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Known interactions

A-hydroCort, Acetasol HC, Acetazolamide, Acetazolamide Injection, Acetazolamide Sustained-Release, Acetic Acid and Hydrocortisone Eardrops, Adenocard, Adenoscan, Adenosine Infusion, Adenosine Injection, AK-Pred, AK-Spore H.C. Otic, AK-Zol, Aldactazide, Aldactone, Alphatrex, Alphatrex Aerosol, Amiloride and Hydrochlorothiazide, Amiodarone Injection, Amiodarone Oral, Analpram HC, Antibiotic, Antiobiotic Ear Solution, Antiobiotic Ear Suspension, Anucort-HC, Anumed HC, Anusol-HC, Aquatensen, Aristocort, Aristocort A, Aristocort Topical, Atenolol and Chlorthalidone, Atolone, Azmacort, Benicar HCT, Betalene, Betamethasone, Betamethasone Foam, Betamethasone Injection, Betamethasone Oral Solution, Betamethasone Skin Aerosol, Betamethasone Topical, Bumetanide, Bumetanide Injection, Bumex, Bumex Injection, Celestone Injection, Celestone Oral, Celestone Syrup, Chlorothiazide, Chlorothiazide Injection, Chlorothiazide Suspension, Chlorthalidone, Cipro HC Otic, Ciprodex Otic, Ciprofloxacin and Dexamethasone Ear Suspension, Ciprofloxacin with Hydrocortisone Ear Suspension, Cordarone, Cordarone Injection, Cort-Dome, Cort-Dome High Potency, Cortaid, Cortane-B. Otic, Cortatrigen, Cortef, Cortef Suspension, Cortenema, Cortic, Cortifoam, Cortisporin Otic, Corzide, Decadrol Injection, Decadron, Decadron Ear Solution, Decadron Injection, Decadron Liquid, Decadron Ophthalmic, Decadron-LA Injection, Decaspray, Del-Beta, Delta-Tritex, Deltasone, Demadex Injection, Demadex Oral, Depo-Medrol, Depoject, Depopred, Dexamethasone Ear Solution, Dexamethasone Injection, Dexamethasone Liquid, Dexamethasone Ophthalmic, Dexamethasone Skin Aerosol, Dexamethasone Tablets, Dexone, Diamox, Diamox Injection, Diamox Sequels, Digitek, Digoxin, Digoxin Injection, Digoxin Liquid, Diprolene, Diprolene Aerosol, Diprosone, Diprosone Aerosol, Diurigen, Diuril, Diuril Injection, Diuril Suspension, Drotic, Duralone, Dyazide, Dyrenium, depMedalone, Ear-Eze, Econopred, Econopred Plus, Edecrin, Enduron, Enzone, Epifoam, Esidrix, Ethacrynic Acid, Ezide, Flutex, Furosemide, Furosemide Injection, Furosemide Oral Solution, GlaucTabs, Hemorrhoidal HC, Hemril-HC Uniserts, Hexadrol, Hexadrol Injection, Hexadrol Liquid, Hydrochlorothiazide, Hydrocortisone and Pramoxine Rectal Aerosol Foam, Hydrocortisone and Pramoxine Topical, Hydrocortisone and Pramoxine Topical Aerosol Foam, Hydrocortisone Dental Paste, Hydrocortisone Injection, Hydrocortisone Oral, Hydrocortisone Rectal Foam or Enema, Hydrocortisone Suppositories, Hydrocortisone Tablets, Hydrocortisone Topical, Hydrocortisone, Chloroxylenol and Pramoxine Eardrops, Hydrocortisone, Neomycin, and Polymyxin Otic, Hydrocortone, Hydrocortone Acetate, Hydrocortone Phosphate, HydroDIURIL, Hygroton, Hytone, Indapamide, Inflamase Forte, Inflamase Mild, Kenacort, Kenalog, Kenalog in Orabase, Kenalog-H, Kenonel, Lanacort, Lanoxicaps, Lanoxin, Lanoxin Injection, Lanoxin Liquid, Lasix, Lasix Injection, Lasix Oral Solution, LazerSporin-C, Lisinopril and Hydrochlorothiazide, Locoid, Lopressor HCT, Lozol, Luxiq Foam, M-Prednisol, Maxidex, Maxivate, Maxzide, Medralone, Medrol, Meprolone Unipak, Methazolamide, Methyclothiazide, Methylprednisolone, Methylprednisolone Injection, Metolazone, Metolazone extended-release tablets, Metoprolol and Hydrochlorothiazide, Microzide, Moduretic, Myco-Triacet II, Mycogen II, Mycolog-II, Myconel, Mykrox, Mytrex, Nadolol and Bendroflumethiazide, Nasacort, Nasacort AQ, Neptazane, Nystatin and Triamcinolone, Octicair, Olmesartan and Hydrochlorothiazide, Orabase HCA, Oralone Dental, Orapred, Oretic, Oti-Med, Otic-Care, OtiTricin, Otocort, Otomar-HC, Otosporin, Pacerone, Pediapred, Pediotic, Pramosone, Pred Forte, Pred Mild, Prednisolone Injection, Prednisolone Liquid, Prednisolone Ophthalmic, Prednisolone Tablets, Prednisone Oral, Prednisone Oral Solution or Syrup, Prelone, Prinzide, Proctocort, Proctofoam-HC, Solu-Cortef, Solu-Medrol, Soluspan Injection, Spironolactone, Spironolactone and Hydrochlorothiazide, Tenoretic, Thalitone, TobraDex, Tobramycin and Dexamethasone Ophthalmic, Torsemide Injection, Torsemide Oral, Tri Nasal, Tri-Otic, Tri-Statin, Triacet, Triamcinolone Acetonide Dental, Triamcinolone Injection, Triamcinolone Nasal Inhalation, Triamcinolone Nasal Spray, Triamcinolone Oral, Triamcinolone Oral Inhalation, Triamcinolone Oral Syrup, Triamcinolone Topical, Triamterene, Triamterene and Hydrochlorothiazide, Triderm, UAD Otic, VoSoL HC, Zaroxolyn, Zestoretic, Zone-A Forte, Zoto-HC.

