LECTURE 10 – Preparations used to treat
some disorders of urinary system
Dr. Ivana Daňková
Dept. of Natural Drugs, Faculty of Pharmacy, VFU Brno
PHYTOPHARMACEUTICALS
academic year 2018/19
URINARY SYSTEM
2
 also known as the renal system
– is the body´s drainage system for
removing urine, which is composed
of wastes and extra fluid excreted
by the kidneys = it produces, stores
and eliminates urine
 Besides filtering and eliminating
wastes from the body, the urinary
system also maintains the
homeostasis of water, ions, pH,
blood pressure, calcium and red
blood cells.
URINARY SYSTEM
3
Major disorders of urinary system:
 infectious and inflammatory diseases
(e.g. glomerulonephritis, urethritis,
cystitis, prostatitis,...)
 acute renal failure
 renovascular hypertension
 renal artery stenosis
 kidney and bladder stones
 obstructive disorders
 neurogenic bladder
 benign prostatic hyperplasia
 carcinomas
 etc.
Phytopharmaceuticals are suitable
as a supplementary and supporting
therapy
DIURETICS
4
 Diuretic is any substance that promote production of urine by the
kidneys. Diuresis = increased excretion of urine.
 In the strict sense, the term is applied to drugs with a direct renal
action. The predominant mode of actions are:
 inhibiting the reabsorption of NaCl and water in the nephrons
 changes in the osmotic balance
 The most important indications for the use of diuretics are:
 diseases of urinary tract – infections, inflammation; kidney stones,
etc.
 elimination of toxic agents
 prophylaxis of renal failure – in case of circulatory failure (shock)
 fluid retention – oedemas, swellings
 hypertension, congestive heart failure
 obesity, rheumatism, gout (= high level of uric acid),…
DIURETICS
5
 active constituents of plant drugs with possible diuretic
effect:
 FLAVONOIDS
 SAPONINS
 ESSENTIAL OILS
 theophylline
 polyols = sugar alcohols – e.g. D-mannitol
 osmotic diuretic agent – these agents bind water osmotically and
retain it in the tubular lumen, consequently there is a reduction of
sodium reabsorption → a larger volume of dilute urine
DIURETIC HERBS
6
Plant drugs containing mostly flavonoids, e.g.:
 Betulae folium – Betula pendula, Betulaceae, birch
 Ononidis radix – Ononis spinosa, Fabaceae, spiny rest-harrow
 Equiseti herba – Equisetum arvense, Equisetaceae, horsetail
 Polygoni avicularis herba – Polygonum aviculare, Polygonaceae,
knotweed
 Sambuci nigrae flos – Sambucus nigra, Adoxaceae, black elder
 Tiliae flos – Tilia cordata, T. platyphyllos, Malvaceae, lime tree
 both plant drugs contain flavonoids as main active principles
→ they have diuretic and diaphoretic effects
DIURETIC HERBS – flavonoids/saponins
Betula pendula
leaf
Ononis spinosa
root
Equisetum arvense
herb
Polygonum aviculare
herb
7
Sambucus nigra
flower
Tilia cordata
flower
DIURETIC HERBS
8
Plant drugs containing mostly flavonoids, or saponins,
or both, e.g.:
 Virgaureae herba – Solidago virgaurea, Asteraceae, golden rod
 Herniariae herba – Herniaria glabra, H. hirsuta, Caryophyllaceae,
rupturewort
 Orthosiphonis herba – Orthosiphon stamineus, Lamiaceae,
cat´s whiskers
 Violae herba cum flore – Viola tricolor, Violaceae, wild pansy
 Urticae herba/folium – Urtica dioica, Urticaceae
common nettle
 flavonoids, chlorophyll, carotenoids, triterpenes, sterols,
minerals, vitamins (B group, C, K1),...
