Drug Information Directory

Patient information: Anaphylaxis symptoms and diagnosis

2010-08-12T09:54:00.000-07:00

ANAPHYLAXIS OVERVIEW — Anaphylaxis is a potentially deadly allergic reaction that is rapid in onset. It is most often triggered by foods, medications, and insect stings. There are many other possible triggers.

Anaphylaxis is an unpredictable condition. Many people who experience it have a known allergy and some have had one or more milder allergic reactions previously. Others, who are not even aware that they have an allergy, can suddenly experience severe anaphylaxis. Even the first episode of anaphylaxis can be fatal.

The severity of anaphylactic reactions can be minimized by recognizing the symptoms early, having proper medication available for self-treatment, and seeking emergency medical care promptly. This topic reviews the symptoms and diagnosis of anaphylaxis. Treatment and prevention of anaphylaxis are discussed separately. A separate topic discusses how to use an epinephrine autoinjector. (See "Patient information: Anaphylaxis treatment and prevention" and see "Patient information: Use of an epinephrine autoinjector").

ANAPHYLAXIS SYMPTOMS — Symptoms of anaphylaxis generally begin within minutes to an hour of exposure to a trigger. Less commonly, symptoms do not develop for several hours.

The most common symptoms of anaphylaxis are hives (urticaria) and swelling of the skin (angioedema), which occur in 80 to 90 percent of reactions. Respiratory symptoms occur in about 50 percent of reactions, and are especially common in people who also have asthma or another chronic respiratory disease. Extremely low blood pressure, causing lightheadedness, dizziness, blurred vision, or loss of consciousness (passing out) occurs in about 30 percent of reactions.

Anaphylaxis can cause symptoms throughout the body: Skin: Itching, flushing, hives (urticaria), or swelling (angioedema) Eyes: Itching, tearing, redness, or swelling of the skin around the eyes Nose and mouth: Sneezing, runny nose, nasal congestion, swelling of the tongue, or a metallic taste Lungs and throat: Difficulty getting air in or out, repeated coughing, chest tightness, wheezing or other sounds of labored breathing, increased mucus production, throat swelling or itching, hoarseness, change in voice, or a sensation of choking Heart and circulation: Dizziness, weakness, fainting, rapid, slow, or irregular heart rate, or low blood pressure Digestive system: Nausea, vomiting, abdominal cramps, or diarrhea Nervous system: Anxiety, confusion, or a sense of impending doom

A severe form of anaphylaxis causes sudden collapse without other obvious symptoms, such as hives or flushing. This form of anaphylaxis occurs most commonly after a person is given a medication into a vein or is stung by an insect.

Up to 20 percent of people with anaphylaxis have biphasic (two-phase) or protracted (prolonged) anaphylaxis. A person with biphasic anaphylaxis has a reaction that resolves and then recurs hours later without further exposure to the trigger. The late phase reaction usually occurs within eight hours, but may occur up to 72 hours after the initial symptoms. A person with protracted anaphylaxis has signs and symptoms that persist for hours or even days despite treatment, although this is rare.

ANAPHYLAXIS TRIGGERS — The trigger for a person's anaphylaxis may be obvious or it may be difficult to identify.

Common anaphylaxis triggers can include: Foods: In children, hen's eggs, cow's milk, peanuts, tree nuts, fish, wheat, and soy are the most common food triggers.

In teens and adults, peanuts, tree nuts, fish, and crustaceans (shellfish such as shrimp) are the most common triggers.

Any food, including fruits and vegetables, and some spices and food additives, can cause anaphylaxis. Medications, especially certain antibiotics (such as penicillin or amoxicillin), medications for pain and fever (such as aspirin or ibuprofen), some x-ray dyes (also called radiocontrast media), and others Venom from insects, including bees, hornets, wasps, and fire ants Latex from natural rubber, found in some latex gloves, balloons, condoms, sports equipment, and medical products Allergen immunotherapy ("allergy shots"), such as those given for the treatment of allergic rhinitis (hay fever) Exercise, either by itself, or after eating certain foods (eg, wheat, celery, seafood), medications (eg, aspirin), or exposure to cold air/water Less common triggers include exposure to airborne allergens (such as horse dander), human seminal fluid, and cold temperatures.

Sometimes a specific trigger cannot be identified, even after a thorough evaluation. This condition is called idiopathic anaphylaxis. (See "Patient information: Anaphylaxis treatment and prevention").

IgE mediated anaphylaxis — In most people, anaphylaxis is caused by the presence of proteins called immunoglobulin E (IgE) antibodies. IgE antibodies are normally produced in the body for the purpose of fighting certain infections. In people with allergies, however, IgE is made in response to non-infectious substances, such as foods, medications, or insect venoms. This IgE then sticks to the outside of mast cells and basophils, a type of white blood cell.

If a person with IgE antibodies to a specific allergen is exposed to that allergen again, the cells may suddenly become activated. The activated cells release large amounts of inflammation-causing chemicals (including histamine) into the blood stream, causing anaphylaxis.

The chemicals released from the cells cause the signs and symptoms typical of anaphylaxis. (See "Anaphylaxis symptoms" above). The allergic reaction can be so strong that it becomes life-threatening; for example, sudden severe swelling in the throat can lead to suffocation.

In some people with anaphylaxis, the reaction is caused by a process that does not involve allergens and IgE. However, the symptoms and treatment are the same.

ANAPHYLAXIS RISK FACTORS — Some people are more likely than others to experience anaphylaxis or to develop severe symptoms during anaphylaxis, for example, those who have one or more of the following: Previous sudden severe allergic reaction involving the whole body — People who have had allergic reactions to a particular substance in the past are at increased risk of anaphylaxis. However, the severity of past allergic reactions does not reliably predict the severity of future reactions; people with mild reactions in the past may experience severe anaphylactic reactions in the future. Asthma — People with asthma are more likely to have more severe respiratory problems during anaphylaxis. The combination of food allergy (especially to peanuts and tree nuts) and asthma seems to put people at risk for life-threatening episodes of anaphylaxis. Other diseases — People with chronic lung disease, especially older adults with chronic obstructive pulmonary disease (COPD) or emphysema, are at increased risk of complications during an anaphylactic reaction. People with coronary artery disease and other heart diseases are also at greater risk of developing complications during an anaphylactic reaction.

ANAPHYLAXIS DIAGNOSIS — The diagnosis of anaphylaxis is based upon symptoms that occur suddenly after being exposed to a potential trigger, such as a food, medication, or insect sting.

Is it anaphylaxis or another problem? — A number of other heath problems can cause symptoms that are similar to those of anaphylaxis. These include a severe asthma attack, a heart attack, a panic attack, or even food poisoning. Evaluation by a specialist can help to clarify the diagnosis.

