Ginseng, Panax ginseng tablets or capsules

What is ginseng?

Ginseng (Ginsana®) is a dietary supplement (herbal remedy) that is being promoted as a "tonic" to help fight fatigue, improve performance, and fight off stress. Asian ginseng is considered more of a stimulant than American ginseng. American ginseng is not used very much in the US and is primarily exported to Asia.

What should my health care professional know before I use ginseng?

They need to know if you have any of these conditions:

• abnormal vaginal bleeding or pain

• breast cancer

• high blood pressure

• an unusual or allergic reaction to ginseng, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

It is important for you to tell your prescriber or other health care professional that you are using ginseng.

How should I use this medicine?

Ginseng is available in many forms, including teas, capsules, extracts, tablets, roots, chewing gum, cigarettes, and candies. Follow the directions on the package labeling, or talk to your health care professional. The capsules and tablets should be swallowed whole with a glass of water. A medicinal tea can be made from whole ginseng roots by chopping the roots, adding ½ teaspoonful of the powdered root to water, bringing the water to a boil, then simmering for 10 minutes. If ginseng liquid (e.g., Ginsana® Liquid) is used, shake well before each use.

Contact your pediatrician or health care professional regarding the use of this herb in children. Special care may be needed.

What if I miss a dose?

Missing a dose is probably not harmful. If you miss a dose, simply resume taking it on your previous schedule. Do not take double doses to catch up, however.

What drug(s) may interact with ginseng?

• certain medicines for high blood pressure or heart-related problems, like amlodipine, diltiazem, nifedipine, and verapamil

• digoxin

• medicines called MAO inhibitors-phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®)

• warfarin

• water pills (diuretics like bumetanide, furosemide, or torsemide)

For many herbs, interactions with other medications are unknown. That is why you should always be careful when mixing herbal remedies with traditional medications.

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking ginseng?

Since ginseng is derived from a plant, allergic reactions are possible. Stop using this herb if you develop a rash.

If you have diabetes, you should monitor your blood sugar closely while taking ginseng.

Different brands of ginseng might contain different amounts of active ingredient so be careful to use the same brand. It is recommended that you use a brand from a reliable manufacturer and one that has been standardized. A standardized product is more likely to contain the same amount of herb from dose to dose. Your health care professional or pharmacist can assist you in finding a standardized product.

What side effects may I notice from using ginseng?

Side effects that you should report to your prescriber or health care professional as soon as possible:

Rare or uncommon:

• breast pain

• signs of low blood sugar (e.g., sweating, increased heart rate, palpitations, tremor)

• vaginal bleeding

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• difficulty sleeping

• irritability

• nervousness

Where can I keep my medicine?

Keep out of the reach of children.

Store at room temperature; do not freeze. Throw away any unused medicine after the expiration date.

GENERAL INFORMATION REGARDING DIETARY SUPPLEMENTS:

Dietary supplements include amino acids, vitamins, minerals, herbs, botanicals, and other plant-derived substances, and extracts of these substances. These products are easy to identify as they must state "Dietary Supplement" on the label. A "Supplement Facts" panel is provided on the label for most products. Supplements are not drugs and are not regulated like drugs. You should note that rigid quality control standards are not required for dietary supplements. Big differences in potency and purity of these products can occur. Scientific data to support the use of a dietary supplement for a certain disease or ailment may not be available. This product is not intended to diagnose, treat, cure or prevent any disease.

The Food and Drug Administration suggests the following to help consumers protect themselves:

• Always read product labels and follow directions.

• "Natural" doesn't mean a product is safe for humans to take.

• Look for products containing ingredients with the "USP" notation. This indicates the manufacturer followed the standards of the US Pharmacopoeia.

• Supplements produced or distributed by a nationally known food or drug company are more likely to be made under tight controls as these companies have standards in place for their other products. You can write to the company for more information about how the product was made.