LECTURE 12 – Preparations used in pregnancy
and breast-feeding period. Therapy of obesity.
Dr. Ivana Daňková
Dept. of Natural Drugs, Faculty of Pharmacy, VFU Brno
PHYTOPHARMACEUTICALS
academic year 2018/19
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used in PREGNANCY
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 Herbal teas in pregnancy:
 do not drink too much black and green tea (Thea sinensis) – mainly
because of caffeine content (psychostimulation effect) and tannin (risk
of obstipation)
 rooibos tea (Aspalathus linearis herba) is suitable for regular drinking
– it does not contain caffeine or tannins; there is a positive effect on
digestion, especially spasmolytic. Thanks to the high content of
polyphenols (flavonoids, chalcones) rooibos tea has a strong
antioxidant activity, it can works as hypolipidemic, hypoglycemic,
hepatoprotective agent…
 Avoid most of drugs with essential oils that can have an irritating
effect and cause blood congestion in the pelvic region (Myristica
fragrans fruit or flower – myristicin, Absinthii herba, Petroselini radix,
Juniperi fructus/, lignum, etc.)
 in the third trimester is recommended to drink raspberry tea tea, Rubi
idaei folium – it promotes uterine contractions
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 LEROS Baby
Tea for Pregnant Women
 20 x 2.0 g
 rose hips (Cynosbati fructus)
rooibos (Aspalathus linearis herba)
black currant berries (Ribes nigri fructus)
lemon balm herb (Melissae herba)
 drink 2-4 times a day
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 Megafyt Pharma
Pregnancy Tea
 20 x 1.5 g
 Cynosbati fructus sine semine
Aspalathi herba
Melissae herba 15 %
Cymbopogonis herba
Menthae crispae folium 10 %
Ribes nigri fructus
 Teekanne
Pregnancy Tea
 16 x 1.8 g
 Urticae herba
Melissae herba
Cymbopogonis herba
Menthae piperitae herba
Alchemillae herba
Rubi idaei folium
Millefolii herba
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 Apotheke, Apotheke BIO
Tea for Pregnant Women
 20 x 1.5 g
 Cynosbati fructus (38 %)
Alchemillae herba (22,5 %)
Rubi idaei folium (15 %)
Calendulae flos (12,5 %)
Hippophae fructus (12 %)
Hippophae rhamnoides
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 Pregnancy nausea, vomiting
 especially in the first trimester, in 60-80 % of women. Severe form
of pregnancy vomiting (hyperemesis gravidarum) is relatively rare.
Recommendation:
 prophylactically (!) higher doses of pyridoxine (vitamin B6) - usual
dose 3 times daily 1 tbl. (20 mg), a maximum daily dose of 120 mg
 ginger - up to 250 mg of dried, powdered rhizome
GRAVIPOP, GRAVIDROPS (VitaHarmony)
 lollipops or candies
 content:
Ginger Oil 5 mg
+ Vitamin C 15 mg, Calcium 10.6 mg
 lollipop 1-4 times a day, 2-8 drops a day
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 ANTIMETIL (Tilman/Ewopharma)
 1 tbl. contains 50 mg of standardized
dried ginger extract (10 % of gingerols)
 apropriate from 1 month of pregnancy
 Dosage: 2 tablets a day
(first tablet in the morning before a meal
at first symptoms, second tablet at 4 hours)

EMESIN (Favea)
 content in 1 tbl.:
ginger essential oil 3 mg
vit. B6 8 mg
 1 tbl. in case of difficulty – swallow
and wash down, or let it dissolve in the mouth
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 Herbal teas during breast-feeding:
 similar principles as teas used in pregnancy, it menas: do not
consume too much real tea, avoid herbs with irritating and allergic
effects, plants containing strong active substances that can pass
into breast milk
 appropriate use of herbal teas to support breast milk production:
mainly Galega officinalis and some other plants from the family
Fabaceae
 use herbal remedies with spasmolytic, carminative effect (e.g.