DIURETIC HERBS – flavonoids/saponins
Solidago virgaurea
herb
Urtica dioica
herb/folium
Viola tricolor
herb (with flower)
Herniaria glabra
herb
Orthosiphonis
stamineus
herb
9
DIURETIC HERBS
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Plant drugs containing mostly essential oils, e.g.:
 Petroselini radix – Petroselinum crispum, Apiaceae,
garden parsley root
 Levistici radix – Levisticum officinale, Apiaceae, lovage
 Juniperi lignum/fructus – Juniperus communis, Cupressaceae,
common juniper
 Bucco folium (Barosmae folium) – Barosma (Agathosma) betulina,
Rutaceae, buchu
 the drug contains essential oils with disinfectant effect and
flavonoids with diuretic effect
DIURETIC HERBS – essential oils, etc.
Petroselinum crispum
root
Levisticum officinale
root
Juniperus communis
wood / (pseudo)fruit
Barosma betulina
leaf
11
DIURETIC HERBS
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 Other plant drugs
 Theae folium
Thea (Camellia) sinensis,
Theaceae
 contains theophylline
(methylxanthine derivative)
with diuretic effect
 Manna
Fraxinus ornus, Oleaceae
 a sweetish exudate is obtained
from the stems of manna ash
by incision
 source of D-mannitol Fraxinus ornus
„manna“
DIURETIC PREPARATIONS
Herbal teas – monocomponent/polycomponent
13
 URINARY TRACT Herbal tea
(Megafyt Pharma)
 loose tea 75 g
 Betulae folium (30 %)
Urticae herba (30 %)
Menthae pip. herba
Petroselini radix (10 %)
Herniariae herba
Ononidis radix (5 %)
Betulae foliumEquiseti herba
Solidaginis herbaUrticae folium/herba
URODISINFECTANT HERBS
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Plant drugs containing phenolic glycosides (arbutin
derivatives):
 Uvae ursi folium – Arctostaphylos uva-ursi, Ericaceae,
bearberry leaf
 Vitis idaeae folium – Vaccinium vitis-idaea, Ericaceae,
cowberry or lingonberry leaf
 Myrtilli folium – Vaccinium myrtillus, Ericaceae, bilberry (blueberry)
leaf
x
 Vaccinium macrocarpon fruits
 „big fruit“ cranberries, American cranberries
 contains proanthocyanidins, flavonoids
and other phenolic compounds
URODISINFECTANT HERBS
Arctostaphylos uva-ursi
leaf
ARBUTIN → HYDROQUINONE = active principle
Vaccinium vitis-idaea
leaf
Vaccinium myrtillus
leaf
15
URODISINFECTANT HERBS
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 Vaccinium macrocarpon fructus
 „big fruit“ cranberries, American
or Canadian cranberries
 it contains proanthocyanidines,
flavonoids and other polyphenolic
compounds (but not arbutin!)
 the effect is bound to proanthocyanidins
(PACs) that are easily absorbed into the blood after ingestion,
then blood is filtered through the kidneys into the urine where they
prevent bacteria (predominantly Escherichia coli) from attaching to
the surface of the urinary tract wall
(E. coli is one of the main agents of urological inflammation!)
 some studies completely deny the cranberries efficiency (??)
URINARY SYSTEM DISORDERS
Herbal teas
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 URCYSTON (Leros)
 POR SPC 20X1.5GM
 composition, in 100 g:
Uvae ursi folium 25 g
Equiseti herba 20 g
Myrtilli herba 15 g
Matricariae flos 10 g
Sambuci nigrae flos 10 g
Solidaginis herba 10 g
Thymi herba 10 g
 SUKL code: 0093469
Selected medicinal products
 ATC: V11
 The main medicinal component
are bearberry leaves.
The antibacterial effects of
bearberry are suitably
supplemented by other
medicinal plants that increase
and supplement its medicinal
effects.
 Drink warm, 3-5x a day, always
prepare fresh, immediately
prior to use. Not suitable for
long term application. Do not
use for more than 2 weeks.
The treatment can be repeated
a maximum of 5 times a year.
 Do not take with acidic food
or acid reacting medication.
URINARY SYSTEM DISORDERS
Herbal teas
18
 SPECIES UROLOGICAE
(Leros)
 POR SPC 20X1.5GM, 1X100GM
 composition, in 100 g:
Betulae folium 27.5 g
Uvae ursi folium 22.5 g
Polygoni avic. herba 10 g
Ononidis radix 10 g
Petroselini radix 11 g
Urticae herba 10 g
Millefolii herba 7 g
Sambuci nigrae flos 2 g
 SUKL code: 0056350
0000966
Selected medicinal products
 ATC: V11
 A supplementary remedy for
inflammatory diseases of the
urinary tract (acute and
infectious urological diseases,
acute and chronic
inflammation of the urinary
tract and the bladder).
