Mucuna pruriens – Contraindications and warnings

Mucuna has some drawbacks.  In principle, the levodopa in itself (albeit with other natural ingredients that improve tolerance) shares many of the contraindications and precautions applicable to synthetic levodopa.  These warnings are well known and we will review some of them.

I want to begin by highlighting the main stumbling block to the beneficial use of mucuna: ignorance on the  part of the patient and lack of medical information.  A physician should monitor treatment at all times.

PATIENTS DO NOT KNOW WHAT THEY ARE TAKING

A major obstacle to treatment with mucuna is that pa-tients don’t have clear ideas about the drugs’ intended purpose

They have heard of several cases where mucuna worked well, but usually these observations have come to them from people without any scientific knowledge, from non-professional websites or from commercial information intended for product sales.

Mucuna is sold freely on the Internet and many patients take it without medical supervision.  Worse still, they engage in speculation based on bizarre opinions they encounter in the forums, and they absorb this erroneous information, and therefore lack sufficient knowledge to use it appropriately.  However, occasionally patients are right or are very close to the truth, but there is still a danger of misuse.  At times patients take mucuna simply because despair leads them to try anything.

THEY DESPISE WHAT THEY DO NOT KNOW

Many patients complain of the disdainful reaction they encounter when they ask their doctors about adding mucuna to their treatment regimen.

As it is an “unorthodox” therapy, it is perfectly understandable that the physician does not want to prescribe mucuna: it is not part of the generally accepted body of treatments they are trained to manage..

When a doctor decides to incorporate mucuna, he faces new difficulties, particularly with patients treated with other drugs.  This requires the additional effort of studying the situation and designing a strategy for each individual case.

On the other hand, we cannot allow patients to treat themselves in hiding.  Therefore, it is desirable that as doctors, we have to educate ourselves about mucuna so that we can choose to use it or not in a particular type of patient.

One should never despise the unfamiliar.  After studying the properties of mucuna and weighing its advantages and disadvantages, we should decide on a rational basis, whether it is beneficial, neutral, or inadvisable for a specific case.

If the patient perceives that we master the subject, he will entrusted his care to us, rather than attempting to treat himself.  That way, he will cooperate if we ban the mucuna or recommend a gradual dosage pattern.  We earn their trust when we have enough information and credibility.

WHY ARE THERE NO FREQUENT MAJOR PROBLEMS?

Mucuna is not a placebo but, rather, has important effects.  However anyone can buy it without a prescription, and most are taking it without medical supervision.  These patients are not sufficiently familiar with the properties of mucuna, they do not know the side effects or complications that may arise; they do not take into account the interactions with other medications or the differences between individuals.

While this scenario suggests a public health issue, it fortunately does not usually cause serious problems.  Why?

I think that one reason is the safety of the components of mucuna, which has been used for millennia in thousands or hundreds of thousands of patients in India without significant harmful effects.

Another issue is that the products are sold often in small doses as a dietary supplement.  That is not, however, always the case: there are some preparations with excessive doses especially when combined with carbidopa (in Sinemet, Madopar or Stalevo), dopamine agonists or other antiparkinsonian drugs.  It is necessary to use extreme caution.

CONTRAINDICATIONS OF LEVODOPA

Although better tolerated, mucuna contains a natural  form of levodopa.  In theory it should share the same contraindications, interactions and precautions of synthetic levodopa:

It is contraindicated in children, pregnancy and lactation (prolactin inhibition) and schizophrenia or psychosis.

It should be used with caution (and is best avoided) in cases of a medium to severe degree of heart disease or diabetes.

Do not take it with MAOIs, or with ergot.

Use caution (due to the additive effect) if the patient takes Levodopa (Sinemet, Madopar), COMT inhibitors (Entacapone Stalevo) or dopamine Agonists (rotigotine, pramipexole, ropinirole).

DRUGS THAT INTERACT WITH LEVODOPA

Neuroleptics antiemetics: metoclopramide (Reglan).

Neuroleptic antipsychotics.

Tetrabenazine. Baclofen.

Ayahuasca and other psychoanaleptics.

Nonselective MAOI (contraindicated).

Use caution with MAO-B; evaluate individual responses.

Anticholinergics. Dopamine uptake inhibitors.

Levodopa and beans (additive effect).

Ergot and other dopaminergics (additive effect).

Antihypertensives, antidepressants, sedatives, alpha blockers (prostate therapy): they may promote orthostatic hypotension.

Substances which inhibit the absorption of levodopa: spiramycin, salts of iron, antacids (dyspepsia).

SIDE EFFECTS WITH LEVODOPA

To avoid use in individuals with known allergy or hypersensitivity to Mucuna pruriens or components.

There have been some side effects of mucuna.  In a study of patients with Parkinson’s disease, a derivative of Mucuna pruriens caused minor adverse effects, which were mainly gastrointestinal in nature.