Foeniculi fructus, Anisi fructus, Carvi fructus, Matricariae flos,
Aspalathi herba...) and with calming effect (e.g. Melissae herba,
Lavandulae flos, Origani herba, ...)
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 LEROS Baby
Tea for Nursing Mothers
 20 x 1.5 g
 Galegae herba (25 %)
Carvi fructus (15 %)
Foeniculi fructus (15 %)
Melissae herba (15 %)
Solidaginis herba (15 %)
Violae tricoloris herba (10 %)
Plantaginis folium (5 %)
 drink 2-3 times a day
 LEROS Baby
BIO Tea for Nursing Mothers
 20 x 2.0 g
 Cynosbati fructus sine semine
Galegae herba (20 %)
Ribes nigri fructus
Lavandulae flos
 herbal drugs are organic
products
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 Megafyt Pharma
Tea for Nursing Mothers
 20 x 2.5 g
 Anisi fructus
Foeniculi fructus
Carvi fructus
Urticae herba
 Megafyt Pharma
Tea for Nursing Mothers
 20 x 1.5 g
 Galegae herba (30 %)
Foeniculi fructus (20 %)
Anethum graveolens fruit
Melissae herba
Origani herba
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 Pavel VÁŇA
Tea for Nursing Mothers
 40 x 1.6 g
 Galegae herba
Melissae herba
Foeniculi fructus
Carvi fructus
Anisi fructus
 Teekanne
Breastfeeding Tea
 16 x 1.8 g
 Melissae herba
Urticae herba
Foeniculi fructus
Cymbopogonis herba
Anisi fructus
Lavandulae flos
Carvi fructus
PREPARATIONS
used in PREGNANCY and LACTATING PERIOD
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 Food Supplements:
 folic acid – important for normal growth of germ tissue, as
protection against teratogenes in the formation of genetic material.
Sufficient income is necessary to provide one month before the
planned pregnancy.
 the recommended daily dose is 400 μg, in pregnancy planning and
in the 1st trimester up to 800 μg; at risk pregnancy (in case of
diabetes, epilepsy, tendency to develop defects) up to 4-5 mg/day
 minerals
 iron, calcium, magnesium, iodine
 vitamins
 essential fatty acids
 especially DHA (docosahexaenoic acid) – important for the proper
development of brain tissue and ocular retina
 daily dose – 200-250 mg
PREPARATIONS
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 PREGNIUM (Walmark)
 content in 1 capsule:
DHA (docosahexaenoic acid)
100 mg
Magnesium 75 mg
Folic acid 200 µg
Iodine 75 µg
 dosage: 2 capsules a day
 food supplement designed for
the period of pregnancy
planning, pregnancy and
lactating
 Folic acid contributes to the
maternal tissue growth during
pregnancy
 Iodine and Magnesium support
functions of nervous system
 DHA plays a role in foetal brain
and eye development
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 FEMIBION 800 – Healthy Pregnancy 1
(Merck)
 when planning a baby until the 1st trimester
 Folates 800 µg (Folic acid and L-methylfolate)
vitamins B group, E, C
Iodine 150 µg
 dosage: 1 tablet a day
 FEMIBION 400+DHA – Healthy Pregnancy 2
 from the 2nd trimester until the end of breastfeeding
 tablets: Folates 400 µg (Folic acid and L-methylfolate)
vitamins B group, E, C
Iodine 150 µg
+ extra capsules: concentrated fish oil rich in DHA (200 mg)
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OVERWEIGHT and OBESITY
 are defined as abnormal or excessive fat accumulation that
presents a risk to health
 A person with a BMI equal to or more than 25 is considered
overweight. A person with a BMI of 30 or more is generally
considered obese.
 BMI is not suitable
parameter for children
and active sportsman!
OVERWEIGHT and OBESITY
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Key facts
 Obesity has reached epidemic proportions globally, with at least 2.8
million people dying each year as a result of being overweight or obese.
 Worldwide obesity has nearly doubled since 1980.
 In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of
these over 200 million men and nearly 300 million women were obese.
 35 % of adults aged 20 and older were overweight in 2008, and 11 %
were obese.
