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Method: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches.

As of Julythe disease seems to be mostly affecting Europe and the Americas. Most people infected with the COVID virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people and those with underlying medical problems such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness WHO, a.

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Teens and adults without underlying medical conditions are asked to self-manage their symptoms in isolation with a minimum of Reading mix herelooking for some cock paracetamol, if fever is high and lifestyle adjustments increased rest and hydration. However, most of the current guidelines do not specifically advise on how to treat cough, one of the main symptoms, which, apart from being very debilitating, contributes to the spread of the virus. There is not yet any evidence-based specific therapy for COVID, and the real efficacy and safety of current therapeutic approaches will need further scrutiny when enough multi-site clinical data become available.

These are readily accessible both in retail commerce and community pharmacies. Their labeling establishes that these medicines are indicated for the treatment of common cold and flu symptoms based on traditional use only. We agree in that COVID is not the common flu, but the WHO definition is clear in that it is a mild, self-limiting condition and, therefore, fitting the boundaries of self-prescription, moreover if the patients have not been tested for the virus WHO, a. In that sense, there is a need to clarify the real potential and safety profile of herbal medicines to scientifically substantiate future recommendations on their benefits and risks of use them.

Therefore, the impetus of this work is twofold. Early COVID symptoms include fever, dry cough, and dyspnea, among other similar ones to other viral respiratory diseases such as common flu Rothan and Byrareddy, In general, the incubation period is around 15 days, but the reported range is 0 to 24 days Bai et al. Older people and those with underlying medical problems such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop severe illness WHO, a.

The precise pathology of the disease is not yet clear, but seems to include a systemic pro-inflammatory response, inducing hemodynamic changes and, consequently, a predisposition to ischemia and thrombosis Tang et al. Due to the emergence of the propagation of the disease, Health Systems have become overloaded, even having sufficient diagnostic capacity and hospital facilities to handle such an outbreak.

In the most vulnerable regions, the COVID epidemic effectively paralyzes health systems at the expense of primary health care Velavan and Meyer, Some measures, such as lock-down of communities, social distancing, and quarantine-type for those suspected to be infected can, at least in part, slow the COVID spread Heymann and Shindo, and, so, enable the health systems to cope. However, these measures are palliative, and people tend to ignore them after a few days of isolation, mainly those in disadvantaged and vulnerable communities. Importantly, at this stage, we are starting to build up an evidence-base for the best strategy to treat, mitigate, and prevent the diseases.

Currently, none of the approaches used is evidence-based. As of Julythe evidence-base for such treatments is often limited if not non-existent. However, often strong, unsubstantiated claims are made about the pros and cons of herbal medicines, which will also result both in false hopes or strong fears of those at risk or ill with COVID Brennen et al.

While some preparations have been claimed to be specifically active, some commonly used medicinal plants are assessed here, especially those on the WHO list of selected medicinal plants, as adjuvant treatments. For example, Hensel et al. Additionally, curcumin, the main constituent in Curcuma longa L. Zingiberaceaeis suggested as a potential clinical option for the treatment of SARS-CoV-2 infection, due to its action in several steps of a viral infection such as protease inhibition, cellular alling pathways modulation, among others Zahedipour et al.

In another paper Panyod et al. Two species Allium sativum L. Moreover, in an elegant evidence-based analysis, eighteen phytotherapeutic preparations were mentioned as having some role in the clinical management of viral respiratory diseases, showing different levels of immunological response Portella et al.

Four plants mentioned in that report [ Echinacea purpurea L. Moench, Glycyrrhiza glabra L. The rationale used in our study was to include, mostly, species known in the Americas and Europe and those already more Reading mix herelooking for some cock available for the management of respiratory conditions Blumenthal, ; Edwards et al. Complementing other papers published on medicinal plants and their potential to be used for COVID, we focused on the therapeutic potential of 39 species, the limitations for their use, and their possible risks.

It must be strongly emphasized that this is not an assessment of any mainline treatment for COVID with such herbal medicines. Although the listed herbal drugs included herein have been used for a long time, the evidence level of their action in the relief of mild respiratory symptoms varies, and they are pointed out here. As of today, there is no clinical backup for such strong recommendations other than trying to prevent unspecific herb-drug interactions should the patient need emergency care. For a treatment to be recommended as adjuvant therapy for respiratory diseases in the context of COVID, we here determine that the treatment is effective and that its expected benefits outweigh its potential risks to patients.

The decision also reflects current applicable laws, regulations, and healthcare recommendations, taking into consideration the uncertainty associated with COVID A search was conducted, considering herbal medicines traditionally used to relieve cold and flu symptoms.

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Several South American Countries use the Brazilian Pharmacopeia documents as a reference, so they are also covered within this search. Based on these documents, a list of target species was prepared to establish a search of clinical evidence for the given indication.

We also included some species which are not listed in monographs based on their ificant widespread use in the self-management of respiratory diseases. Some of them are also linked to food uses. We did not consider species that have given rise to major safety concerns such as Ephedra sp. Furthermore, we do not assess multi-herbal preparations. They consist of a step-by-step approach to follow for good decision-making practice and to increase transparency. Descriptive frameworks are usually general, and most of the time, reiterate common sense. Frame the problem. We agreed on six key criteria for safety Table 2.

