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Home Made Cough Lozenges

May 19, 2016 Petina Walsh

Product:          Sambucus nigra, Thymus vulgaris & Althaea officinalis cough lozenges.

Introduction

A lozenge will dissolve slowly in the mouth and throat providing local relief for coughs, colds and sore throats (Adams and Tan 2015, p. 65). Patient compliance, particularly with children, is high due to the sweet taste. Leksell and Meiare (1994) showed that lozenges are well tolerated by children aged 3-5 years. Lozenges are also a convenient dosage form.

Medicinal uses for Althaea officinalis includes coughs, bronchitis and respiratory catarrh (Fisher 2009, pp. 172). Traditionally, Thymus vulgaris has been used to treat the common cold due to its antibacterial, antitussive and expectorant actions (Braun and Cohen 2015, p. 982). Sambucus nigra fruit has been shown as an effective antiviral and has potential immunomodulating activity (Fisher 2009, pp. 77). Honey is used in the recipe in place of sugar due to its antibacterial, antifungal and antioxidant properties (Braun and Cohen 2015, p. 554).

Rationale

Herb Althaea officinalis Thymus vulgaris Sambucus nigra
Part Used Root Leaves Fruit
Active Constituents Up to 20% mucilage, 2% tannins, volatile oils, 35% pectin as well as flavanoids, phenolic acids and asparagine (Fisher 2009, p. 173). Phenols: thymol, eugenol and carvacrol. Flavonoids: apigenin, luteolin. Tannins (Braun and Cohen 2015, p. 982). Phenolic acids: caffeic, gentistic, syringic and p-coumaric acids (Fisher 2009, p. 151). Flavonoids: quercetin, hyperoside and rutin (Fisher 2009, p. 77).
Actions Demulcent, emollient, diuretic (Fisher 2009, p. 173). Antimicrobial, carminative, antitussive, expectorant, spasmolytic, astringent (Fisher 2009, p. 151) Analgesic, antioxidant, astringent, antifungal, anti-inflammatory (Braun and Cohen 2015, p. 983). Sudorific, diuretic, emetic, alterative and laxative (Fisher 2009, p. 77)
Indications First used in the 9th Century BC for dry cough irritations and mild gastric inflammation. The high mucilage content soothes mucosa. Indicated for coughs, bronchitis and respiratory catarrh (Fisher 2009, p. 173). Respiratory tract infections and bronchitis (Braun and Cohen 2015, p. 984). Respiratory tract infections include pertussis, coughs, laryngitis, bronchial catarrh and asthma (Fisher 2009, p. 152). Influenza, common cold, chronic nasal catarrh with blocked ears, sinusitis (BHP 1983, p. 186). Historically, the fruit was indicated for rheumatism, syphilis, asthma, dropsy and as an emmenagogue (Fisher 2009, p. 78)
Cautions/ Contraindications High mucilage content may delay absorption of other drugs. Do not consume at the same time (Fisher 2009, p. 173). Potential for drug/ herb interactions. In vitro studies show induction of detoxification enzyme activity in the liver. Unripe fruit may cause nausea, vomiting and diarrhoea (Fisher 2009, p. 78).

 

Evidence

Althaea officinalis

A combined herbal preparation containing Hedera helix extract, a decoction of Thymus vulgaris and Pimpinella anisum, and mucilage of Althaea officinalis root mucilage was shown to alleviate cough symptoms in an open clinical trial by Beuchi et al. 2005. Althaea officinalis has been used traditionally for symptomatic relief of coughs (Fisher 2009, p. 173). 

Thymus vulgaris

Thymus vulgars extracts are indicated for cough due to colds, pertussis, bronchitis, laryngitis and tonsillitis and has been approved by German Commission E (Fecka and Turek 2008). 

Sambucus nigra

Sambucus nigra has been used for centuries to treat influenza, colds, and upper respiratory tract infections. Zakay- Rones (1995) investigated the efficacy and safety of elderberry syrup. The syrup was shown to be effective at inhibiting the proliferation of 10 influenza type A and B strains (Zakay- Rones Z et al 1995, p.361). Barak V et al (2002) suggest Sambucus nigra has immunomodulating potential by increasing inflammatory and anti-inflammatory cytokines production. 