Tryptase is a protein that is released into the blood during an anaphylactic reaction. An increased amount of tryptase can sometimes be measured in a blood sample collected during the first three hours after anaphylaxis symptoms have begun. Unfortunately, tryptase levels are normal in many people with anaphylactic reactions. For example, it is seldom elevated in food-induced anaphylaxis

Patient information: Allergy to penicillin and related antibiotics

2010-08-12T09:46:00.000-07:00

PENICILLIN ALLERGY OVERVIEW — Serious allergies to penicillin are common, with about 10 percent of people reporting an allergy. However, about 90 percent of people who believe they are allergic can take penicillin without a problem, either because they were never truly allergic or because their allergy to penicillin diminished and resolved over time.

People who have a remote history of allergic reaction to a medication may become less allergic as time passes. Only about 20 percent of people will be allergic to penicillin 10 years after their initial allergic reaction if they are not exposed to it again during this time period.

WHAT IS PENICILLIN? — Penicillin is one of the most commonly prescribed antibiotics. It is part of a family of antibiotics known as beta lactams. Penicillins can be classified into the following categories: Penicillin G (also known as benzylpenicillin) Anti-staphylococcal penicillins (nafcillin, oxacillin, cloxacillin and dicloxacillin) Broad spectrum penicillins

- Second generation (ampicillin, amoxicillin and related agents)
- Third generation (carbenicillin and ticarcillin)
- Fourth generation (piperacillin)

Anyone who is allergic to one of the penicillins is allergic to all penicillins. One of the major differences among the penicillins is the range of bacteria against which they are active. Penicillin G and the anti-staphylococcal penicillins treat a small number of specific bacteria. On the other hand, the second, third, and fourth generation penicillins are capable of treating a wide range of bacteria, and are therefore called "broad spectrum".

REACTIONS TO PENICILLIN — A variety of unexpected reactions can occur after taking penicillin.

Adverse reactions — "Adverse reaction" is the medical term for any undesirable reaction caused by a medication. Allergic adverse reactions are less common than non-allergic adverse reactions. Stomach upset and diarrhea are examples of non-allergic adverse reactions.

It is important to distinguish non-allergic adverse reactions from true allergic reactions. Some people report that they are allergic to penicillin when actually they have had a non-allergic side effect. As a result, the person may be treated for a particular infection with a less-effective or more toxic antibiotic. This can lead to antibiotic failure or resistance, which can be costly and prolong illness.

When reporting past problems with antibiotics, it is important to provide as much detail as possible about the reaction. Anyone who is uncertain if a past allergic reaction was truly caused by allergy should avoid the antibiotic until they have discussed the situation with their healthcare provider.

Rashes — Several different types of rashes can appear while people are taking penicillin. Rashes that involve hives (raised, intensely itchy spots that come and go over hours, show picture 1) suggest a true allergy.

However, some people, especially young children, can develop flat, blotchy rashes that spread over days but do not change by the hour (show picture 2). These rashes typically start after several days of treatment. This type of rash is less likely to indicate a dangerous allergy, although it can be difficult to distinguish between different types of rashes that occurred in the past. Taking a photograph of a rash is always helpful.

Allergic reactions — An allergic reaction occurs when the immune system begins to recognize a drug as something "foreign". Several different symptoms can indicate that a person is allergic to penicillin. These include hives (raised, intensely itchy spots that come and go over hours) (show picture 1), angioedema (swelling of the tissue under the skin, commonly around the face), wheezing and coughing from asthma-like reactions (narrowing of the airways into the lungs).

A past history of these types of reactions is important because the person might develop a more severe reaction, such as anaphylaxis, if they were to take the antibiotic again. Mild to moderate allergic reactions to penicillins are common, occurring in 1 to 5 percent of people.

Anaphylaxis — Anaphylaxis is a sudden, potentially life-threatening allergic reaction. Symptoms include those of an allergic reaction, as well as very low blood pressure, difficulty breathing, abdominal pain, swelling of the throat or tongue, and/or diarrhea or vomiting. Fortunately, anaphylaxis is uncommon. (See "Patient information: Anaphylaxis symptoms and diagnosis").

PENICILLIN ALLERGY TESTING — In some situations, it is necessary to determine with certainty if a person is allergic to penicillin. Testing for allergy is recommended in the following situations: People who have a suspected penicillin (or closely related antibiotic) allergy and require penicillin to treat a life-threatening condition for which no alternate antibiotic is appropriate. People who have frequent infections but have suspected allergies to many antibiotics, leaving few options for treatment. Penicillin skin testing is suggested for anyone with a history of penicillin allergy (when penicillin skin test solutions become commercially available again). Because 90 percent of people will test negative, this type of evaluation can decrease medical costs and reduce the use of unnecessarily strong (ie, broad-spectrum) antibiotics.

Penicillin skin testing does not provide any information about certain types of reactions. This includes anyone who has experienced a severe reaction with extensive blistering and peeling of the skin (Stevens-Johnson syndrome or toxic epidermal necrolysis), a widespread sunburn-like reaction that later peeled (erythroderma), or a rash composed of small bulls-eyes or target-like spots (erythema multiforme),
People with these types of reactions should never again be given the medication that caused the reaction. This applies to all situations since a second exposure could cause a severe progressive reaction and even death.

Skin testing — Skin testing is the most reliable method to determine the risk of a serious, sudden onset allergic reaction in a person with a history of allergy to penicillin.

Several different types of penicillin preparations are required for skin testing. These preparations can be manufactured commercially but are not currently available in the United States. Thus, the most reliable type of skin testing for penicillin allergy cannot be performed in the United States at this time. It is expected that the preparations will be available again within the next 12 to 24 months.

Until skin tests are available, options for people who may be allergic to penicillin include: Take an different antibiotic Undergo a challenge test (See "Challenge testing" below) Undergo desensitization (See "Penicillin desensitization" below)

Skin testing procedure — Skin testing should be done by an allergist in an office or hospital setting. Testing usually takes less than one hour to complete. The skin is pricked with weak solutions of the various preparations of penicillin and observed for a reaction. This may cause discomfort due to itching, but it is not painful. If there is no skin reaction, slightly stronger solutions are then used.

A positive skin reaction is an itchy, red bump that lasts about half an hour and then resolves. The testing is stopped if a skin reaction occurs since this indicates that the person is truly allergic.

If the patient completes the skin testing without a positive reaction, a single oral dose of full strength penicillin is commonly given. This confirms that the patient does not have an allergy to the medication. The oral dose is given since there is a very small risk of false negative results (when the skin test is negative although the person is actually allergic).

Interpreting results — Medical tests, including skin testing, are rarely 100 percent accurate. Most people with a positive penicillin skin test will experience an allergic reaction if given penicillin or a related antibiotic (as would be expected). However, 3 percent or less of people with a history of penicillin allergy and a negative skin test will experience an allergic reaction. These reactions are always mild, and anaphylaxis in this situation is rare.

If a person has a negative skin test and has no reaction to an oral dose of the antibiotic, no future precautions are necessary.

