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What is Hyperlipidemia?
Hyperlipidemia is an excess of fatty substances called
lipids,
largely cholesterol and triglycerides, in the blood.
• Cholesterol is required to build and maintain cell
membranes
• It is the major precursor for the synthesis of vitamin D
and of the various steroid hormones
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• Cholesterol is primarily synthesized from acetyl CoA
through the HMG-CoA reductase pathway in many
cells and tissues.
Alfalfa
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Family :fabaceae/leguminosae
Species: medicago sativa
Part used: herb
Herbal use :
treatment arthritis ,high cholesterol ,diabetes and peptic
ulcer
 It has bactericidal ,cardiotonic ,diuretic &emetic
 It is source of vitamins A,C,E,K &mineral ca
,k,phosphorus and iron
Constituent
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Acids: lauric acid, malic acid, malonic acid …
Alkaloids: pyrrolidine type ,pyridine type in the seeds only
Amino acids :arginine ,asparagines, cystine ….
the non protein toxic Amino acids canavanine is present in leaves
,stem and seeds
Coumarins: medicagol
Isoflavonoid:coumestrol,biochaninA,daidzein….
Saponins: 2-3%hydrolsis yield aglycone ,medicagenic acid
,soyasapogenolsA-F and hedragenin .
sugar chain component include arabinose galactose …
Steroids
Other consisteunts:
Carbohydrates ,vitamin ,pectin methylestrase pigments, protein
and trace element
Pharmacological action
 Saponins is decrease plasma cholesterol concentration
without change in (HDL)
 decrease intestinal absorption of cholesterol and increase
excretion of neutral steroids and bile acids .
 stimulate lipolytic activity of a mixture of porcine pancreatic
enzymes including lipase ,amylase and proteases
 Clinical study
 reduced plasma cholesterol concentration by less than 5% in
(LDL)
Side effect /toxicity :
 It induce asystemic lupus erthematosus like syndrome
because there is canavanine which is toxic due to it is
structure analogue of arginine and may interfere with the
binding of this amino acid to enzymes and its incorporation
into protein
Contra indication &warning
 should be avoided it with (SLE) .
 Not take with oral contraceptive &hormonal replacement
therapy because the potential oestrogenic &anticoagulant
activity
Pregnancy and lactation:
 The safety not established .
Preparation& dosage:
 Tablet ,capsule and teas
 Dried herbs
 Liquidextract
Artichoke
 Family asteraceae /compositae
 Species cynara scolymus L
 Part used leaves
 Herbal use :
 treatment hyperlipidemia , hyperlipoprotinaemia
condition require an increase in choleresis and nonulcer dyspepsia
 It has choleretic,hypocholesterlamic,hypolipidaemic
,diuretic and hepatostimulating properties
Pharmacological action
 Inhibition of cholesterol biosynthesis by 65% .
 The hypolipidemic effect well document for globe
aritichoke leaf extract and the Constituent: cynarin
 Luteolin the most important constituent for this effect
by indirect inhibition of hydroxymethylglutrayl-COA
reductase(HMG-COA)
 Clinical study :
 It is reported cynarin tobe effective in lowering serum
concentration of cholesterol and triglyceride when taken
daily dose ranging from 60mg to 1500mg
Side effect /toxicity :
1- No series adverse effect were reported
2Non- specific gastrointestinal complaints: dyspepsia&
constipation gastric irritation
3-Allergic contact dermatitis
Contra indication &warning
 globe aritichoke yields cynaropicirin potentially allergenic
Pregnancy and lactation:
The safety not established .
Preparation& dosage
 Leaf extract
 Liquid extract
A teabag containing artichoke tea
Fenugreek
 Family: Leguminosae
 Species: Trigonella foenum –graecum
 Part used : seed
 Herbal use :It possess as mucilaginous
demulcent,laxative,nutritive ,expectorant .
 Traditionally ,use for treatment of anorexia
,dyspepsia ,gastritis
 topically for myalgia,lymphadenitis ,gout wounds
and leg ulcers .
