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For severe dry mouth, pilocarpine Salagen can be prescribed see PDR for dosing and side effects. Huperzine-A 200 to 400 mcg/d. Donepezil Aricept starting with 2.5 mg/d. Some insurance companies only pay for Aricept for patients diagnosed with Alzheimer’s disease. If the patient’s insurance plan will not cover Aricept, then Huperzine-A is a less expensive alternative. Nausea and Vomiting Nausea and vomiting can sometimes be relieved by taking ginger tea or ginger capsules 40 minutes prior to ingestion of medications. Candied ginger is also useful, and can be carried in a plastic bag should nausea occur while driving, on public transportation, or at work.

Acupressure bands Sea Bands applied to acupressure points at the wrist can relieve nausea. For severe nausea secondary to chemotherapy, Amrit Kalash an Ayurvedic herbal compound can be helpful. Hepatic Dysfunction Many medications used in psychiatry and general medical practice can cause hepatitis as indicated by elevations in liver enzymes. For a detailed discussion of the benefits of S-adenosylmethionine SAMe for liver function, see Chapters 2 and 9. Numerous studies have shown that SAMe can prevent or reverse abnormal liver function cause by other medications e.g., anticonvulsants and mood stabilizers. In clinical practice, the authors find that SAMe is also effective in counteracting hepatic dysfunction caused by antidepressants, particularly SSRIs.

The effectiveness of SAMe for improving liver function is enhanced further by polyenylphosphatidylcholine Liverpro from Life Extension Foundation. For bipolar patients, who should not be given SAMe, two Chinese herbal compounds containing bupleurum have shown efficacy in improving liver function tests LFTs in practice: Ease Two or Ease Plus or www. CraneHerb. A physician or licensed herbalist must order these herbs for patients. Follow dosing recommendations on the labels. For very mild elevations in liver function tests, milk thistle Silybum marianum can be tried.

Constipation and Hemorrhoids Constipation caused by medications, such as antipsychotics and tricyclic antidepressants, often responds to Triphala an Ayurvedic herb two to four capsules/day or magnesium 600 to 800 mg/day. The pressure of straining during bowel movements can exacerbate hemorrhoids. Herbs that strengthen the walls of blood vessels, helping to heal and prevent hemorrhoids, include Butchers Broom CircuCaps and Horse Chestnut Extract. Galantamine 4 to 32 mg/day. If the patient does not have insurance coverage for this prescription medication, the herb galanthus 4-32 mg/d is less expensive and works as well. Artichoke extract may be of benefit in cognitive impairment secondary to chronic use of benzodiazepines. Insomnia Insomnia due to overstimulation by antidepressants or other medications may respond to a change in the dosing schedule or the use of more sedating antidepressants at night. For more details on breath practices see Post 3.

CAM treatments for insomnia include: Melatonin 3 to 9 mg at bedtime. Regular melatonin helps reduce sleep onset latency and extended release melatonin helps sustain sleep. A combination may be needed depending on the patient’s sleep pattern. Many of the CAM treatments used for sexual dysfunction in general can be applied to the same disorders when they are secondary to medication. For more details see Post 6. Anorgasmia Anorgasmia due to antidepressants may be relieved by maca, R. rosea, and muira puama. Erectile Dysfunction Erectile dysfunction may respond to ArginMax or maca.

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