Challenge testing — Because skin testing is not currently available in many places, a healthcare provider may recommend a challenge test. However, this is only recommended if the person requires penicillin, no other antibiotic is available, and the chances of a true allergy are small (eg, last reaction was at least 10 years ago or allergic reaction symptoms not likely caused by true allergy). If the chances of a true allergy are high, desensitization is generally recommended.

Challenge testing is usually done in an office setting, starting with a very small dose of the antibiotic given by mouth. If the person tolerates the smallest dose, a larger dose is given every 30 to 60 minutes until he/she has signs of an allergic reaction or the full dose is given. If the person tolerates the full dose, he or she is not allergic to the antibiotic.

PENICILLIN DESENSITIZATION — Desensitization can be done for people who are truly allergic to penicillin but require treatment with it or a closely related antibiotic. Desensitization refers to a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction.

Technique — Desensitization can be performed with oral or intravenous medications, but should always be performed by an allergy specialist. There are different techniques for desensitization. Some patients undergo desensitization in an outpatient clinic under supervision while others are treated in an intensive care unit.

Limitations — While usually successful, desensitization has two important limitations. Desensitization does not work and must never be attempted for certain types of reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, erythroderma, and erythema multiforme). Desensitization also does not work for other types of immunologic reactions to antibiotics, such as serum sickness, drug fever, or hemolytic anemia. Desensitization is temporary. A person is unlikely to have an allergic reaction to the medication during treatment, after undergoing desensitization, as long as the antibiotic is taken regularly. However, once the antibiotic is stopped for more than 24 hours (times differ slightly for different medications), the person is again at risk for a sudden allergic reaction. Repeat desensitization is required if the same medication is needed again.

OTHER ANTIBIOTIC ALLERGIES — Reliable skin tests are not commercially available for some antibiotics. Thus, determining if a person has an allergy to these antibiotics is more difficult, and is mostly based on the history of the reaction. Skin testing with other antibiotics is sometimes performed, but the results are much less certain than those of penicillin testing.

Cephalosporins — Cephalosporins are a class of antibiotics closely related to penicillin. There are a number of cephalosporin medications available, a few of which include cephalexin (Keflex®), cefaclor (Ceclor®), cefuroxime (Ceftin®), cefadroxil (Duricef®) , cephradine (Velocef®). cefprozil (Cefzil®), loracarbef (Lorabid®), ceftibuten (Cedax®), cefdinir (Omnicef®), cefditoren (Spectracef®), cefpodoxime (Vantin®) and cefixime (Suprax®).

People with a history of penicillin allergy have a small risk of having an allergic reaction to cephalosporins. If possible, penicillin skin testing should be performed in these individuals. Since testing will be negative in about 90 percent of these people, a negative test will allow them to take cephalosporins safely. People with a positive skin test to penicillin have a small risk of an allergic reaction to cephalosporins and may require more caution in terms of how the cephalosporin is administered.

Allergic reactions to cephalosporins are less common than reactions to penicillin. In addition, skin testing to evaluate cephalosporin allergy is not as accurate as penicillin skin testing. If a cephalosporin is required, then there are several options: Take an different antibiotic Undergo a challenge test (See "Challenge testing" above) Undergo desensitization (See "Penicillin desensitization" above)

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Barbados Cherry

2010-08-02T23:22:00.000-07:00

The Barbados cherry, a member of the Malpighiaceae, is an interesting example of a fruit that rose, like Cinderella, from relative obscurity about 40 years ago. It was at that time the subject of much taxonomic confusion, having been described and discussed previously under the binomial Malpighia glabra L., which properly belongs to a wild relative inhabiting the West Indies, tropical America and the lowlands of Mexico to southern Texas, and having smaller, pointed leaves, smaller flowers in peduncled umbels, styles nearly equal, and smaller fruits. M. Punicifolia L. (M. glabra Millsp. NOT Linn.) has been generally approved as the correct botanical name for the Barbados cherry, which is also called West Indian cherry, native cherry, garden cherry, French cherry; in Spanish, acerola, cereza, cereza colorada, cereza de la sabana, or grosella; in French, cerisier, cerise de St. Domingue; in Portuguese, cerejeira. The name in Venezuela is semeruco, or cemeruco; in the Netherlands Antilles, shimarucu; in the Philippines, malpi (an abbreviation of the generic name).

Plate XXV: BARBADOS CHERRY, Malpighia punicifolia

Description

The Barbados cherry is a large, bushy shrub or small tree attaining up to 20 ft (6 m) in height and an equal breadth; with more or less erect or spreading and drooping, minutely hairy branches, and a short trunk to 4 in (10 cm) in diameter. Its evergreen leaves are elliptic, oblong, obovate, or narrowly oblanceolate, somewhat wavy, 3/4 to 2 3/4 in (2-7 cm) long, 3/8 to 1 5/8 in (9.5-40 mm) wide, obtuse or rounded at the apex, acute or cuneate at the base; bearing white, silky, irritating hairs when very young; hairless, dark green, and glossy when mature. The flowers, in sessile or short-peduncled cymes, have 5 pink or lavender, spoon-shaped, fringed petals. The fruits, borne singly or in 2's or 3's in the leaf axils, are oblate to round, cherry-like but more or less obviously 3-lobed; 1/2 to 1 in (1.25-2.5 cm) wide; bright-red, with thin, glossy skin and orange-colored, very juicy, acid to subacid, pulp. The 3 small, rounded seeds each have 2 large and 1 small fluted wings, thus forming what are generally conceived to be 3 triangular, yellowish, leathery-coated, corrugated inedible "stones".

Origin and Distribution

The Barbados cherry is native to the Lesser Antilles from St. Croix to Trinidad, also Curacao and Margarita and neighboring northern South America as far south as Brazil. It has become naturalized in Cuba, Jamaica and Puerto Rico after cultivation, and is commonly grown in dooryards in the Bahamas and Bermuda, and to some extent in Central and South America.

The plant is thought to have been first brought to Florida from Cuba by Pliny Reasoner because it appeared in the catalog of the Royal Palm Nursery for 1887-1888. It was carried abroad rather early for it is known to have borne fruit for the first time in the Philippines in 1916. In 1917, H.M. Curran brought seeds from Curacao to the United States Department of Agriculture. (S.P.I. #44458). The plant was casually grown in southern and central Florida until after World War II when it became more commonly planted. In Puerto Rico, just prior to that war, the Federal Soil Conservation Department planted Barbados cherry trees to control erosion on terraces at the Rio Piedras Experiment Station. During the war, 312 seedlings from the trees with the largest and most agreeably-flavored fruits were distributed to families to raise in their Victory Gardens. Later, several thousand trees were provided for planting in school yards to increase the vitamin intake of children, who are naturally partial to the fruits.