 65 % of the world's population live in countries where overweight and
obesity kills more people than underweight.
OVERWEIGHT and OBESITY
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 Risks of obesity
 an enormous load for joints
and all musculoskeletal system,
difficult physical activity
 stasis (congestion) of body
fluids causes swellings
(oedemas)
 major risk factors for a number
of chronic diseases, including
diabetes, cardiovascular diseases
and cancer
 social exclusion, difficulties in
social relations
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Therapeutic approaches to obesity treatment
 lifestyle modification
 dietary management – reduction of caloric intake in
the diet – low-fat, low-carbohydrate diet
(recommended weight loss about 0.5-1 kg per week)
 physical activity – helps to decrease body fat
and to prevent decrease in muscle mass with
dieting; plays an integral role in weight maintenance
 behaviour modification – helps to improve
compliance
 pharmacotherapy
 approved prescription anti-obesity drugs
 OTC anti-obesity drugs
 bariatric surgery
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Therapeutic approaches:
 to slow down nutrient absorption,
especially fat and carbohydrates, and alcohol as well
 to increase the feeling of fullness
 to suppress hunger, appetite
 to stimulate fat metabolization and elimination
 promote removal of waste materials
from the body (use diuretics, laxatives)
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 dietary fibre/hydrophilic colloids – it binds water → increased
filling of stomach and intestine brings the feeling of fullness
and decreased appetite
 Psyllium husk – seed coats of different Plantago species;
contains mucilage (polysaccharides)
 apple fibre = pectin – positive effect on bowel content but on
the other hand it supports appetite!
 oligosaccharides (glucomannans, galactomannans,…)
 chitosan = a linear polysaccharide of D-glucosamine units that
is obtained from the chitin of hard outer skeleton of shellfish
(crab, shrimp, lobster). It might block absorption of dietary fat and
cholesterol
 take before meal, wash down with higher volume of water
 do not use more than 14 days !! – the risk of malabsorption
of other nutrients
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 Bio PSYLLIUM –
ISPAGHULA
(Megafyt Pharma)
 150 g
 Plantago psyllium
Plantago ovata
– seed coat (testa)
 PSYLLIUM
– many producers, various
packages
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 Apple Fibre
(Apple Pectin)
 Swiss APPLE VINEGAR
with chromium
(Swiss Herbal, Canada)
 composition:
500 mg apple vinegar with fibre
150 µg chromium salt
 for better nutrient metabolism
and regulation of blood sugar
 dosage: 1-2 tablets day
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 MedPharma CHITOSAN tbl.
 Chitosan 500 mg
Vitamin C 50 mg
Chromium 50 µg
 recommended dosage:
1 tablet 2 times a day
before meal
 Delpharma CHITOSLIM tbl.
 composition:
chitosan
different fibre types (plant
cellulose, oat and rise bran,
beet fibre, inulin, psyllium husk)
 dosage: 1-3 tablets (max. daily
dose) before meals
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 OBETHINTM cps. (Maxivitalis)
 content in 1 capsule:
500 mg Glucomannan
70 mg flax fibre (Linum usitatissimum)
35 mg sodium alginate (from brown seaweed – Fucus vesiculosus)
30 mg xanthan gum (secreted by the bacterium
Xanthomonas campestris)
30 mg Spirulina (Arthrospira platensis,
fresh-water cyanobacterium)
160 µg Chromium salt (equal to 20 µg Cr)
 recommended dosage: 2 capsules 15 min
before each meal (ideally 3 times a day);
drink min. a glass of water (0.2-0.3 L)
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 DIGELLA tbl.
