Ginseng

Panax ginseng is also known as Asian ginseng, Chinese ginseng, Korean ginseng, Oriental ginseng, Panax quinquefolius L. is also known as American ginseng. Other species used include: Panax notoginseng

Sanchi ginseng, Tienchi ginseng and Panax pseudo-ginseng Wall. also known as Himalayan ginseng. It is important to note that Siberian ginseng (Eleutherococcus senticosus Maxim.) is often used and marketed as a ginseng, but it is from an entirely different plant of the Araliaceae family and possesses constituents that are chemically different.

Constituents

• The actual composition of ginseng extracts used varies depending on the species used and the way the root is prepared.

• The main constituents are the saponin glycosides such as the ginsenosides or the panaxosides in Panax species, or the eleutherosides in Eleutherococcus senticosus, which are chemically different.

• Also present are volatile oils containing mainly sesquiterpenes.

Use and indications

• Ginseng is used to enhance the body’s resistance to stress and to improve mental and physical performance.

• It has also been used for diabetes, insomnia, sexual inadequacy, for degenerative conditions associated with ageing, to improve healing and as a stimulant.

Ginseng + Alcohol

Panax ginseng (Asian ginseng) increases the clearance of alcohol and lowers blood-alcohol levels.

Mechanism

The reasons for this interaction are uncertain, but it is suggested that Panax ginseng possibly increases the activity of the enzymes (alcohol and aldehyde dehydrogenase) that are concerned with the metabolism of the alcohol, thereby increasing the clearance of the alcohol.

Ginseng + Antidiabetics

In patients with diabetes taking various oral antidiabetics, Panax quinquefolius (American ginseng) and Panax ginseng (Asian ginseng) have both shown modest reductions in postprandial glucose levels after a glucose tolerance test, but Panax ginseng did not result in any improvement in diabetes control when given for 12 weeks.

Mechanism

Additive blood-glucose-lowering effects are theoretically possible when ginseng is given with antidiabetics. However, very limited data suggest no specific interactions with conventional antidiabetics.

Ginseng + Caffeine

Panax ginseng (Asian ginseng) did not alter caffeine metabolism in one study. Note that both ginseng and caffeine have stimulant effects.

Mechanism

These studies show that Panax ginseng does not have a clinically significant effect on the cytochrome P450 isoenzyme CYP1A2 by which caffeine is metabolised.

Ginseng + Herbal medicines; Guarana

The stimulant effects of guarana, a caffeine-containing herb, appear to be additive to those of Panax ginseng (Asian ginseng).

Mechanism

Both guarana and ginseng are used for their putative stimulative effects. In this study, they affected different tasks and, in combination, their effects were generally additive. The effect of guarana was not considered to be solely attributable to the caffeine content, since the dose of caffeine was low.

Ginseng + MAOIs

Case reports describe headache, insomnia and tremulousness, which was attributed to the concurrent use of ginseng and phenelzine.

Mechanism

Uncertain. It seems unlikely that the bee pollen had any part to play. Note that the ginsengs have stimulant effects, and adverse effects include insomnia, nervousness, hypertension and euphoria.

Ginseng + Tamoxifen and other oestrogen antagonists

Ginseng may contain oestrogenic compounds that might directly stimulate breast cancer growth and oppose the actions of competitive oestrogen receptor antagonists such as tamoxifen.

However, there is some evidence that ginseng use before diagnosis might not adversely affect breast cancer survival.

1. Lee FC, Ko JH, Park KJ, Lee JS. Effect of Panax ginseng on blood alcohol clearance in man. Clin Exp Pharmacol Physiol (1987) 14, 543–6.

2. Lee YJ, Pantuck CB, Pantuck EJ. Effect of ginseng on plasma levels of ethanol in the rat. Planta Med (1993) 59, 17–19.

3. Petkov V, Koushev V, Panova Y. Accelerated ethanol elimination under the effect of ginseng (experiments on rats). Acta Physiol Pharmacol Bulg (1977) 3, 46–50.

4. Choi CW, Lee SI, Huh K. Effect of ginseng on the hepatic alcohol metabolizing enzyme system activity in chronic alcohol-treated mice. Korean J Pharmacol (1984) 20, 13–21.

5. Vuksan V, Sung M-K, Sievenpiper JL, Stavro PM, Jenkins AL, Di-Buono M, Lee K-S, Leiter LA, Nam KY, Arnason JT, Choi M, Naeem A. Korean red ginseng (Panax ginseng) improves glucose and insulin regulation in well-controlled, type 2 diabetes: Ginseng 221 results of a randomized, double-blind, placebo-controlled study of efficacy and safety. Nutr Metab Cardiovasc Dis (2008) 18, 46–56.

6. Vuksan V, Sievenpiper JL, Koo VYY, Francis T, Beljan-Zdravkovic U, Xu Z, Vidgen E. American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Arch Intern Med (2000) 160, 1009–13.

7. Vuksan V, Stavro MP, Sievenpiper JL, Beljan-Zdravkovic U, Leiter LA, Josse RG, Xu Z. Similar postprandial glycemic reductions with escalation of dose and administration time of American Ginseng in type 2 diabetes. Diabetes Care (2000) 23, 1221–6.

8. Vuksan V, Sievenpiper JL. Panax (ginseng) is not a panacea. Author reply. Arch Intern Med (2000) 160, 3330–1.

9. Gurley BJ, Gardner SF, Hubbard MA, Williams DK, Gentry WB, Cui Y, Ang CYW. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in humans. Clin Pharmacol Ther (2002) 72, 276–87.

10. Cui Y, Shu X-O, Gao Y-T, Cai H, Tao M-H, Zheng W. Association of ginseng use with survival and quality of life among breast cancer patients. Am J Epidemiol (2006) 163, 645–53.