An explosion of interest occurred as a result of some food analyses being conducted at the School of Medicine, University of Puerto Rico, in Rio Piedras in 1945. The emblic (Emblica officinalis L.) was found to be extremely high in ascorbic acid. This inspired one of the laboratory assistants to bring in some Barbados cherries which the local people were accustomed to eating when they had colds. These fruits were found to contain far more ascorbic acid than the emblic, and, because of their attractiveness and superior eating quality, interest quickly switched from the emblic to the Barbados cherry. Much publicity ensued, featuring the fruit under the Puerto Rican name of acerola. A plantation of 400 trees was established at Rio Piedras in 1947 and, from 1951 to 1953, 238 trees were set out at the Isabela Substation. By 1954, there were 30,000 trees in commercial groves on the island. Several plantings had been made in Florida and a 2,000-acre (833-ha) plantation in Hawaii. There was a great flurry of activity. Horticulturists were busy making selections of high-ascorbic-acid clones and improving methods of vegetative propagation, and agronomists were studying the effects of cultural practices. Smaller plantings were being developed in Jamaica, Venezuela, Guatemala, Ghana, India, the Philippines and Queensland, Australia, and even in Israel. Many so-called "natural food" outlets promoted various "vitamin C" products from the fruits–powder, tablets, capsules, juice, sirup.

At length, enthusiasm subsided when it was realized that a fruit could not become a superstar because of its ascorbic acid content alone; that ascorbic acid from a natural source could not economically compete with the much cheaper synthetic product, inasmuch as research proved that the ascorbic acid of the Barbados cherry is metabolized in a manner identical to the assimilation of crystalline ascorbic acid.

The large plantation of the Hawaiian Acerola Company (a subsidiary of Nutrilite Products Company) was abandoned for this reason, and low fruit yields; and, so it is said, the low ascorbic acid content because of the high copper levels in the soil. Puerto Rican production was directed thereafter mainly to the use of the fruit in specialty baby foods.

Frozen fruits are shipped to the United States for processing.

Varieties

In 1956, workers at the University of Florida's Agricultural Research and Education Center in Homestead, after making preliminary evaluations and selections, chose as superior and named the 'Florida Sweet', a clone that was observed to have an upright habit of growth, large fruits, thick skin, apple-like, semi-sweet flavor, and high yield.

The first promising selections in Puerto Rico, on the bases of fruit size, yield and vitamin content, were identified as 'A-l' and 'B-17', but these were later found to be inferior to 'B-15' in ascorbic acid level and productivity. Yields of 10 clones ('A-l', 'A-2', 'A-4', 'A-10', 'A-21', 'B-2', 'B-9', 'B-15', 'B-17', and 'K-7') were compared over a 2-year period (1955-56) in Puerto Rico and 'B-15' far exceeded the others in both years.

A horticultural variety in St. Croix, formerly known as M. thompsonii Britton & Small, has displayed unusually large leaves and fruits and more abundant flowers than the common strain of Barbados cherry.

Climate

The Barbados cherry can be classed as tropical and subtropical, for mature trees can survive brief exposure to 28º F (-2.22º C). Young plants are killed by any drop below 30º F (-1.11º C). It is naturally adapted to both medium- and low-rainfall regions; can tolerate long periods of drought, though it may not fruit until the coming of rain.

Soil

The tree does well on limestone, marl and clay, as long as they are well drained. The pH should be at least 5.5. Elevation to 6.5 significantly improves root development. Acid soils require the addition of lime to avoid calcium deficiency and increase yield. The lime should be worked into the soil to a depth of 8 in (20 cm) or more.

Propagation

If seeds are used for planting, they should be selected from desirable clones not exposed to cross-pollination by inferior types. They should be cleaned, dried, and dusted with a fungicide. It should also be realized that the seeds in an individual fruit develop unevenly and only those that are fully developed when the fruit is ripe will germinate satisfactorily. Germination rates may be only 50% or as low as 5%. Seedlings should be transferred from flats to containers when 2 to 3 in (5-7.5 cm) high.

Air-layering (in summer) and side-veneer, cleft, or modified crown grafting are feasible but not popular because it is so much easier to raise the tree from cuttings. Cuttings of branches 1/4 to 1/2 in (6-12.5 mm) thick and 8 to 10 in (20-25 cm) long, with 2 or 3 leaves attached, hormone-treated and set in sand or other suitable media under constant or intermittent mist, will root in 60 days. They are then transplanted to nursery rows or containers and held in shade for 6 months or a year before being set out in the field. Some fruits will be borne a year after planting but a good crop cannot be expected until the 3rd or 4th year. The tree will continue bearing well for about 15 years. There is a lapse of only 22 days between flowering and complete fruit maturity.

Grafting is generally practiced only when cuttings of a desired clone are scarce or if a nematode-resistant rootstock is available on which to graft a preferred cultivar; or when top-working a tree that bears fruits of low quality.

Culture

The Barbados cherry tree will grow and fruit fairly well with little care. For best performance, Puerto Rican agronomists have recommended a fertilizer formula of 8-8-13 twice annually for the first 4 years at the rate of 1/2 to 1 lb (0.22-0.45 kg). Older trees should have 3 to 5 lbs (1.35-2.25 kg) per tree. In addition, organic material should be worked into the planting hole and also supplied in amounts of 10 to 20 lbs (4.5-9 kg) per tree. Under Florida conditions, a 10-10-10 formula is given in February, 1 lb (0.22 kg) for each year of growth. In May, July and September, a 4-7-5-3 formula is recommended, 1 lb (0.22 kg) for each year of age up to the 10th year. Thereafter, a 6-4-6-3 mixture is given–5 lbs (2.25 kg) per tree in late winter and 10 lbs (4.5 kg) per tree for each of the summer feedings. On limestone soils, sprays of minor elements–copper, zinc, and sometimes manganese–will enhance growth and productivity. Young trees need regular irrigation until well established; older trees require watering only during droughts. Mature plants will bear better if thinned out by judicious pruning after the late crop and then fertilized once more.

Pollination and Fruit Set

In Florida, bees visit Barbados cherry flowers in great numbers and are the principal pollinators. Maintenance of hives near Barbados cherry trees substantially improves fruit set. In Hawaii, there was found to be very little transport of pollen by wind, and insect pollination is inadequate. Consequently, fruits are often seedless. Investigations have shown that growth regulators (IBA at 100 ppm; PCA at 50 ppm) induce much higher fruit set but these chemicals may be too costly to buy and apply.

Season

In Florida, the Bahamas, Puerto Rico and Hawaii the fruiting season varies with the weather. There may be a spring crop ripening in May and then successive small crops off and on until December, but sometimes, if spring rains are lacking, there may be no fruits at all until December and then a heavy crop. In Zanzibar, the bearing season is said to be just the months of December and January.

Harvesting

For home use, as dessert, the fruits are picked when fully ripe. For processing or preserving, they can be harvested when slightly immature, when they are turning from yellow to red. As there is continuous fruiting over long periods, picking is done every day, every other day, or every 3 days to avoid loss by falling.

The fruits are usually picked manually in the cool of the early morning, and must be handled with care. For immediate processing, some growers shake the tree and allow the ripe fruits to fall onto sheets spread on the ground. Harvested fruits should be kept in the shade until transferred from the field, which ought to be done within 3 hours, and collecting lugs are best covered with heavy canvas to retard loss of ascorbic acid.

