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2005, vol. 55, br. 2, str. 197-208
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Biljni proizvodi u prevenciji i terapiji blažih oblika simptoma menopauze
Herbal medicinal products in the prevention and therapy of mild symptoms of menopause
Univerzitet u Beogradu, Farmaceutski fakultet, Institut za farmakognoziju
Sažetak
Kod najvećeg broja žena sindrom menopauze nije izražen u meri koja zahteva medikamentozni tretman. Ipak, često se javljaju određeni simptomi koji svakodnevni život žene čine manje prijatnim. U tom slučaju, pravima primena odgovarajućih biljnih preparata može značajno uticati na kvalitet života žene. Odluka lekara ili farmaceuta o preparatu koji će preporučiti, zavisi od razgovora sa pacijentkinjom i od procene stanja simptoma. Jedna grupa biljnih preparata, bazirana je na fitoestrogenima (kumestani, izofiavoni, flavonoidi, stilbeni, lignani). Zbog određenih hemijskih karakteristika, ova jedinjenja pokazuju afinitet vezivanja za alfa i/ili beta estrogene receptore. Do danas, klinička ispitivanja potvrđuju samo uticaj na odnose između lipidnih frakcija u serumu i na smanjenu učestalost kardiovaskularnih problema. Najčešće se koriste izoflavoni (genistein i daidzein) u obliku preparata na bazi soje (Glycine max) i crvene deteline (Trifolium pratense). Dnevna doza odgovara 40-160 mg izoflavona. Koren Cimicifuga racemosa sadrži smešu triterpena (27-deoksiaktein), tragove izoflavona (formononetin) i flavonola (kemferol). Primena umanjuje valunge, preznojavanje i poboljšava raspoloženje. Brojne studije nisu razjasnile mehanizme delovanja i objasnile rezultate kliničkih ispitivanja. Preovlađuje mišljenje da triterpeni cimicifuge deluju centralno, dopaminergičnim efektom, a flavonoidi (ili neka druga jedinjenja iz ekstrakta) ispoljavaju "estrogenima sličan efekat". Koriste se standardizovani ekstrakti korena. Dnevna doza je 2 mg ukupnih triterpena, odnosno 8 mg ekstrakta (2x4mg) ili 40 mg korena (2x20 mg). Primena 6 nedelja do 6 meseci. Kod depresije i naglih promena raspoloženja, karakterističnih za menopauzu, mogu se koristiti preparati izrađeni od standardizovanog ekstrakta herbe kantariona LI 160 (0,3% hipericina i najmanje 3% hiperforina). Dnevna doza odgovara 1-3 mg hipericina, odnosno iznosi 900 mg ekstrakta (3x300 mg); efekti primene vidljivi posle šest nedelja.
Abstract
In the more then 70 % women, the menopause symptoms are not so strong and hormone replacement therapy is not necessary, but that period of their life can be quite unpleasant. In that case, herbal remedies could be taken to improve the quality of life. After the talk with patient and evaluation of symptoms, the duty of pharmacist is to make a choose suitable preparation and recommend it. One group of preparations is based on phytoestrogens (coumestanes, isoflavones, flavonoids, stilbenes, lignans). Because of specific chemical characteristics, these compounds have affinity for binding to α and/or β oestrogen receptors. Up to day, the results of clinical studied have shown only the positive effect on the ratio between lipid fractions in serum and influence the reduction of cardiovascular diseases. The isoflavones (genistein and daidzein) are the most used as soybean (Glycine max) and red clover (Trifolium pratense) preparations. Daily dose corresponds to 40-160 mg of isoflavones. Cimicifuga racemosa roots contain the mixture of triterpene glycosides (27- deoxyactein), traces of isoflavones (formononetin) and flavonols (kaempherol). Its use has positive effect on reduction of hot flushes, outbreaks of sweat and depressive moods. Many studies did not reveal the mechanism of action and explain the results of clinical research. The most abandon opinion is that the triterpenes of black cohosh exhibits dopaminergic effect, while flavonoids (or some other compounds from extract) possess oestrogen-like activity. The standardized extracts of roots are used for formulation of preparations. Daily dose is 2 mg of total triterpenes or 8 mg of extract (2x4mg), and 40 mg of roots (2x20 mg). Duration of use is six weeks to six months. The preparations of St. John's Worth (Hypericum perforation) made from standardized herb extract LI 160 (0,3 % of hypericine and not less then 3 % hyperforine), could be used for depression and emotional disturbances, characteristic for menopause. Daily dose corresponds to 1-3 mg of hypericine, or 900 mg of extracts (3x300 mg); the effects are noticeable after six weeks.
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