Consider options to be evaluated against the treatment. Currently available over-the-counter OTC medications endorsed by health authorities are non-steroidal anti-inflammatory drugs NSAIDs ibuprofen, naproxen, Reading mix herelooking for some cock. They may be taken as monotherapy or alternating therapies. Therefore, one of each category ibuprofen, paracetamol, and codeine was chosen to be evaluated based on the same criterion. Assess the balance between favorable and unfavorable effects and the associated uncertainty.

The last two allowed for the inclusion of two different degrees of uncertainty Table 3. See conclusions. Also, Cochrane, Drug. The last two allowed for the inclusion of two different degrees of uncertainty. We are aware that for many herbal drug preparations, preclinical evidence exists, and this is not considered in this assessment since it cannot be translated directly into clinical practice. However, such estimation might be of relevance to unveil potential mechanisms of action only so in that case this information was included. Based on the defined parameters, three recommended drugs for early symptoms of COVID - codeine, ibuprofen, and paracetamol - were evaluated.

Preclinical evidence. In vitro and in vivo studies showed evidence of antipyretic and mild analgesic activities Rainsford, Clinical evidence. In a review on the effects of non-steroidal anti-inflammatory drugs NSAIDs for treating pain or respiratory symptoms e.

However, there is no clear evidence of their effect in easing respiratory symptoms. Overall, the clinical evidence is High. Side effects of ibuprofen include anemia, decreased hemoglobin, eosinophilia, hemorrhage, vomiting, and hypertension. Other side effects include upper gastrointestinal hemorrhage, upper gastrointestinal tract ulcers, dizziness, and dyspepsia.

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Com, a. Overall, safety is Medium. Specific warnings and precautions of use. Ibuprofen may cause severe cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Ibuprofen is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft CABG surgery.

NSAIDs can also cause an increased risk of serious gastrointestinal adverse events, especially in the elderly, including bleeding, ulceration, and perforation of the stomach or intestines, which can also be fatal McGettigan and Henry, Overall assessment. According to well-established use, ibuprofen may be useful in the symptomatic relief of respiratory conditions by reducing fever and aches. However, there is only a relatively low of clinical studies, and meta-analyses do not provide consistent evidence that ibuprofen is effective in reducing symptoms and duration and prevention of the common cold.

Ibuprofen may have antiplatelet activities; its safety may be considered Medium. Some in vitro, ex vivoand in vivo studies show evidence of anti-cough activity Ohi et al. Although codeine is widely used as antitussive, the clinical evidence supporting this action is controversial. A study, involving 91 adults presenting cough associated with acute upper respiratory tract infection, showed codeine statistically had the same effect than vehicle syrup in controlling cough Eccles et al.

Overall, the clinical evidence is Low. Commonly reported side effects of codeine include drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, sweating, and constipation. Other possible effects include bronchospasm, laryngospasm, respiratory depression; heartbeat irregularities, blood pressure changes, syncope, itching, facial swelling, pruritus, urticaria, histamine release; dry mouth, loss of appetite, nausea, vomiting, paralytic ileus, toxic megacolon, anorexia, stomach cramps; miosis, blurred or double vision; euphoria, dysphoria, unusual dreams, hallucinations, insomnia, anxiety 0.

Overall, safety is Low. Death due to respiratory depression has been reported in children Friedrichsdorf et al. Moreover, codeine can lead to opioid misuse, abuse, and addiction Casati et al. According to established use, codeine may be useful in the symptomatic relief of cough. However, clinical studies and meta-analyses do not provide consistent evidence that codeine is effective in treating cough. Due to the severe side effects, codeine safety may be considered Low. Numerous in vitro and in vivo studies show evidence of antipyretic and mild analgesic activities Graham et al.

Paracetamol acetaminophen did not show any efficacy in flu, according to a clinical trial involving 80 patients Jefferies et al. In a systematic review, the authors concluded that the data did not provide sufficient evidence to inform practice regarding the use of acetaminophen for common cold in adults Li S. Paracetamol acetaminophen is hepatotoxic Athersuch et al. There are reported cases of deaths in flu patients taking paracetamol Stevenson et al. Overall, the safety evidence is Low.

Reading mix herelooking for some cock indicated in cases of liver disease and alcoholism Drugs. According to a well-established use, paracetamol may be useful in the symptomatic relief of respiratory conditions by reducing fever and aches although a relatively low of clinical studies and meta-analyses do not provide consistent evidence that paracetamol can reduce symptoms and durationand prevention of the common cold. The clinical evidence may be considered Low or at best Medium.

It is known to be hepatotoxic, and a frequent incidence of respiratory adverse effects may justify serious concerns and a safety rating of Low. Risk is inherent to any therapeutic intervention herbal or not. The level of risk of herbal interventions in adults experiencing common flu symptoms without underlying conditions is very low. General warning: allergic reactions and gastrointestinal GI disturbances are common adverse effects in all medicines and apply to herbal ones.

Their use in pregnancy and lactation, babies, children, and the elderly, as well as patients with known severe conditions, is to Reading mix herelooking for some cock individually assessed by a registered healthcare professional. The recommendations made here are for medicinal products regulated by national authorities to ensure their quality and safety.

Reading mix herelooking for some cock

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