The infusion is diuretic, has
antiseptic (antibacterial)
effects, relaxes smooth
muscle spasms.
 Do not use for more than two
weeks except on medical
advice. Treatment may only be
repeated up to 5 times a year.
If the symptoms persist, seek
medical advice.
URINARY SYSTEM DISORDERS
Herbal teas
19
 UROLOGICAL Herbal Tea
(Megafyt Pharma)
 20 x 1.5 g
 Betulae folium 450 mg
Uvae ursi folium 450 mg
Menthae pip. herba 225 mg
Ononidis radix 150 mg
Petroselini radix 150 mg
Herniariae herba 75 mg
 SUKL code: 0076432
Selected medicinal products
 ATC: V11
 A supplementary remedy for acute
infectious diseases of the urinary
tract. The infusion has diuretic,
antiseptic (antibacterial) effects,
relaxes smooth muscle spasms.
 CI: swellings caused with heart and
kidney insufficiency, pregnancy,
lactating, children up to 12 years.
 Do not use more than 1 week.
Treatment may only be repeated up
to 5 times a year.
URINARY SYSTEM DISORDERS
Herbal teas
20
Other plant drugs used as a component of urologic herbal teas:
 Callunae herba – Calluna vulgaris, Ericaceae, common heather
 contains proanthocyanidins, flavonoids, a small amount of
arbutin
 it has anti-inflammatory properties, especially with respect to the
urinary system
 Cynosbati fructus sine semine (Cynosbati pericarpium)
– Rosa canina, Rosaceae, dog rose
 contains carbohydrates (saccharides), pectin, sorbitol, vitamin C,
organic acids, tannins
 Filipendulae herba – Filipendula ulmaria, Rosaceae
 contains flavonoids and other phenolic compounds
 Hibisci flos – Hibiscus sabdariffa, Malvaceae
 contains proanthocyanidins, polysaccharides, phenolics, organic
acids
URINARY SYSTEM DISORDERS
Herbal teas
21
 KIDNEYS, URINARY
TRACT Herbal Tea
(Leros)
 20 x 1.5 g
 Betulae folium (30%)
Solidaginis herba (15 %)
Callunae herba (15 %)
Equiseti herba (15 %)
Polygoni avic. herba (10 %)
Menthae pip. herba (10 %)
Ononidis radix (5 %)
 UROLOGICAL Herbal Tea
(Teekanne)
 10 x 2.0 g
 Solidaginis herba (25 %)
Betulae folium
Equiseti herba
Ononidis radix
Menthae piperitae herba (5 %)
Liquiritiae radix (5 %)
URINARY SYSTEM DISORDERS
Herbal teas
22
 URINARY TRACT
Herbal Tea with cranberry
(Megafyt Pharma)
 20 x 1.5 g
 Hibisci flos
Cynosbati fructus sine semine
Callunae flos (13 %)
Solidaginis herba (6 %)
cranberry juice granular (5 %)
Cymbopogonis herba
Liquiritiae radix
Anisi fructus
 URINARY TRACT
Herbal Tea (Leros)
 20 x 1.5 g
 Callunae herba (25 %)
Hibisci flos (25 %)
Solidaginis herba (20 %)
Anisi fructus (15 %)
Cynosbati fructus sine semine
(10 %)
cranberry (5 %)
URINARY SYSTEM DISORDERS
Other preparations
23
 URINAL® cps. (Walmark/Idelyn)
 contains Vaccinium macrocarpon fruit extracts:
NutriCran® = concentrated extract of cranberry juice – 200 mg
CystiCran® = highly concentrated extract of whole fruits – 3 mg
(this extract contains minimally 40 % of PACs)
+ extract of Solidaginis herba 20 mg
+ vitamin D 1.7 µg
 daily dose (= 3 capsules) replies to the content minimally
57,3 g of fresh cranberries
 suitable as a supplementary preparation with antibiotic therapy
(in some studies it was more effective than trimethoprim!)
 chronic usage: 1 capsule a day
URINARY SYSTEM DISORDERS
Other preparations
24
 URINAL Akut® tbl. 10 (Walmark/Idelyn)
 suitable for treatment of acute disorders,
effective from the first day of usage
 content in 1 tbl.:
 90 mg CystiCran® highly concentrated extract of whole fruits (min.