Information about Red Squill

Scientific Name: Red Squill

Who is this for?

Unlike drugs, the statements on the manufacturer's label describing the role of dietary supplements need not be authorized by the FDA.2 To inform the consumer of this fact, the following statement is required by law to appear on the supplement label: "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease." Red squill is promoted for use in hair tonics and for the treatment of seborrhea or dandruff. It is also used as a rat poison.1

Uses

Supplements are defined by the FDA as any products intended for ingestion as a supplement to the diet. If a product is sold as a supplement, it must state on its label "dietary supplement."Red squill supplements are derived from the dried inner scales of the bulb from the perennial herb Urginea maritima var. pancratium Stein Baker.1 Red squill is one variation of a large group of herbs known as squill which are native to the Mediterranean.1 Other squill varieties are Urginea indica Kunth. also known as Indian squill, and Urginea maritima L. Baker also known as European or white squill.

When should I be careful taking it?

The U.S. Food and Drug Administration (FDA) has stringent rules pertaining to safety, efficacy, and quality that pharmaceutical manufacturers must follow in order to market drugs in the U.S.3,4 Manufacturers of supplements do not have to follow these same rules to sell their products.5 For this reason, there is limited research evaluating supplements' safety and efficacy in the human body.6 As a result, those who choose to take these substances do so at their own risk.Precautions

  • Use of red squill is inadvisable.
  • All squill varieties may affect the actions of cardiac (heart) drugs.7 Anyone taking these medications should therefore avoid the use of squill supplements.
  • Consultation with a health care professional is the best way to identify the most appropriate options for managing or treating any condition. Before using any dietary supplement, it is best to consult with your physician or pharmacist.

    What side effects should I watch for?

