Dong quai

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use dong quai, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

If you use a product containing dong quai to prevent premature ejaculation, apply it only to the outer skin of the tip of your penis. People who have used dong quai for this purpose have applied the product 1 hour before sexual activity, and washed it off just before intercourse.

Do not take topical (for the skin) dong quai by mouth. Topical forms of this product are for use only on the skin.

Do not use different forms (creams, tablets, liquid, tincture, teas, etc) of dong quai at the same time without medical advice. Using different formulations together increases the risk of an overdose.

Dong quai can affect blood-clotting and may increase your risk of bleeding. If you need surgery, dental work, or a medical procedure, stop taking dong quai at least 2 weeks ahead of time.

Call your doctor if the condition you are treating with dong quai does not improve, or if it gets worse while using this product.

Store at room temperature away from moisture, heat, and light.

Do not take dong quai without medical advice if you are using any of the following medications:

• warfarin (Coumadin, Jantoven); or

• other medicine used to prevent blood clots, such as alteplase, clopidogrel, dipyridamole, ticlopidine, and urokinase.

This list is not complete. Other drugs may interact with dong quai, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

Avoid continued use of topical dong quai if you or your sexual partner have severe genital irritation during or after sexual intercourse.

Avoid exposure to sunlight or tanning beds. Dong quai can make your skin more sensitive to the sun or increase your risk of skin cancer. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Avoid using dong quai together with other herbal/health supplements that can also affect blood-clotting. This includes capsicum, clove, danshen, garlic, ginger, ginkgo, horse chestnut, panax ginseng, poplar, red clover, turmeric, and willow.

Do not take dong quai without medical advice if you are using any of the following medications:

• warfarin (Coumadin, Jantoven); or
• other medicine used to prevent blood clots, such as alteplase, clopidogrel, dipyridamole, ticlopidine, and urokinase.

This list is not complete. Other drugs may interact with dong quai, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

Several forms of the plant exist and dosages vary widely: crude root extract by decoction ranges from 3 to 15 g/day; while in combination, preparations 75 mg to 500 mg may be taken up to 6 times a day.

Avoid use. Uterine stimulant and relaxant activity have been reported with A. sinensis , while a related species, Angelica archangelica L., was a reported abortifacient and affected the menstrual cycle.

Data are limited. Chemical constituents have demonstrated cytotoxic properties.

A. sinensis (Oliv.) Diels is synonymous with A. polymorpha var. sinensis (Oliv.). Three species of angelica are monographed separately in the Pharmacopoeia of the People's Republic of China : dong quai, the root of A. sinensis ; bai zi, the root of Angelica dahurica (Fisch.) Benth. et. Hook. f. or A. dahurica var. formosana (Boiss.) Shan et Yuan; and du huo, the root of A. pubescens Maxim. f. biserrata Shan et Yuan. In Korea, A. gigas Nakai is used medicinally, while in Japan, A. acutiloba Kitagawa is used. The European A. archangelic L. is used to flavor liqueurs and confections. While botanically related, the various species of Angelica , which differ in chemistry, pharmacology, and toxicology should not be confused. A molecular biology study of A. acutiloba may lead to efficient methods for distinguishing raw materials. 1 , 2 , 3

The chemistry of A. sinensis is distinct from that of other species in the genus. While coumarins have been reported from this species, 6 a recent comparative study of commercial dong quai products and related species 7 found coumarins to be lacking, while the lactone Z -ligustilide was a major constituent. 8 In this study, A. sinensis more closely resembled Levisticum officinale in chemical composition than other species of Angelica . Thus, there is justification for terming the latter plant European dong quai. Several other lactones related to ligustilide have been found in A. sinensis . 9 , 10 , 11 Ferulic acid and its esters were also found in A. sinensis . A capillary electrophoresis method for measuring ferulic acid in A. sinensis has been published. 12

In contrast, the roots of A. dahurica were found to contain an abundance of coumarins. Imperatorin and isoimperatorin are the major constituents, with many other related compounds (eg, bergapten, phellopterin, scopoletin) reported. 13 Ferulic acid was also detected in this species. 14