Constituent
 Alkaloids: pyridine type.
 Protein :23%-25%
 Flavonoids: flavone glycosides including orintin
and vitexin,quercetin(flavonol)
 Saponins: 0.6-1.7%.glycosides yeilding steroidal
sapogenins diosgenin and yamogenin (major)
 Other constituent:
coumarin,lipid,mucilaginous,fibre,vitamins and
minerals
Pharmacological action
 Hypocholesterolaemic activity due to fibre and saponin
fraction
 It has Hypocholesterolaemic activity and lowering
triglyceride concentration but without change (LDL)&
(HDL)
 Clinical study :
 A significant reduction in serum cholesterol
concentration in diabetic patients was also noted
Side effect /toxicity :
 No reported
Contra indication &warning:
 It has hypoglycemic activity so it is interfere
hypoglycemic therapy
 Cation is advisable in patients receiving monoamine
oxidase inhibitor ,hormonal or anticoagulant therapies
Pregnancy and lactation:
 It is reputed to be uterine stimulant activity .
Preparation& dosage
 Seed 1-6g or equivalent three times daily
Garlic
 Family :Amaryllidaceae /liliaceae
 Species :Allium sativum L .
 Part :used bulb
 Herbal use :
 expectorant ,antispasmodic, antiseptic ,bacteriostatic
,antiviral,hypotensive and anthelmintic properties
 Traditionally :it used to treat chronic bronchitis ,recurrent
colds ,bronchitic asthma and influenza .
 Modern use :
antihypertensive ,antiartherogenic
,antithrombotic,antimicrobial ,cancer preventive and lipid
lowering effects .
Constituent
 Enzyme :allinase ,peroxidases,myrosinase and others
 Volatile oils:0.1-0.36% .sulfur containing compound
including alliin , compound produced enzymetically from
alliin including allicin,S-allylmercaptocysteine and Smethylmercaptocysteine ;terpenes
 Other constituents :
Protein ,amino acids ,minerals, vitamins, trace element ,lipid
and prostaglandins
Pharmacological action
Sulfur-containing constituent inhibit
cholesterol biosynthesis including :
 Inhibition (HMG-COA)reductase
 Reduction in triacylglycerol biosynthesis
 Increase in hydrolysis of triacylglycerols via increased
lipase activity and inctivation of enzymes ivolved in
lipid synthesis
 inhibit triglyceride biosynthesis in part by decreasing
de novo fatty acid synthesis via inhibition of fatty acid
synthase.
 garlic significantly reduced total serum cholesterol
concentration by about 9%
Side effect :
 Non toxic
 Burning sensation in the mouth and gastrointestinal
tract
 Garlic breath &body odour
 The allergenic potential due to allergen as:diallyl
disulfide ,allylpropyl sulifide and allicin
Contra indication &warning:
 Interfere with hypoglycemic and anticoagulant
therapies
 It potentiate the antithrombotic effects of antiinflammatory drugs such as aspirin
 Gastrointestinal irritation may occur
Pregnancy and lactation:
There is no experimental or clinical reports
Preparation& dosage
 Dried bulb Tincture
 Oil
 Juice of garlic
 Syrup of garlic
 Garlic powder tablets
Milk Thistle
 Species: silybum marianum
 Synonym: carduus marianus
 Part used: fruits, herb.
 Legal category: milk thistle is not included in the
GSL.
 Constituents:
 Fruit: flavolignans,flavonoids,lipids,sterols.
 Leaves: flavonoids
 Food use: it is not used in foods.
 Herbal use:
 ✭Milk thistle fruits have been used for disorder of
liver,spleen and gall bladder.
 ✭Also used for nursing mothers for stimulating milk
production,as abitter tonic for haemorrhoids.
 ✭The leaves have also been used for the treatment of
liver, spleen and gall bladder disorders and as an
antimalarial and for uterine complaints.
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 Pharmacological actions:
 As well as inhibition of lipid peroxidation, stimulation
of protein biosynthesis and acceleration of liver
regeneration.