    Drugs have several inherent characteristics like manufacturer reporting, quality assurance, drug labeling, premarket clearance, benefit-risk assessment, pharmacovigilance, and learned intermediaries which facilitate the identification of serious adverse effects. Supplements generally do not have these features and therefore information on their adverse effects is limited.8Ingestion of squill has been reported to cause a fatal poisoning.9 All squill varieties contain components that have cardiac effects and toxicity similar to those of the drug digitalis (slowing of the heart, drop in blood pressure, tiredness, dizziness, gastrointestinal upset, seizures, increase in blood pressure, and coma) and can be life threatening even in low doses.In general, squill has not been associated with massive numbers of poisonings because vomiting is usually triggered by overdoses thus preventing absorption. Also, squill is poorly absorbed from the gastrointestinal tract. But, some preparations are enteric coated or modified to enhance absorption thus increasing the risk of toxicity.Adverse events reported to the FDA on a particular supplement can be viewed at http://www.cfsan.fda.gov/~dms/aems.html.

    What interactions should I watch for?

    Red squill may affect the actions of antiarrhythmics, calcium, corticosteroids, digoxin, diuretics, laxatives, and quinidine. Anyone taking these medications should therefore avoid the use of red squill supplements. Drug interactions with red squill have not been well studied, so it is not known whether other potential interactions exist.

    If red squill is substituted for proven remedies, the disease being treated may advance beyond the point at which proven therapies are effective. Before using any dietary supplement, it is best to consult with your physician or pharmacist.

    Should I take it?

    At present there is no data comparing squill to current therapies for the treatment of seborrhea or dandruff.

    Dosage and Administration

    Prescription and over-the-counter products are regulated by the FDA and therefore offer an advantage over supplements. Unlike the pharmaceutical companies, supplement manufacturers are not regulated, so the potencies and purity of supplements often differ by brand and even by bottle.10,11 The United States Pharmaocpeia (USP), an agency that sets the standards of quality, purity, and consistency of products, is in the process of establishing standards for the manufacturing of some supplements, but the standards are optional and not all manufacturers follow them. To determine if the supplement manufacturer claims to follow USP standards look for USPNF or USP on the supplement's label.Exact dosing recommendations cannot be made due to the differences in herbal supplement content between various manufacturers of the products. If you choose to utilize this supplement, follow the directions for proper use printed on the product's label.Carefully examine all the potential benefits and risks when considering the use of supplements.

    Summary

    Given the large number of safe and effective alternatives for the treatment seborrhea or dandruff, use of squill is not worth the risk.

    References

    1. Anon: Squill, In Olin BR, ed.: The Review of Natural Products. St. Louis, MO, Facts and Comparisons< Apr 1991.
    2. Overview of dietary supplements. U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition. http://vm.cfsan.fda.gov/~dms/ds-oview.html. Accessed 1999 June.
    3. Farley D. Benefit vs. risk: How the FDA approves new drugs. FDA Consumer Special Issue: From Test Tube to Patient: New Drug Development in the United States. 2nd ed U.S. Food and Drug Administration http://www.fda.gov/fdac/special/newdrug/ndd_toc.html. Accessed 1999 April.
    4. Flieger K. Testing drugs in people. FDA Consumer Special Issue: From Test Tube to Patient: New Drug Development in the United States. 2nd ed U.S. Food and Drug Administration http://www.fda.gov/fdac/special/newdrug/ndd_toc.html. Accessed 1999 April.
    5. Kurtzweil P, An FDA guide to dietary supplements. U.S. Food and Drug Administration http://www.fda.gov/fdac/features/1998/598_guid.html. Accessed 1999 Feb.
    6. Winslow LC, Kroll DJ. Herbs as medicines. Arch Intern Med.1998;158(9):2192-99.
    7. Brinker F, ed. Herb Contraindications and Drug Interactions, 2nd ed. Sandy, Oregon: Eclectic Medical Publications;1998:154, 161.
    8. Statement by Joseph A. Levitt, Director, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Department of Health and Human Services before the Committee on Government Reform U.S. House of Representatives May 27, 1999. http://www.fda.gov/ola/aems599.html. Accessed 1999 June.
    9. Ernst E. De Smet. Risks associated with complementary therapies. In Dukes MNG, ed. Meyler's Side Effects of Drugs: an Encyclopedia of Adverse Reactions and Interactions. 13th ed. Amsterdam, Netherlands: Elsevier; 1996:1442.
    10. Borins M. The dangers of using herbs: what your patients need to know. Postgrad Med.1998;104(1):91-100.
    11. Herbal Rx: the promises and pitfalls. Consumer Reports. March,1999.44-8.


(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)

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