(Walmark)
 contains natural source of dietary fibre:
apple pectin,
oat glucans,
dextro- and galactooligosaccharides,
chlorella,
spirulina,
psyllium,
vitamin B3
 dosage: 3-4 tablets 3 times a day, rinse
down with an adequate amount of water
(at least 2 litres a day)
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 XL to S MEDICAL (Omega Altermed)
„carbohydrates blocker“
„appetite suppressant“
„fat binder“
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 XL to S MEDICAL (Omega Altermed)
 „fat binder“, clinically proven
 active ingredient is LITRAMINETM
and fat-soluble vitamins A,D,E
 LitramineTM = patented natural fibre complex
derived mainly from Opuntia ficus-indica
and enriched with additional soluble fibres
from Acacia spp., mechanically treated with
fibre from Zea mays
 it first binds fat molecules to form a fat-fibre
complex too large to be absorbed by the
intestine; after that the fat-soluble vitamins
A,D,E are released and absorbed into the
body
 dosage: 1-3 tablets a day after meal at once
http://www.xlsmedical.com/site/cz/xlsmedical/
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 RIVIERIN cps. (Brainway Inc.)
 contains glucomannane fiber from tubers
of Amorphophallus rivieri
 fiber absorbs water in the stomach and
intestines, swells and gives a feeling of
fullness. It limits the absorption of fat from food
 1 cps contains:
glucomannane 500 mg
gelatine 70 mg
 dosage: 2 caps. 3 times a day 20-30 minutes
before a meal. Wash down with sufficient
amount of water (about 200-300 mL).
A beneficial effect is achieved when receiving
3 g per day.
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 LIPOXAL Effect (Salutem Pharma)
 contains Konjac glucomannane fiber from
tubers of Amorphophallus rivieri, Konjac
 content in 1 tbl.:
Konjac glucomannan 500 mg
green tea extr. (80 % EGCG) 100 mg
Guarana extract 30 mg
Korean ginseng extract 15 mg
L-carnitine tartrate 85 mg
Oleae folium extract 20 mg
Synephrine 4 mg
 dosage: 1-2 tablets 3 times a day 20-30
minutes before a meal. Wash down with
sufficient amount of water (about 200-300 mL).
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 BELLASIN 40+ tbl.
(Garden State, USA)
 suitable for women in pre-menopausal or menopausal periods
when hormone production is reduced, metabolism is slowed down
– water retention in the body, fat storage in risk areas, weight gain
 LipoTherm komplex – for better fat metabolism
(green tea extract, guarana, ginger, L-carnitine)
 CardioVit – Oleae folium extract, Rhodiola rosea
 EstroTrim Complex – Trifolium pratense extract,
soya beans, pumpkin seeds
 Osteoplex – calcium, vitamin D3
 dosage: 1 tablet twice a day with food
(preferably in the morning and at noon).
Do not take at night before bedtime.
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 APPETITE STOP cps.
(Krewel Meuselbach)
 acts as appetite suppressant
 contains oil from the Korean Pine seeds
(Pinus koraiensis) (PinnoThinTM)
+ natural tocoferols concentrate
 high content of pinolenic acid that
supports the release of the „hunger
suppressant“ hormones:
CCK (cholecystokinin) and
GLP-1 (glucagon-like peptide)
 dosage: 1-2 capsules 0.5-1 hour before
meal or between meals. Maximally
3 capsules per day.
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 REDUKTAN (Leros)
 POR SPC 1X100GM
 composition, in 100 g:
Fucus (sea-weed) 15 g
Frangulae cortex 15 g
Sambuci nigrae flos 15 g
Sennae folium 10 g
Foeniculi amari fructus 10 g
Petroselini radix 10 g
Sambuci nigrae fructus 10 g
Betulae folium 10 g
Liquiritiae radix 5 g
 SUKL code: 0002142
OTC Medicinal Product
 ATC: V11
 used in weight reduction diet
or to combat obesity (mainly
if there is constipation),
positively influences
metabolism
 it has a mildly laxative and
diuretic effect
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 SLIM FIGURE Herbal Tea
(Leros Natur)
 20 x 1.5 g
 PuErh (black tea) 20 %
green tea 20 %
Menthae pip. herba 20 %
Maté folium 10 %
Betulae folium 10 %
Urticae herba 10 %
Foeniculi fructus 5 %
Fucus vesiculosus 5 %
 Teekanne
SLIMMING TEA
 16 x 1.8 g
 Maté folium 55 %
Menthae pip. folium
Verbenae herba
Liquiritiae radix 5 %