Formulation

Ingredients:

  • 25 grams dried Sambucus nigra fruit
  • 25 grams dried Thymus vulgaris leaf
  • 25 grams dried Althaea officinalis root
  • 750 ml filtered water.
  • Raw honey as required 

Method:

  1. Gently simmer dried herbs to make a concentrated decoction (1:10)
  2. Strain and press the marc.
  3. Measure volume of liquid. Add double the quantity of honey and dissolve of low heat. (for example, 300 mls of liquid = 600 ml honey). (1:2)
  4. Gently bring to the boil and boil for 10 minutes or until mixture hardens when dripped into cold water (taking care not to burn).
  5. Pour into moulds to set.

 Conclusion & Evaluation

13th April 2016

I initially used 375ml of water which was mostly absorbed into the dry herbs. I then added the remaining 375ml. I simmered for approximately 30 minutes to get a dark purple coloured decoction. Once the decoction was strained and the marc pressed, I had 400 ml of liquid. Due to time consuming method of packaging and the need to set the lozenges in the fridge, I completed steps 5 and 6 at home.

14th April 2016

I measured 200 ml of the decoction and added 400 ml of honey and followed steps 5 and 6. I put them in the refrigerator overnight however they did not set. 

15th April 2016

I measured the remaining 150 ml of decoction and 300 grams of raw sugar and repeated steps 5 and 6. I put them in the refrigerator overnight to set. The lozenges are still quite soft and chewy, however, the flavour is pleasant and palatable. I recommend keeping them in the refrigerator to prevent them getting any softer.

I believe I needed to boil the mixture for longer to get the lozenges to set harder. (edit) I should not have stirred the mixture.

Using lozenges as a dosage method would result in a large intake of sugar which would not be of beneficial for the client. The amount of heat required to manufacture the lozenges is not beneficial for the herbs either. I believe an infusion with some honey would be just as well received by children as the flavour is quite good.

References

Adams, J and Tan E 2015, Herbal Manufacturing: How to make medicine from plants., 3rd Edition, Ligare, Australia. 

Barak, V, Birkenfeld, S, Halperin, T and Kalickman, I 2002, ‘The effect of herbal remedies on the production of human ingflammatory and anti-inflammatory cytokines’, Isr Medical Association Journal, vol. 4, no. 11 supp, pp. 919- 922. Viewed 12th April 2016. http://www.ncbi.nlm.nih.gov/pubmed/12455180

Braun, L and Cohen, M 2015, Herbs & Natural Supplements: An evidence based guide., 4th Edition, Volume 2, Elsevier, Chatswood 

Buechi, S, Vogelin, R, Von Eiff, MM, Ramos, M and Melzer, J 2005, ‘Open trial to assess aspects of safety and efficacy of a combined herbal cough syrup with ivy and thyme.’, Forsch Komplementarmed Klass Naturheilkd, vol. 12, no. 6, pp. 328- 332. Viewed 13th April 2016 http://www.ncbi.nlm.nih.gov/pubmed/16391481

Fecka, I and Turek, S 2008, ‘Determination of polyphenolic compounds in commercial herbal drugs and spices from Lamiaceae: thyme, wild thyme and sweet marjoram by chromatographic techniques.’, Food Chemistry, vol. 108, no. 3, pp.1039-1053. Viewed 13th April 2016 www.sciencedirect.com/science/article/pii/S0308814607011466

Fisher, C 2009, Materia Medica of Western Herbs., Vitex Medica, Nelson. 

Leksell, E and Meiare, I 1994, ‘How do 3 to 5-year-old children handle a lozenge? A clinical experimental study.’, Swedish Dental Journal, vol. 18, no. 4, pp. 149-153. Viewed 13th April 2016 http://europepmc.org/abstract/med/7825117 

Zakay- Rones, Z, Thom, E, Wollan, T and Wadstein, J 1995, ‘Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.’, Journal of Alternative Complementary Medicine, vol. 1, no. 4, pp. 361- 369. Viewed 13th April 2016. http://www.ncbi.nlm.nih.gov/pubmed/15080016 PMID:7825117

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