Yield

There is great variation in productivity. Individual trees may yield 30 to 62 lbs (13.5-28 kg) in Puerto Rico. In Jamaica, maximum yield in the 6th year is about 80 lbs (36 kg) per tree; 24,000 lbs/acre (24,000 kg/ha). Venezuelan growers have reported 10 to 15 tons/ha; the average in Puerto Rico is 25 tons/ha/yr. 'Florida Sweet' in Florida has yielded 65 tons/ha. A plot of 300 trees of 'Florida Sweet' has borne crops of 6,300 to 51,300 lbs (2,858-23,270 kg) of fruit from March to November, in Homestead, Florida.

In Puerto Rico, a planting of 200 trees may be expected to produce 3,600 to 5,400 lbs (1,636-2,455 kg) of juice. From the juice there can be extracted at least 120 lbs (54.5 kg) of vitamin C expressed as dehydroascorbic and ascorbic acid, providing the content is determined to be 2%. In Puerto Rico, it is calculated that 10 tons of fruit should yield 435 lbs (197 kg) ascorbic acid. In a commercial operation using ion-exchange resins, the yield of ascorbic acid from Barbados cherry juice is expected to be about 88%.

Keeping Quality

Ripe Barbados cherries bruise easily and are highly perishable. Processors store them for no more than 3 days at 45º F (7.22º C). Half-ripe fruits can be maintained for a few more days. If longer storage is necessary, the fruits must be frozen and kept at 10º F (-12.22º C) and later thawed for use. At one time it was believed that the fruits could be transported to processing plants in water tanks (as is done with true cherries) but it was discovered that they lose their color and ascorbic acid content in water.

At room temperature–85º F (29.44º C) in Puerto Rico–canned Barbados cherries and also the juice lose color and fresh flavor and 53% to 80% of their ascorbic acid content in one month, and metal cans swell because of the development of CO₂. Refrigeration at 44.6º F (7º C) considerably reduces such deterioration. Juice in the home refrigerator will lose 20% of its ascorbic acid in 18 days. Therefore, the juice and the puree should be kept no longer than one week.

Pests and Diseases

One of the major obstacles to successful cultivation of the Barbados cherry is the tree's susceptibility to the root-knot nematode, Meloidogyne incognita var. acrita, especially in sandy acid soils. Soil fumigation, mulching and regular irrigation will help to keep this problem under control. The burrowing nematode, Radopholus similis, is also a cause of decline in otherwise healthy trees.

In Florida, the foliage is attacked by wax scale, Florida mango scale, and other scale insects, whiteflies, a leaf roller, and aphids. In Guatemala, the aphid, Aphis spiraecola, attacks the leaves and young, tender branches. This pest and the Hesperid caterpillar, Ephyriades arcas, require chemical control. In Puerto Rico, the tree is often damaged by the blue chrysomelid of acerola, Leucocera laevicollis. Some fruits may be malformed but not otherwise affected by the sting of stinkbugs. None of these predators is of any great importance.

The major pest in Florida is the Caribbean fruit fly, Anastrepha suspensa, which seems to attack all but very sour fruits and the larvae are commonly found inside. In Guatemala, a fruit worm, Anthonomus florus, deposits its eggs in the floral ovary and also in the fruits; the larvae feed in the fruits causing deformity and total ruin. Drastic control measures have been employed against this predator, including the incineration of all fallen, infested fruits and the elimination of all related species that serve as hosts.

Few diseases have been reported. However, in Florida, there are cases of anthracnose caused by Colletotrichum gloeosporioides, and leafspotting by the fungus, Cercospora bunchosiae, is a serious malady in Florida, Puerto Rico and Hawaii. Green scurf, identified with the alga, Cephaleuros virescens, occurs in Puerto Rico.

Food Uses

Barbados cherries are eaten out-of-hand, mainly by children. For dessert use, they are delicious merely stewed with whatever amount of sugar is desired to modify the acidity of the particular type available. The seeds must be separated from the pulp in the mouth and returned by spoon to the dish. Many may feel that the nuisance is compensated for by the pleasure of enjoying the flavorful pulp and juice. Other-wise, the cooked fruits must be strained to remove the seeds and the resulting sauce or puree can be utilized as a topping on cake, pudding, ice cream or sliced bananas, or used in other culinary products. Commercially prepared puree may be dried or frozen for future use. The fresh juice will prevent darkening of bananas sliced for fruit cups or salads. It can be used for gelatin desserts, punch or sherbet, and has been added as an ascorbic acid supplement to other fruit juices. The juice was dried and powdered commercially in Puerto Rico for a decade until the cost of production caused the factory to be closed down.

The fruits may be made into sirup or, with added pectin, excellent jelly, jam, and other preserves. Cooking causes the bright-red color to change to brownish-red. The pasteurization process in the canning of the juice changes the color to orange-red or yellow, and packing in tin cans brings on further color deterioration. Enamel-lined cans preserve the color better.

Wine made from Barbados cherries in Hawaii was found to retain 60% of the ascorbic acid.

Food Value Per 100 g of Edible Portion*
Calories	59
Moisture	81.9-91.10 g
Protein	0.68-1.8 g
Ether Extract	0.19-0.09 g
Fiber	0.60-1.2 g
Fat	0.18-0.1 g
Carbohydrates	6.98-14.0 g
Ash	0.77-0.82 g
Calcium	8.2-34.6 mg
Phosphorus	16.2-37.5 mg
Iron	0.17-1.11 mg
Carotene	0.003-0.408 mg
(Vitamin A)	408-1000 I.U.
Thiamine	0.024-0.040 mg
Riboflavin	0.038-0.079 mg
Niacin	0.34-0.526 mg
Ascorbic Acid**

*According to analyses made in Hawaii, Guatemala, and elsewhere.

**According to analyses at the Massachusetts Institute of Technology of fruits grown in Barbados: 4,500 mg (green), 3,300 mg (medium-ripe), 2,000 mg (very ripe). The ascorbic acid level of unripe fruits can range up to 4,676 mg and such ratings are exceeded only by the fruits (rose hips) of Rosa rugosa Thunb., which may have as much as 6,977 mg/100 g. This constituent varies as much as 25% with the clone, the locale, cultural methods and degree of exposure to sunlight during developmental stages and after harvesting. At INCAP (Instituto de Nutricion de Central America and Panama), in Guatemala assays in 1950-1955 showed distressingly low levels–an average of 17 mg/100 g, whereas fruits sent to INCAP by air and in dry ice from Florida were analyzed and contained 1,420 mg/100 g. In field experiments, treatment of young fruits on the tree with 200 ppm gibberellic acid has brought about a marked increase in the ascorbic acid content of the mature fruits.

