogon citratus 16 5.9 Semi Contract Chenopodium ambrosioides 15 5.6 Search-mi-Heart Rytidophyllum tomentosum 15 5.6 Commonly Used Medicinal Plants

Common Name Scientific Name n %

Cerasee Mormodica charantia 114 42.2 Leaf of Life Bryophyllum pinnatum 93 34.4 Sinkle Bible Aloe vera 68 25.2 Jack-in-the-Bush Eupatorium odoratum 61 22.6 Soursop Annona muricata 41 15.2 Ginger Zingiber officinale 37 13.7 Susumber Solanum torvum 35 13.0 Garlic Allium sativum 34 12.6 Maranga Gliricidia sepium 27 10.0 Pepper Elder Peperomia pellucida 26 9.6 Vervine Stachytarpheta jamaicensis 26 9.6 Rice & Peas Clerodendrum thomsoniae 25 9.3 Rice Bitters Andrographis paniculata 24 8.9 Dogblood Rivina humilis 22 8.2 Noni Morinda citrifolia 21 7.8 Tuna Opuntia tuna 20 7.4 Aralia Polyscia guilfoylei 19 7.0 Fever Grass Cymbopogon citratus 16 5.9 Semi Contract Chenopodium ambrosioides 15 5.6 Search-mi-Heart Rytidophyllum tomentosum 15 5.6 Jamaican Submission to TRAMIL

Scientific Name Common Name Health Issue Preparation %

Allium sativum Garlic Hypertension Decoct/Natural 28 Aloe vera Sinkle Bible Washout Blend/Decoct/Infuse 54 Blood cleanse Blend/Decoct 33 Andrographis paniculata Rice Bitters Blood cleanse Decoct 21 Annona muricata Soursop Nerves Decoct/Infuse 83 Bryophyllum pinnatum Leaf of Life Cold Decoct/Juice 51 Chenopodium ambrosioides Semi Contract Worms Decoct/Infuse/Juice 73 Cymbopogon citratus Fever Grass Fever Decoct/Infuse 70 EupatoriumMost odoratum culturally Jack-in-the-Bush SIGNIFICANT Cold speciesDecoct – frequency of citation33 Mormodica charantia Cerasee Blood cleanse Decoct 67 Bellyache/gas Decoct 44 Tonic Decoct 40 Washout Decoct 22 Opuntia cochenillifera Tuna Backache Macerate 50 Piper amalago Jointer Bellyache Decoct 21 Petiveria alliacea Guinea Hen Weed Headache Crush/Compress 23 Rivina humilis Dogblood Painful periods Decoct 67 Zingiber officinale Ginger Bellyache/gas Decoct 25 Jamaican Submission to TRAMIL

Scientific Name Common Name Health Issue Preparation %

Allium sativum Garlic Hypertension Decoct/Natural 28 Aloe vera Sinkle Bible Washout Blend/Decoct/Infuse 54 Blood cleanse Blend/Decoct 33 Andrographis paniculata Rice Bitters Blood cleanse Decoct 21 Annona muricata Soursop Nerves Decoct/Infuse 83 Bryophyllum pinnatum Leaf of Life Cold Decoct/Juice 51 Chenopodium ambrosioides Semi Contract Worms Decoct/Infuse/Juice 73 Cymbopogon citratus Fever Grass Fever Decoct/Infuse 70 Eupatorium odoratum Jack-in-the-Bush Cold Decoct 33 Mormodica charantia Cerasee Blood cleanse Decoct 67 Bellyache/gas Decoct 44 Tonic Decoct 40 Washout Decoct 22 Opuntia cochenillifera Tuna Backache Macerate 50 Piper amalago Jointer Bellyache Decoct 21 Petiveria alliacea Guinea Hen Weed Headache Crush/Compress 23 Rivina humilis Dogblood Painful periods Decoct 67 Zingiber officinale Ginger Bellyache/gas Decoct 25 Concomitant Herb-Drug Use

Herb only 74% Concomitant Herb-Drug Use

Herb only 74% (200/270) Drug only 20%

Pharmaceutical drug users Physician Awareness

Physician Aware 19% (14/72)

Physician Not Aware 81% (56/72)

Key Findings

58% moderate to 20% potent weak inhibition inhibition

CYP450 inhibitions of Further research clinical significance are warranted unlikely in vivo

(specific to enzyme tested, plant part used & type of extract) Further Research

• Herb use • Herb safety • Herb + drug Lab • CYP450 inhibition Survey • Dr aware? Screening • Efficient in • TRAMIL vitro screen Further Research

• Herb use • Herb safety Impact on drug • Herb + drug Lab • Herb-drug Clinical interactions metabolism in Survey • Dr aware? Screening • Efficient in Trial humans • TRAMIL vitro screen