Isolated cases of acute toxic psychosis have been reported1, probably due to levodopa content.  Therefore, as with Sinemet and Madopar, its use should be avoided in patients with psychosis or schizophrenia

SPECIFIC WARNING ABOUT MUCUNA

We assume that all contraindications, interactions, precautions and side effects that we know about synthetic levodopa should be considered when taking levodopa from mucuna.

Specific contraindications include thinning of the blood (anticoagulants), and care should be taken with antiplatelet and anti-inflammatory drugs because mucuna increases clotting time.

Mucuna should not merge with anticoagulants (Sintrom, Dabigatran, heparin, warfarin) or with antiplatelet drugs such as clopidogrel.  Caution should be exercised and the additive effect should be taken into account if it is associated with acetylsalicylic and NSAIDs (nonsteroidal anti-inflammatory).

We should also be careful with antidiabetic medicines: mucuna lows glycemic index, and thus is to be considered a potential additive effect.  Other interactions are possible, so always consult your regular doctor.

On the one hand, it can be argued that mucuna has been used for many centuries in India and has been available for several years online without a prescription, and yet serious problems have not been revealed.  But that is just an observation.

Regarding Sinemet and Madopar, we have thousands of controlled studies, while publications on mucuna are still scarce.  One must therefore use greater caution when choosing mucuna.  While the future appears to be positive, we need the confirmation of more scientific studies.

BE CAREFUL WHEN COMBINING MUCUNA AND GREEN TEA

te verde aumenta efecto mucuna

Green tea enhances the effect of beans in general and of mucuna in particular. This effect can also be seen in patients taking Sinemet or Madopar: you should know this phenomenon due to the increase in potency it can cause.

There is something in green tea that acts like carbidopa.  It contains polyphenols which inhibit dopa-decarboxylase2

an action similar to that carried out by the carbidopa or benserazide contained in Sinemet or Madopar.

In addition, there is something that acts like entacapone in green tea.  Ponifenol, EGCG (Epi-Gallo-Catecin-gallate) promotes the entry into the brain of levodopa and prolongs its bioavailability in the blood because it inhibits the COMT enzyme3.

This action is similar to that of entacapone; namely beans mixed with green tea have Stalevo-like effects, but with different proportions.  Obviously, if you take levodopa (mucuna or otherwise), its effectiveness will be reinforced and this should be taken into account as there is risk of overdose.  Always consult your doctor.

These “carbidopa-like” and “entacapone-like” effects can be seen with green tea and they are independent of their other neuroprotective benefits4 so the tea is recommended in many Parkinson’s patients.

[su_note note_color=”#ffbcba” radius=”6″]MEDICAL DISCLAIMER: All content found on this website were created for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician with any questions you may have regarding a medical condition.[/su_note]

Show 4 footnotes

  1. Infante ME et al. Outbreak of acute toxic psychosis attributed to Mucuna pruriens. Lancet 1990; 336:1129
  2. Bertoldi M, Gonsalvi M, Voltattorni CB. Green tea polyphenols: novel irreversible inhibitors of dopa decarboxylase. Biochem Biophys Res Commun 2001; 284:90-93.
  3. Kang KS et al. Dual beneficial effects of (-) epigallocatechin-3-gallate on levodopa methylation and hippocampal neurodegeneration: in vitro and in vivo studies. PLoS One 2010; 5(8):e11951. doi: 10.1371/journal.
  4. Guo S et al. Protective effects of green tea polyphenols in the 6-OHDA rat model of Parkinson’s disease through inhibition of ROS-NO pathway. Biol Psychiatry 2007; 62:1353-1362.

6 thoughts on “Mucuna pruriens – Contraindications and warnings”

  1. Excelente artículo educativo. Tengo a mi madre y a mi padre en cama con Parkinson (papá desde hace 15 años y mamá desde hace 9 años). Solo la extensa investigación y un pensamiento crítico mas la ayuda de un excelente neurólogo (especializado en Parkinson y Alzheimer) y una profunda conciencia de las ventajas y ventajas de la medicina y los tratamientos no ortodoxo son los mejores frentes para ayudarlos con altas dosis de buenos cuidos y comprensión.

    Por ejemplo. Cuando el paciente diga algo, no importa si no entiendes lo que dicen, simplemente actúa como si lo entendieras y usa respuestas que podrían aplicarse a cualquier pregunta. Hágales sentir que lo que dicen es importante y use el tono de su voz para hacerles creer que es importante de lo que dicen. Eso los hace felices porque evitan la frustración de ser mal entendidos. Haga preguntas cortas que puedan responderse con sí o no. Cuando les haga preguntas, espere pacientemente porque su cerebro es mucho más lento, pero no significa que su mente no puedan entender. Deje que respondan a su propio paso o tiempo y verá que están muy conscientes de lo que le está preguntando. Intenta ayudarlos a recordar viejos tiempos y buenos momentos. Mejor si puedes hacerlos sonreír.