The ascorbic acid is not totally destroyed by heat, for the jelly may contain 499-1,900 mg/100 g. Of the total ascorbic acid in Barbados cherry juice, 0.18% is in the bound form. Other constituents include dextrose, levulose, and a little sucrose.

Harmful Effects

Physicians in Curacao report that children often require treatment for intestinal inflammation and obstruction caused by eating quantities of the entire fruits, including seeds, from the wild Barbados cherries which abound on the island.

People who pick Barbados cherries without gloves and long sleeves may suffer skin irritation from contact with the minute stinging hairs on the leaves and petioles.

Other Uses

Bark: The bark of the tree contains 20-25% tannin and has been utilized in the leather industry.

Wood: The wood is surprisingly hard and heavy. Trials have demonstrated that it refuses to ignite even when treated with flammable fluid unless perfectly dry.

Medicinal Uses: The fruits are considered beneficial to patients with liver ailments, diarrhea and dysentery, as well as those with coughs or colds. The juice may be gargled to relieve sore throat.

Black sugar maple

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Hard maple

A. nigrum Michx. f.

Source: Magness et al. 1971

Maple sugar and syrup are obtained from the sap of these two species and are solely products of the United States and Canada. The Indians were making crude syrups and sugar from maple sap before the coming of white men. The preparation of maple sugar and syrup is strictly a farm industry, occurring from Kentucky northwest to Iowa, northeast to Maine and north into Canada. Native stands of these maple species are tapped to obtain the dilute juice or sap. The trees are not a cultivated crop, although competing useless trees may be removed and maple stands may be thinned to promote better growth and sugar yield. Only a small proportion of the available trees of these species are actually tapped. It is estimated that more than 200 million such trees are growing in the United States, and less than 6 million are tapped.

The tapping is done by boring a small hole (under 0.5-inch diameter) horizontally into the tree so as to penetrate through the outer or sap wood. On large trees up to four such taps may be made at one time. Tapered spouts (hollow tubes) are driven into the holes to fit tightly, and the sap flows through this tube and is collected in sap buckets. it is important to protect the buckets and contents from rain water. Tapping is done in late winter, before bud break. During periods when temperatures are above freezing at this season sap flow is quite abundant, A tap hole usuallv produces 5 to 15 gallons of sap, though much more than that is sometimes obtained. Sugar content of the sap also varies widelv, from l0 to 30°Brix or higher.

Portable tanks of various types are used to collect the sap, which is poured into the tank through strainers. An alternative method is to use pipc lines to carry the sap to the evaporation equipment.

Originally a single open kettle over a fire was used to evaporate the excess water in the sap to produce syrup. Now multiple evaporators are mainly used, the syrup being transferred as it becomes more dense. Usually 2 or 3 transfers are made. Modem evaporating pans have flues in them through which the heat from the fuel passes to speed the process and codserve fuel. For standard-density syrup, concentration is to 65.5°Brix, which is about 86 percent solids by weight. If the sap tests 2.4°Brix, 34 gallons would be required to produce one gallon of syrup.

Slow evaporation--or longer heating time--in the final stages of concentration result in a darker colored syrup. More rapid evaporation at this stage gives a lighter colored, higher grade syrup. Sensitive thermometers are used to determine when the syrup is concentrated to the standard of 65.5 Brix. The completed syrup contains solid granules, mainly calcium malate, termed sugar sand. For toable syrup these must be removed. On the farm they may be allowed to settle out or are removed by filtering. Centrifuging is efficient if available.

To produce various types of maple sugar, the syrup is further heated and additional water driven off. If heated to a boiling point of 230°F. and cooled rapidly without stirring a solid cake is formed. Stirring during cooling results in crystal formation. For fine crystals the highly supersaturated solution is seeded with fine crystals and stirred rapidly, which results in rapid formation of great numbers of fine crystals.

Numerous products, as maple cream, or butters, soft-sugar candies, maple spread, and candies utilize maple syrup or sugar. Total maple syrup production in the United States averaged approximately 1,400,000 gallons, 1961-66, inclusive. This includes that made into sugar. In addition about 800,000 gallons of syrup and 5,145,000 pounds of sugar were imported annually from Canada during those years.

Cucurbit Resources in Namibia

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Namibia has several cucurbits with potential for development into commercial crops either through selection or through the introduction of genes into known crops. Acanthosicyos horrida Welw. ex J.D. Hook., wild Citrullus ecirrhosus Cogn., and C. lanatus (Thunb.) Matsum. & Nakai in the Cucurbitaceae are examples of gene sources. The areas from which these plants come are arid and the plants derive their water needs from dew precipitation in the mornings, very occasional rains every few years, and deep ground water (Seely l987; Lovegrove 1993).

ACANTHOSICYOS HORRIDA

Acanthosicyos horrida forms clumps of vegetation in the dunes of the Sossuvlei region near Walvis Bay (Fig. 1) (Craven and Marais 1986; Lovegrove 1993; Klopatek and Stock 1994). Acanthosicyos horrida is a dioecious perennial cucurbit attaining a height of about 1.5 m (Fig. 2). It forms plants of one sex in single clumps which may touch plants of the same or other sex nearby (Fig. l). It bears deep water table seeking roots (G. Wardell–Johnson, pers. commun. 1998). The plants are totally leafless (Fig. 2) and have a fruiting habit of oblong spherical fruits reaching up to 25 cm average diameter. The plants are able to build up sand deposits around themselves and continuously grow to be above these sand deposits. New plants establish only when rain falls and quickly form deeply growing roots that seek the water table (G. Wardell–Johnson, pers. commun. 1998).


Fig. 1. View of Acanthosicyos horrida in sand dunes at the Sossuvlei region near Walvis Bay Namibia.	Fig. 2. A close up of Acanthosicyos horrida plants. Note the leaflessness.

The fruit may not be spaced apart and may occur in clusters of several touching each other. The fruits are spiny (Fig. 3). Maturation of the fruits occurs between February and April. The fruits do not change color and remain green on the outside but the flesh surrounding the seeds dissociates from the skin, turns orange in color (Fig. 4), extremely sweet in taste and strongly aromatic. Maturational changes are easily detected by the bushmen living in the area without breaking the fruit in any way. The fruits are used by the bushmen for two main purposes. The first is for the extraction of the seed which are consumed as pips by splitting in the mouth and the second is for pulp processing where the flesh is boiled and poured to form a fruit leather. This fruit leather is eaten throughout the year and is considerably less flavorful than the pulp. The plant thus forms an important food resource because of the easy storage of both the seeds and the dried pulp (leather). The fruits are eaten also when immature by animals including jackals and rodents who do not seem to be bothered by the bitter taste of the fruits caused by cucurbitacins (Hylands and Magd 1986).


Fig. 3. Back of a mature fruit of Acanthosicyos horrida showing the large spines on the surface of the fruit. The distances separating the spines are small in young fruits.	Fig. 4. Cross section through three fruits of Acanthosicyos horrida. The one on the extreme right is a bitter immature fruit of full size. The one on the top an almost mature fruit with only a little bitterness. The bottom left hand fruit a fully mature fruit with a flesh having an orange color, no bitterness and very aromatic in flavor.

