Licorice - Medicinal Uses, Interactions, Side Effects, Dosage
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<p><strong>Licorice </strong></p>
<p>There are <em>several </em>flowering plants whose roots <em>provide </em>the well-known product known as licorice or liquorice. <em>Glycyrrhiza </em>means sweet root, a tribute to the plant's intense sweetness. The best and sweetest product comes from warmer countries in Europe, such as Italy and Spain. The main commercial plant is <em>Glycyrrhiza g/abra </em>(also called <em>Liquiritiae officinalis </em>or <em>L. radix). </em>Less sweet products come from G. <em>ura/ensis </em>(Chinese licorice), which grows in Asia and Turkey, and G. <em>glandulifera, </em>the source of Russian licorice.</p>
<p><strong>Uses and Benefits: </strong></p>
<p>Licorice has been in use for thousands of years in major medical systems as a confection and <em>flavoring, </em>as well as an herbal medicine. In traditional Chinese formulations, licorice <em>(gan cao </em>or <em>kan tsiao) </em>is a frequent component; it is used as a "harmonizer" to integrate and reduce toxicity of the other herbs in prescribed mixtures. It has been used in both Chinese and Western medicine for respiratory problems, including allergies, colds, coughs, sore throat, bronchitis, asthma, and tuberculosis. It has also been a popular agent for treating stomach and bowel disorders, including dyspepsia, bowel spasm, and constipation. Licorice and <em>derivatives, </em>such as carbenoxalone, <em>have </em>been used for many years in Europe and Japan as allopathic drugs for treating peptic ulcer disease. Although use has declined because of the superiority of pharmaceutical drugs, many herbalists still <em>favor </em>licorice products.</p>
<p>other indications include infectious diseases, aphthous ulcers, rheumatic disorders, and skin diseases. Licorice has been em<em>ployed</em> by many herbalists for inflammatory disorders. In several countries, but particularly Japan, it has a reputation of being able to prevent the <em>adverse </em>effects of hepatotoxic agents; it has been used for treating various forms of poisoning and in the management of viral hepatitis. It is also regarded as an antioxidant and adatogen, and numerous other uses <em>have </em>been described. </p>
<p><strong>Pharmacology:</strong></p>
<p>The terpenoids of licorice are thought to control; to many of its healing properties. The main constituent, gly­ vllilizin, is a <em>very </em>sweet, saponinlike triterpene glycoside that is in a concentration of at least 4%. Glycyrrhizin (also known lycyrrhizic acid or glycyrrhizinic acid can be hydrolyzed in the to yield the more <em>active </em>aglycone, glycyrrhetic acid (also know as glycyrrhetinic acid or enoxolone) Enoxolone is the of a synthetic succinate <em>derivative, </em>carbenoxolone, which b een used in Europe and Japan to treat gastric ulcers; it has effects than other licorice constituents. Glycyrrhizin cani' <em>removed </em>during the pharmaceutical preparation of licorice, the resulting deglycyrrhizinated licorice (DGL) has been used </p>
<p><strong>Clinical Trials: </strong></p>
<p> Liver Disease-Licorice products have been used in Chinn and Japan for more than 25 years to treat chronic hepatitis An open Japanese study9 evaluated a popular product, Stronger Neo-Minophagen, which has been used for many years to treal hepatitis C. It consists of 0.2% glycyrrhizin, 0.1 % cysteine, and 2% glycine. Eighty-four patients were treated with 100 mg/day given intravenously for 8 weeks, followed by 2-7 times a week in­fusion for 2 to 16 (median 10) years. A comparable group of 109 patients was given a nonactive infusion. After 15 years, the incidence of cirrhosis was reported as 21 % in the treated group, and 37% in the control group (p = 0.07). The Japanese investigators claimed that the glycyrrhizin helped prevent cirrhosis and hepato­cellular carcinoma; its effectiveness was shown by a significant reduction in liver enzymes as well as cirrhosis incidence. </p>
<p><strong>Adverse Effects: </strong></p>