40 % of proanthocyanidines, PACs = 36 mg) – equivalent to 423 g
of cranberry fruits
 20 mg extract of Solidaginis herba
 5 μg vitamin D
 dosage: 1 tablet per day
 URINAL® sirup (Walmark/Idelyn)
 contains NutriCran® 500 mg in 5 mL
(equivalent to 12,5 g of fruits)
 suitable for children over 1 year (5 mL)
URINARY SYSTEM DISORDERS
Other preparations
25
 UROVAL® gtt. (Valosun)
 contains herbal extracts of:
Arctostaphylos uva-ursi leaf
Calendula officinalis flos
Calluna vulgaris herb
Galium odoratum herb
 support remedy for better function of urinary system
– diuretic, antibacterial, anti-inflammatory effects
 UROVAL® Manosa tbl. (Valosun)
 Vaccinium macrocarpon fruit extract
– contains PACs (36 mg in daily dose = 5 tablets)
+ D-mannose
+ enzymes – trypsine, bromelaine – supportive effect
 1-2 tablets, 2-3 times a day
URINARY SYSTEM DISORDERS
Other preparations
26
 D-MANNOSE
 = monosaccharide, naturally occurring
in some fruits (pears, apples), produced
during the fermentation
 is practically not metabolized, is largely
secreted by the urine. In the urinary tract,
it binds to the surface of uropathogenic
bacteria E. coli (= UPEC), which then lose
the ability to attach to the bladder mucosa
and are subsequently flushed with urine
stream
 a natural alternative to antibiotics, it works
quickly and efficiently
 products, e.g.: BLOKURIMA, URO-MANOSA,
Uroval D-MANOSA, PM D-MANOSA…
URINARY SYSTEM DISORDERS
Other preparations
27
UPEC INVASIVE CYCLE
URINARY SYSTEM DISORDERS
28
Benign prostatic hyperplasia (BPH):
 is common urological condition caused by
the non-cancerous hypertrophy (enlargement)
of the prostate gland as men get older
 as the prostate enlarges, it can squeeze down
on the urethra – this can cause trouble urinating
 the symptoms associated with BPH
are known as lower urinary tract symptoms (LUTS)
 frequent urination, urinary urgency, the need to frequently empty the
bladder, especially at night (nocturia)
 urinary retention
 formation of bladder stones (due to crystallization of salts)
 increased risk of urinary tract infections and inflammation
URINARY SYSTEM DISORDERS
29
 in the pathogenesis of BHP, a major role is played by increased
production of androgenic hormone DHT (dihydrotestosterone) which is
formed from testosterone produced by the 5-α-reductase enzyme
 DHT induces growth of prostate tissue through binding to androgen
receptors in the cytosol
Pharmacological treatment – influencing of plasma androgen
concentration or competition on androgen receptors
 5-α-reductase inhibitors
 blockers of α1-adrenergic receptors
 5-phosphodiesterase inhibitors
 irreversible binding of steroid hormones (testosterone)
 (estrogens, progestins due to inhibition of LH-RH secretion - are
not used in therapy for a number of side effects)
URINARY SYSTEM DISORDERS
30
Phytotherapy:
 plant drugs with high PHYTOSTEROL content
(especially beta-sitosterol)
 the mechanism of action is not fully elucidated,
it could be due to:
inhibition of 5-α-reductase, competitive testosterone binding to
adrenergic receptors, aromatase inhibition, attenuation of prostate cell
metabolism and fibroblast proliferation, inhibition of prostaglandin and
leukotriene synthesis,…
 other effects: inhibition of prolactin binding to receptors, antiinflammatory
action (inhibition of 5-lipoxygenase),
anti-edematous effect