 Mechanism of Action?
 *Found a dose dependent decrease in HMG-CoA
reductase in the liver with increasing silymarin
concentration .
 *A decrease in HMG-CoA reductase leads to a decrease
in synthesis of cholesterol.
 Sid-effects, toxicity:
 Sever sweating, abdominal cramping,
nausea,vomiting, diarrhoea,anaphylactic shock in a
54-year-old man with immediate type allergy to kiwi
fruit.
 Contra-indications, warning s:
 ✭It is conta-indication for individuals with
hypersensitivity to species of asteraceae.
 ✭Pregnancy and lactation should be avoided.
 Pharmaceutical prepration:
Extract milk thistle
capsules
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Hawthorn
 Species: crataegus laevigata (rosaceae)
 Synonym: whitethorn
 Part used: fruit
 Legal category: it is not included in the GSL.
 Constituents:
 Amine,flavonoids(flavonol,flavones), tannins.
 Food used:
 It is not common used in food.
 Herbal use:
 ✭It is stated to possess cardiotoinc,coronary
vasodilator and hypotensiveproperties,hypertension
 Pharmacological action:
 An inhibition of lipid peroxidation which can be
caused by highly reactive free radicals was also
documented.
 Mechanism of Action:
 The mechanism of action of hawthorn remains
unknown.
 Side-effect,toxicity:
 Nausea,fatigue,sweating,rash on the hand.
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 Contra-indications,warnings:
 ✭Cardiovascular disorder such as hypertention,
hypotention and cardiac disorders.
✭pregnancy and lactation should be avoided.
 Pharmaceutical prepration:
Capsule
liquid
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Ginger
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Species: Z. officinale
Synonym: zoingiber
Part used: rhizome
Legal category: GSL
Constituents:
Carbohydarates starch, lipids, oleo-resin gingerol
homologues, volatile oils.
 Food used:
 It is the natural source of food flavouring,and used
widely in foods as a spice.
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 Herbal use:
 ✭Ginger is stated to possess carminative, diaphoretic
and antispasmodic properties.
 ✭Also used for colic, flatulent dyspepsia and used to
prevention of nausea and vomiting.
 Pharmacological actions:
 ✭Anti-atherosclerotic
 Ginger (dried ginger)oleo-resin by intragastric
administration has been reported to inhibit elevation
in serum and hepatic cholesterol concentration in rats
by impairing cholesterol absorption and those with
existing hypercholesterolamai.
 ✭Fresh ginger not effect on serum cholesterol.
 Side-effect,toxicity:
 Non toxic
 Contr0indication,warnings:
 ✭Effect to blood pressure
 ✭Pregnancy and lactation should be avoided.
 Pharmaceutical prepration:
Oleo-resin
cream
 Ispaghula
 Species: Plantago ovata Forsk.
 Family: Plantaginaceae
 Synonym: Blond psyllium Indian
plantago,Ispagol, Pale psyllium,Spogel
 Part used: seed, husk
Herbal use:
Ispaghula is started to posses demulcent and laxative
properties.
Traditional use:
in the treatment of the:
 chronic constipation.
 dysentery diarrhea.
 cystitis.
The German commission A approved use for chronic
constipation and disorder in which bowel movement with
loose stool are desirable.
Active constituent:
1- Alkaloids Monoterpene-type. Plantagonin and
indicainin.
2- Mucilages 10-30% mucopolysaccharide consisiting
mainly of ahighly branched arabinoxylan with a xylan
backbone and branches of arabinose, xylose and 2-Ogalacturonic-rhamnose moites.
3- Other constituents:
 Aucubin
 sugars (fructose, glucose, sucrose).
 protein.
 steroils .
 triterpenes .
 fatty acid .
 tnnins.