<p>The most important concern about licorice, and particularly glycyrrhizin, is that susceptible people can develop pseudo-hyperaldosteronism with chronic intake of large amounts (e.g., more than about 20 g/day). This can result from using herbal licorice; excessive dosing with flavored medicines; or over-indulgence in confectionary, chewing gum, or tobacco containing real licorice as a flavor. The mineralocorticoid,potentiating properties of the herb can result in serious adverse effects such as hypernatremia, hypertension, peripheral edema, pulmonary edema, or other evidence of cardiac failure.</p>
<p>Some patients are susceptible to developing hypokalemia, and this can result in profound muscle weakness or paralysis, which may be accompanied by rhabdomyolysis and myoglobinuria.Hypokalemic alkalosis can occur, and sometimes arrhythmillll may be precipitated. </p>
<p>Licorice and even safer derivatives, such as carbenoxolone , have lost favor in medical practice because of these serious side effects. </p>
<p><strong>Side Effects and Interactions:</strong> </p>
<p>Licorice derivatives, in large amounts, could adversely interact with drugs affecting electrolyte balance (such as diuretics and corticosteroids), and with antihypertension, antiar rhythmic, and cardiac failure medications. One of the constituents of licorice (isoliquiritigenin) has been reported to have antiplatelol activities, but no significant clinical interactions affecting clotting have been recognized. </p>
<p><strong>Cautions:</strong></p>
<p>Licorice is contraindicated in patients with hypertension, heart failure, renal insufficiency, and disorders of potassium regulation. Despite claims that it can cause hypoglycemia, there is no evidence in humans to support this contention. Excessive intake should be avoided in pregnancy and lactation since it may have effects on estrogenic and progestin balance,and its safety in pregnancy has not been established. One study suggested that licorice in a dose of 7 g/day (0.5 g glycyrrhizin) could inhibit the enzymatic conversion of 17-hydroxy-progesterone to androstenedione, and could thus, in theory, impair gonadal function. </p>
<p>Licorice products should not be taken in excessive dosages, and a course of treatment of no more than 20 g/day should probably be limited to 4-6 weeks. Low dosages of the herb and the use of licorice in cosmetic creams or gels are unlikely to cause harm and may be taken indefinitely. DGL is less likely to be harmful, even with chronic intake. </p>
<p><strong>Preparations </strong><strong>& </strong><strong>Doses:</strong></p>
<p>Licorice is used in candies and chewing gum, and in many other products including tobaccos. However, socalled licorice confection in the U.S. usually contains very little real licorice; most of these products are based on molasses and corn oil, with anise flavoring and coloration added. Licorice is marketed as the raw root and it is made available in many helthcare products.</p>
<p>The raw root is made available as chewing sticks; cut or powdered root is more uniform, with 5 g containing about 200 mg glycyrrhizin. Products are marketed in liquid or solid forms. The typical doses are 0.5-4 ml of a liquid extract, or more commonly as 2-4 g t.i.d. of a solid dosage form, although up to 15 g/day can be used. DGL is available in tablets of 350 mg, and 2-4 tablets can be taken before each meal. Carbenoxolone (sold by sanofi Winthrop under the name Biogastrone) is used in a dosage of 50-100 mg t.i.d. It is not marketed in the U.S. </p>
<p><strong>Summary Evaluation </strong></p>
<p>Licorice is an ancient drug that is particularly popular in traditional , Iililese medical practice. It has been used in many cultures as xpectorant and antitussive, although these properties have been proved. Glycyrrhizin can increase cortisol effects and may have anti-inflammatory properties, but this has not been studied clinically. Overuse of licorice products can, however pseudo-hyperaldosteronism. Licorice and derivatives have approved in some countries for use as a treatment of peptic deer disease, but they are less acceptable as orthodox remedies . Many additional uses have been described, but the benefits are of dubious clinical relevance; claims of value serious diseases such as viral hepatitis, AIDS, and cancer have been adequately established. Overall, in spite of its popularity, appears that licorice has very little benefit to offer as a medica­lion. Nevertheless, reported studies showing benefit in hepatitis suggest that further clinical investigations would be justified. </p>
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