The root of A. pubescens contains coumarins, but with some differences from A. dahurica . The simple prenylcoumarin, osthole, and the linear furocoumarins, columbianadin and columbianetin acetate, are the major constituents, while the coumarins, angelols A-H, are characteristic of the species. 15 , 16

The common polyacetylene falcarindiol has been isolated from various species of Angelica . 7 Polysaccharides have been isolated from different species of Angelica ; however, they have not been characterized sufficiently to permit comparison. 17 Simple plant sterols and lipids have also been found. 18

Summary of Use during Lactation

Dong quai (Angelica sinensis) root contains a number of chemicals, including ligustilide, ferulic acid, angelicide. Dong quai has no generally recognized lactation-related uses, although some midwives in the United States reportedly have used it for postpartum blues or depression.[1] It is often used as part of a postpartum herbal mixture in Asia[2][3] and is used as a "women's herb" in Chinese medicine for symptoms associated with menstruation and menopause. No data exist on the excretion of any components of dong quai into breastmilk or on the safety and efficacy of dong quai in nursing mothers or infants. Although it is usually well tolerated in general use, it may increase the risk of bleeding in patients taking warfarin and antiplatelet drugs and cause photosensitivity reactions. Dong quai is best avoided during breast feeding.[4]

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

A study in Japan compared the use of a mixture of 13 herbs, including dong quai, to ergonovine for their effects on lactation and serum prolactin in postpartum women. The herbal mixture, called Xiong-gui-tiao-xue-yin, was given in a randomized fashion to 41 women in a dose of 2 grams of a dried aqueous extract 3 times daily. A comparable group of 41 women were randomized to receive methylergonovine 0.375 mg daily. Therapy was started on the day of delivery, but the duration of therapy was not specified. Plasma oxytocin and prolactin were measured on days 1 and 6; milk volumes were measured daily, although the method of measuring milk volume was not specified. Serum prolactin was higher on days 1 and 6 in the women who received the herbals; plasma oxytocin was lower on day 1 in the women who received the herbal, but not different on day 6. Milk volumes were greater on days 4, 5, and 6 in women who received the herbal mixture.[5] This study has serious flaws that make its interpretation impossible. First, milk volume measurement is subject to considerable variability depending on the measurement method used, but the method was not specified. Second, methylergonovine has caused decreases in serum prolactin and milk production in some studies.[6][7] Because of the lack of a placebo group, the differences found could be a negative effect of methylergonovine rather than a positive effect of the herbal preparation. Because this study used a multi-ingredient combination products in which dong quai was only one component, the results might be different from studies in which dong quai was used alone.

References

1. Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives. Obstet Gynecol. 2000;95:19-23. PMID: 10636495

2. Chuang CH, Chang PJ, Hsieh WS et al. Chinese herbal medicine use in Taiwan during pregnancy and the postpartum period: a population-based cohort study. Int J Nurs Stud. 2009;46:787-95. PMID: 19193377

3. Wong HB. Effects of herbs and drugs during pregnancy and lactation. J Singapore Paediatr Soc. 1979;21:169-78. PMID: 262485

4. Amir LH, Pirotta MV, Raval M. Breastfeeding - Evidence based guidelines for the use of medicines. Aust Fam Physician. 2011;40:684-90. PMID: 21894275

5. Ushiroyama T, Sakuma K, Souen H et al. Xiong-gui-tiao-xue-yin (Kyuki-chouketsu-in), a traditional herbal medicine, stimulates lactation with increase in secretion of prolactin but not oxytocin in the postpartum period. Am J Chin Med. 2007;35:195-202. PMID: 17436360

6. Peters F, Lummerich M, Breckwoldt M. Inhibition of prolactin and lactation by methylergometrine hydrogenmaleate. Acta Endocrinol (Copenh). 1979;91:213-6. PMID: 463447

7. Arabin B, Ruttgers H, Kubli F. [Effects of routine administration of methylergometrine during puerperium on involution, maternal morbidity and lactation]. Geburtshilfe Frauenheilkd. 1986;46:215-20. PMID: 3519353