The mature pulp has a flavor which is aromatic and maybe due in part to sulphur components as in some types of Cucumis melo L. No trace can be tasted of cucurbitacins in the mature pulp. The pulp could be commercialized and used to make ice-cream, and could be freeze dried and chocolate coated. The seeds which are already sold to an European population in Walvis Bay can have their market expanded by selling the seeds either whole or dehusked in packaging developed for nuts. Their rarity should provide a premium price and help the economic existence of the bushmen in this area. Ice-cream manufacture and freeze drying facilities are only within 30 km of the bushmen. Partnerships with firms interested in commericalizing the unique, aromatic pulp of Acanthosicyos horrida could be fostered to further improve the economic existence of the native people in the area.

CITRULLUS ECIRRHOSUS

Citrullus ecirrhosus is a desert perennial (Fig. 5, 6) which is monoecious. Fruits mature (Fig. 7, 8) February to March. The leaves form an annual stems which die back each year. The leaves have a special feature where the lamina is curved over the mid-rib and the lateral veins so that when viewed from above the top surface is only visible in the vein regions and the leaves have a greenish white appearance due to the lower epidermis being reflected up as the upper surface of the leaf. This lower epidermis is covered with warts and hairs which account for the whitening effect. Both lower and upper epidermis contain similar amounts of stomata. The water relations of this plant are reliant on a deep water layer in the ground which the roots reach and possibly some water availability from morning fogs and the very occasional rainfall. The fruit and seeds contain cucurbitacins but the seeds are harvested in times of need and processed by crushing and decantation to remove the bitter substances. Citrulls ecirrhosus plants may be a source of drought tolerance genes for Citrulls lanatus. Successful crossability of Citrulls ecirrhosus and C. lanatus is discussed in Navot and Zamir (1986) and Navot et al. (1990). They have shown the way for breeding Citrullus lanatus containing genes from C. ecirrhosus.


Fig. 5. Citrullus ecirrhosus perennial plant growing approximately 20 km inland from Walvis Bay, showing a mature fruit on current years growth and brown dead stems from last years growth.	Fig. 6. Citrullus ecirrhosus perennial plant showing young developing fruit in the foreground and the bending of the leaves over the mid-rib and lateral veins.


Fig. 7. Mature Citrullus ecirrhosus showing folded nature of the leaves of the mid-rib and lateral veins.	Fig. 8. Fruit of Citrullus ecirrhosus cut showing white creamy flesh which is non juicy and brown seeds.

Fig. 9. Citrullus lanatus mature fruit from a plant growing on a dry river bed approximately 20 km inland from Walvis Bay, cut to show chlorophyll in the flesh and browny-black seeds. The more deeply colored regions of the flesh are green. The flesh is more juicy than in Citrullus ecirrhosus.

CITRULLUS LANATUS

Citrullus lanatus wild plants seen near Walvis Bay have green fleshed fruit unknown from domesticated watermelons (Fig. 9). The genetics of fruit color in the watermelon, Citrullus colocynthis and ecirrhosus are discussed by Navot et al. (1990). White, yellow, orange, pink, red, and crimson flesh types are known. The green flesh color of this wild Citrullus lanatus (Fig. 9) is a unique feature which can be transferred to domestic watermelon due to the crossability of wild and domestic watermelons. This would offer a new fruit type for consumers to enjoy. A red flesh cultivated watermelon from the north of Namibia has some green zone within the fruit suggesting that the green flesh character can be easily introduced. However, the wild watermelon has cucurbitacins which would render them unfit for human consumption. Drought tolerance and green flesh color from C. ecirrhosus and wild Citrullus lanatus, could be valiable traits for watermelon improvement.

REFERENCES

Craven, P. and C. Marais. 1986. Namib Flora Swakopmund to the Giant Welwitschia via Goanikontes. Gamsberg MacMillan Publishers: Windhoek. p. 80–83.
Hylands, P.J and M.S. Magd. 1986. Cucurbitacins from Acanthosicyos horridus. Phytochemistry 25:1681–1684.
Klopatek J.M. and W.D. Stock. 1994. Partitioning of nutrients in Acanthosicyos horrida, a keystone endemic species in the Namib Desert. J. Arid Environments 26:233–240.
Lovegrove, B. 1993. The living deserts of Southern Africa. Fernwood Press, Vlaeberg, South Africa. p. 30, 47, 71, 158, 190.
Navot, N. and D. Zamir. 1987. Isozyme and seed protein phylogeny of the genus Citrullus (Cucurbitaceae). Plant Syst. Evol. 156:61–68.
Navot, N., M. Sarfatti, and D. Zamir. 1990. Linkage relationships of genes affecting bitterness and flesh colour in watermelon. J. Hered. 81:162–165.
Seely, M. 1986. The Namib. Shell Namibia: Namibia. 2nd ed. 19, 43–45, 50, 84, 90.

Acacia seyal Del.

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Uses

According to some Biblical scholars, the Shittah tree is mentioned in the Bible only once (I will plant in the wilderness... the Shittah tree. Isaiah 41), but its wood is referred to many times as shittium, which is the plural of shittah in Hebrew. Some even speculate that it was only natural that Moses should turn to shittium when he came to build the Ark of the Covenant and the Tabernacle and needed beams and timber. No one can really be sure which species of Acacia was meant. Wood is white to yellow-brown, finely-striated with dark lines, coarse-grained, soft, easy to work, polishes well, but discolors eastly with mold and is susceptible to insect attack. Ancient Egyptians made coffins, some still intact, from the wood. Nigerians used sapling stems, or also the roots for spear shafts. Tree also yields a gum of good quality, inferior to that of A. senegal. Systematic tapping has produced a product of better color and taste. Bark contains tannin and yields a red liquid extract. The gum is said to be edible. The leaves are important for forage and the wood for fuel where the trees are abundant. In parts of Africa the tree is important for livestock, natives driving their animals to where it is common and lopping off branches for them, both leaves and young pods being eaten. The pods are sold, especially for fattening sheep. The tree is believed to provide the best firewood in Chad, and the best fodder in Sahelian savannas (NAS, 1980a; Duke, 1983a).

Folk Medicine

The gum is believed to be aphrodisiac. The bark decoction Is used for dysentery and leprosy. Tanganyikans use the bark as a stimulant in tropical Africa. The gum is used as emollient and astringent for colds, diarrhea, hemorrhage and ophhthalmia. Mixed with Acacia sieberana DC, it is used for intestinal ailments on the Ivory Coast. Wood used as a fumigant for rheumatic pains, and to protect puerperal mothers from colds and fevers. Eating the gum is supposed to afford some protection against bronchitis and rheumatism (Duke, 1983a).

Chemistry

This species has been reported to contain 18–20% tannin.