    Si les trae bebidas de malta o pomelo, tenga en cuenta que ambos contienen un ingrediente que no los ayuda bien en la función cerebral. Tenga en cuenta que la alimentación enteral no es completa. Debe vigilar los bajos niveles de la sal y el azúcar, porque los pacientes generalmente carecen estos ingredientes.

    Esté atento a los niveles de hemoglobina. Los medicamentos extensivos disminuyen los niveles de hemoglobina de la sangre en silencio y cuando te das cuenta es demasiado tarde.

    cambie la posición en la cama cada 3 a 5 horas para evitar úlceras y use colchones de aire computarizados para prevenir las úlceras.

    El aceite de coco virgen orgánico prensado en frío podría ayudar al cerebro en pequeñas dosis mezcladas con alimentos si pueden comer por vía oral, pero tenga cuidado con la función renal. La molécula de aceite de coco es una molécula grande para el riñón en altas dosis y si el paciente ya tiene el riñón comprometido el aceite de coco está contraindicado.

    Hay muchas herramientas en medicina alternativa, pero deben ser manejadas por un verdadero profesional con ese conocimiento. Mejor si es un experto en ambos lados de los tratamientos, tradicional y ortodoxo.

    Si los pacientes usan clonazepam o cualquier medicamento similar, verifique a los pacientes cada hora para evitar que se asfixien boca abajo sobre la almohada. Se vuelven mientras duermen con medicamentos y podrían bloquear su respiración y terminar en un episodio asfixiante.

    Y lo mejor de todo. NO permita gente enferme cerca de ellos. Incluso un simple resfriado o gripe pueden matarlos prematuramente. Las enfermedades respiratorias son el peor enemigo de los pacientes en cama. Entonces, investigue con precaución, no creas todo pero no niegues las posibilidades. Traiga mucho amor al paciente, incluso si es difícil. Esconde tus malos sentimientos e intenta hacerlos reír dentro de su condición, dándoles comodidad y seguridad, es lo que mas necesitan.

    (Nota: esta semana me di cuenta de que también estoy sufriendo la enfermedad, pero soy estoico, no le tengo miedo a la muerte, así que disfrutaré cada minuto como si fuera el último) (también cuido de un hermano con TOC , depresión y ataques de pánico.) Entonces, quizás puedo saber algo sobre estas condiciones o temas.

    Reply
  2. Excellent educational article. I have my mother and my father on the bed with Parkinson (dad 15 years and Mom 9 years). Only the extensive critical thinking research, an excellent neurologist (specialized in Parkinson and Alzheimer) and a deep conscience of the pros and advantages of medicine and none orthodox treatment are the best fronts to help them with high doses of good loving care and understanding.

    For example. When they say anything, no matter if you don’t understand what they say, just act like you do and use responses that could be applied to any questions. Let them feel that what they say is important and use the tone of your voice to make them believe the importance of what they say. That makes them happy because they avoid the frustration of being misunderstood. Ask short questions that can be answered with yes or no. When ask them questions wait patiently because there brain is a lot slower but not means they cant understand. Let them answer as they can and you will see that they are aware of what you are asking. Try to help them remember old times and good moments. Better if you can make them smile.

    If you bring them malt beverage or grapefruit be aware that both contain an ingredient that doesn’t help them well on there brain function. Be aware that the enteral alimentation is not a complete one. You have to monitor salt and sugar because the patients usually lack of enough of these ingredients. be vigilant on hemoglobin levels. The extensive medications decrease the hemoglobin levels of the blood silently and when you became aware are just too late.

    Rotate every 3 to 5 hours on the bed to avoid ulcers and use computerized air matress to prevent ulcers.

    Organic Virgin Coconut oil cool pressed could help the brain in small doses mixed in food if they can eat by mouth but be cautious of kidney function. Coconut molecule of oil is a big molecule for the kidney in high doses and patients some time has already compromised kidney functions in which case coconut oil is contraindicated.

    There is a lot of tools in alternative medicine but have to be handled by a real professional on that’s knowledge. Better if is an expert on both sides of treatments, traditional and orthodox.

    If the patients use clonazepam or any medicine similar check the patients every hour to avoid the patients became suffocated by being face down on the pillow. They turn themselves while are on medication sleep and could block his respiration ending in an asphyxiating episode.

    And the best of all. DONT let people sick around them. Even a simple cold or flu can kill them prematurely. Respiratory illness are the worse enemy of bed patients. So, research with caution, don’t believe everything but don’t deny the possibilities. Bring a lot of love to the patient even if it’s hard. Hide your bad feelings and try to make them laugh inside their condition bringing them comfort and security, they needed more.

    (Note: this week I became aware that I’m suffering the illness too, but I am stoic, Not afraid to it or to death so I will enjoy every minutes like it is the last) (I also care of one brother with TOC, depression and Panic attacks. ) So maybe I could know something about these issues.

    Reply
  3. Wow, this info I needed badly.
    I am on stale vo and of the amantadine.
    Would my starting mucuna interfere with it?
    I have a problem with salicylates and glutamate.
    Multiple food and chemical allergies.

    Reply

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