 Pharmacological action
 In clinical studies:
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Hypocholesterolaemic effects:
26 men with mild to moderate hypercholesterolemia
(serum cholesterol concentration: 4.86- 8.12 mmol/L) received
isphagula 3.4 g for eight weeks , and the end of study ,
serum cholesterol concentration were reduced by 14.8 % and
LDL cholesterol by 20.2% and ratio of LDL to HDL
cholesterol by 14.8 %.
Laxative effect.
• Antidiarrhoeal effect.
• Hypoglycemic effect.
 Mechanism of actin:
 IN CHOLESTEROL CONTROL :
The content has cellulose fiber, which is responsible
for decreasing the absorption of cholesterol into the
blood stream.
Dosage:
Seeds/ 5-10g (3g in children ) three times daily, seed
should be soaked in worm water for several hr before
taking.
Liquid extract/ 2-4 ml (1:1 in 25% alcohol) three times
daily.
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Ispaghula Husk 225 Capsules
Ispaghula Husk (300g
Side effects, toxicity:
 Increase flatulence and abdominal distention, and
may be cause intestinal obstruction
 If swllowed dry ,may cause oesphageal obstruction.
Contra-indictions, warnings:
Not given to patints with intestinal obstruction.
Should be taken fluid to avoid oesphageal obstruction.
Interaction with other medicinal products and other form of
interaction:
 Absorption of minerals ( calcium, iron, lithium, zinc),
vitamins (B12), cardiac glycoside and coumarine derivatives
may be delayed .for this reason the product should not be
taken 0.5-1 hr before or after intake of other drugs.
 If the product is taken together with meals in the case of
insulin-dependent diabetics it may be necessary to reduce
the insulin dose .
Pregnancy and lactation:
Ispaghula may be used during pregnancy and lactation
 Gugulipid
(Gum Guggul, Guggulu )
 Species : Commiphora mukul
 Local Name : Bdellium Gum,
Guggulipid, Gum Gugal, Salaitree
Gugulipid, gum guggulu.
 Parts Used : Gum resin extract.
 Origin:
The mukul myrrh (Commiphora mukul) tree is a
small, thorny plant distributed throughout India.
Traditional use:
guggul lipid has been used to treat arthritis,
rheumatism, haemorrhids, urinary disorder, obesity,
skin diseases and high cholesterol. It has been claimed
to be widely used for over 2,000 years.
 active constituents:
 Ketone fraction that is extracted from the resin contains
 the most potent cholesterol lowering components.
 This is composed of C21 or C27 steroids, with the major
 components being Z- and E-guggulsterone.
 Guggul contains resin, volatile oils, and gum.
 The extract isolates ketonic steroid compounds known
 as guggulsterones. These compounds have been
 shown to provide the lipid-lowering actions noted
 for guggul.
Dosage:
A common intake of guggulsterones is 25 mg three
times per day. Most extracts contain 5-10%
guggulsterones. For a 5 percent guggulsterone
extract, this translates to an effective dose of 500
milligrams three times per day.
Pharmacology:
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lowers serum triglycerides and cholesterol as well as LDL
and VLDL cholesterols (the "bad" cholesterols). At the
same time, it raises levels of HDL cholesterol (the "good"
cholesterol).
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inhibits platelet aggregation,
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stimulation of the thyroid, potentially resulting in
weight loss.,
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deposits of waste or toxic material in the body
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A direct anti-inflammatory effect
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reduce the stickiness of platelets.thate
lowers the risk of coronary artery disease.
mechanism of action:
 Guggul works on the liver by increasing the metabolism (or
break down) of the bad cholesterol known as LDL
Cholesterol.
 After taking the product for 4 to 12 weeks, total cholesterol
levels can drop, triglyceride levels can drop and an increase
in HDL (the good cholesterol) of approximately 16% can
occur.
 Guggul can lower blood cholesterol by 14-27% and can
lower triglycerides by 22-30%
Advers effect:
Gugulipid is a fairly nontoxic product
 there may be mild skin rashes or GI upset/diarrhea.
 It is safe to use during pregnancy and does not
adversely affect liver or kidney function,
Pharmaceutical prepration:
Guggul - Pure extract (250 mg capsule)