 in combined preparations also contain:
 plant drugs with a diuretic, urodisinfecant, anti-inflammatory effect
 vitamin E, zinc…
URINARY SYSTEM DISORDERS
Preparations for care of prostate
31
Plant drugs used to treat and prevent prostate disorders:
 Saw palmetto – Serenoa repens, Arecaceae
 fruits are rich in phytosterols and fatty acids
 contributes to maintain normal urinary function
and right urinary flow, support reproductive
function
 Pygeum africanum (Prunus africana), Rosaceae,
the African cherry tree
 bark contains phytosterols
 Cucurbita pepo, Cucurbitaceae
 seeds
(seed oil/lipophilic extract from the seeds)
URINARY SYSTEM DISORDERS
Preparations for care of prostate
32
Plant drugs used to treat and prevent prostate disorders:
 Epilobii herba
Epilobium sp., Onagraceae, willow-herb
 contains flavonoids, phytosterols,
gallic acid derivatives
 cyclic dimeric ellagitannins – oenothein A, B
 Urticae radix
Urtica dioica, Urticaceae
 lipophilic extract of the root contains phytosterols (beta-sitosterol and
its derivatives)
 other compounds: polyphenolic structures (tannins, phenylpropanoids),
coumarines
 other plant drugs with diuretic and urodisinfectant properties
URINARY SYSTEM DISORDERS
Preparations for care of prostate
33
 WILLOW-HERB
(Megafyt Pharma, Leros)
 Epilobii herba
 loose tea
 EPILOBIN Planta (Leros)
 20 x 1.5 g
 composition in 100 g:
Epilobii herba 50 g
Bucco folium 25 g
Solidaginis herba 15 g
Calendulae flos cum calyce 10 g
 SUKL code: 0057688
Selected medicinal products
 ATC: V11
URINARY SYSTEM DISORDERS
Preparations for care of prostate
34
 PROSTAMOL UNO
POR CPS MOL 30X320MG
(Berlin-Chemie AG – Menarini Group)
 content in 1 cps:
320 mg of Serenoae extract (9-11:1),
extracted with ethanol 96%
 SUKL code: 0059710
OTC medicinal products
 ATC: G04CX02
 treatment of BPH: 1 capsule a day (effect after 4-6 weeks)
 CI: in case of known hypersensitivity to any component of product
 other products: PROSTAKAN MONO, PROSTA-URGENIN,
CAPISTAN, NO-PROSTAL
URINARY SYSTEM DISORDERS
Preparations for care of prostate
35
 PROSTAKAN Forte POR CPS MOL 60
(Dr. Willmar Schwabe GmbH & Co., Germany)
 content in 1 capsule:
160 mg Serenoae extractum (10-14,3:1)
120 mg Urticae radicis extractum siccum (7,6-12,5:1)
 SUKL code: 0007430
OTC
 ATC: G04CX02
 dosage: 1 capsule 2 times a day
URINARY SYSTEM DISORDERS
Preparations for care of prostate
36
 PROSTENAL® cps. (Walmark)
 a combination of herbal extracts that helps
to maintain healthy prostate - maintenance
of normal urinary function and right urinary flow
 content in 1 cps (soft-gel):
Saw palmetto extract – 300 mg
Urtica dioica extract – 250 mg
Lycopene (obtained from tomatoes) – 0.5 mg
Pumpkin oil (Cucurbita pepo seed oil) – 300 mg
Bearberry extract (Uvae ursi folium) – 50 mg
 1-2 capsules daily 2 times a day,
 It is recommended to use it for long time. The positive effects can
be seen after 3-6 weeks.
URINARY SYSTEM DISORDERS
Preparations for care of prostate
37
 PROSTENAL® Perfect complex cps.
(Walmark)
 content in 1 cps:
160 mg of Saw palmetto extract (10:1)
– fatty acids 85-95 %, sterols 0.2-0.4 %)
120 mg of Urtica dioica root extract (10:1)
Lycopene 3 mg
 daily dose: 1-2 capsules
 positive effect usually after 3-6 weeks
 PROSTENAL® Forte cps. (Walmark)
 320 mg of Saw palmetto extract
240 mg of Urtica dioica root extract
10 mg of Zinc