Description

Tree 3–12 m tall, crown flat-topped; bark powdery, white to greenish-yellow or orange-red; sparsely branched, the branches horizontal or ascending; young branchlets with sparse hairs or almost glabrous, with numerous reddish sessile glands; epidermis of twigs becoming reddish and shed annually; leaves often with a large gland on petiole and between the top 1–2 pairs of pinnae; stipules spinescent, up to 8 cm long, ant-galls present or absent; pinnae usually 3–7 pairs, the leaflets in 11–20 pairs, 3–8 cm long, 0.75–1 mm wide, sparingly ciliolate or glabrous; lateral veins invisible beneath; flowers bright yellow, in axillary, pedunculate heads 10–13 mm across, borne on terminal or short lateral shoots of current season; involucel in lower half of peduncle 2–4 mm long; apex of bracteoles rounded to elliptic, sometimes pointed; calyx 2–2.5 mm long, puberulous in upper part; corolla 3.5–4 mm long, glabrous outside; pods 7–20 cm long, 0.5–0.9 cm in diameter, dehiscent, falcate, constricted between seeds, glabrous except for sessile glands, 6–9-seeded; seeds elliptic, 7–9 mm long, 4.5–5 mm wide, compressed, minutely wrinkled, olive-brown to olive; areole 5–6 mm long, 2.5–3.5 mm wide.

Germplasm

Species has several botanical varieties. The two main ones are: A. seyal var. fistula (Schweinf.) Oliv. (A. fistula Schweinf.), is white-barked with some pairs of spines fused at base into 'ant-galls', 0.8–3 cm in diameter, grayish or whitish, often marked with sienna-red and with longitudinal furrows down center, more or less 2-lobed. Found in Zambia, Malawi, and Mozambique. A. seyal var. multijuga Schweinf. ex Baker f. (A. stenocarpa Oliv., pro partem), a shrub or tree, usually less than 5 m tall, sometimes up to 13 m, flattened crown; bark on main stem greenish-brown, peeling in papery rolls; bark on branchlets red-brown, thorns straight, weak, usually less than 2.5 cm long, sometimes absent; pinnae 4–12 pairs, leaflets 10–20 pairs; flowers golden-yellow; pod narrow-linear, strongly curved, up to 10 cm long, 0.6 cm wide, dehiscing on tree. Common in overgrazed pastures and widely distributed in East Africa. Hybrids, A. seyal var. fistula X A. xanthophloea Benth., are known from woodlands on black clay loams on flood plains in Malawi. Pods are conspicuously irregular, 4–11 cm long, 6–10 mm wide, ill-formed and curved. Assigned to the Africa Center of Diversity, shittim wood or cultivars thereof is reported to exhibit tolerance to high pH, heavy soil, insects, mycobacteria, poor soil, salt, savanna, slope, and waterlogging. (2n= 26.)

Distribution

Native to the Sahelian Zone from Senegal to Sudan, it also occurs in Egypt and eastern and southern Africa, from Somalia to Mozambique and Namibia (NAS, 1980a).

Ecology

Trees thrive in Sclerocarya caffra woodlands, wooded grasslands and especially on seasonally flooded black-cotton soils along water courses. Requires a heavy clay-alluvium, but will grow on stony ground at base of hills. Grows at 20–2,100 m altitude. A gregarious savanna tree, ranging from Subtropical Desert to Dry through Tropical Desert to Very Dry Forest Life Zones, shittim wood is reported to tolerate annual precipitation of 8.7–22.8 dm (mean of 7 cases = 15.0 dm), annual mean temperature of 18.7–27.8°C (mean of 7 cases = 24.0°C) and pH of 5.0–8.0 (mean of 5 cases = 6.9).

Cultivation

Propagated from scarified seed. large cuttings are said to strike root readity in moist soils.

Harvesting

Pods, bark or wood are harvested in season from trees or shrubs in native habitats. Gum also obtained from native plantings, in manner similar to that for other gum arabic plants.

Yields and Economics

Gum and other products of some local importance in East Africa, but do not enter international trade.

Energy

The dense wood is highly prized for firewood, in areas where few other plants survive. Considered one of the best firewoods in Chad, it is used in the Sudan to make fragrant fires over which women perfume themselves.

Biotic Factors

Following fungi reported on this plant: Fomes rimosus, Ganoderma lucidum, Leveillula taurica, Ravenelia volkensii, Trametes meyenii, and Uromyces schweinfurthii. Although the plant is reportedly resistant to insect attacks, felled logs may be severely damaged by wood borers.

References

Duke, J.A. 1983a. Medicinal plants of the Bible. Trado-Medic Books, Owerri, NY.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.

Acacia tortilis (Forsk.) Hayne

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Syn.: Acacia raddiana Savi,
Acacia spirocarpa Hochst. ex A. Rich
Acacia heteracantha Burch.
Mimosaceae
Umbrella Thorn, Israeli Babool

Source: James A। Duke. 1983. Handbook of Energy Crops. unpublished.

Uses

Since this is one of the few timber species of the Arabian deserts, it is suspected as being the wood from which the Biblical Ark of the Tabernacle was made. Kaplan (1979) says rather emphatically it is the Shittim of the Bible, which provided the Israelites with the large-size timbers for the Ark. The timber is also used for fenceposts, firewood, furniture, and wagonwheels. The prolific pods made good fodder for desert grazers and the foliage is also palatable, being one of the major dry season fodder trees for the Sahara-Sahelian belt. Bark, used for string in Tanganyika. Gum used as a poor man's gum arabic, said to be edible. It is the tree most recommended for reclaiming dunes in India and Africa (Roy et al, 1973). The thorny branches are used to erect temporary cages and pens. Bark said to be a good source of tannin (Roy et al, 1973). Africans once strung the pods into necklaces. Senegalese use the roots for spear shafts, Lake Chad natives use the stems for fish spears. African nomads often use the flexible roots for frameworks of their temporary shelters.

Folk Medicine

While I find few data specific to this species, I suspect that the gum is used like that of gum arabics in folk remedies. In French Guinea, the bark is used as a vermifuge and dusted onto skin ailments (Dalziel, 1937).

Chemistry

Pods contain close to 19% protein (Palmer and Pitman, 1972). NAS (1979) reports unconfirmed allegations that the foliage can be toxic to livestock. Certainly HCN has been reported in several Acacias. The following tables are reproduced, with permission, from FAO's Tropical Feeds (1981):

Nutritive tables (Gohl, 1981)

		As % of dry matter
	DM	CP	CF	Ash	EE	NFE	Ca	P	Ref.
Fresh leaves, South Africa		19.2	11.6	8.7	6.1	54.4	2.27	0.17	213
Pods, South Africa		17.3	24.8	5.7	3.1	49.1	0.79	0.34	213
Seeds, South Africa		37.8	10.9	5.9	6.0	39.7	0.56	0.73	213
Pod husks, South Africa		8.7	34.3	6.2	1.6	49.2	1.10	0.14	213

Acacia tortilis (Forsk.) Hayne subsp. heteracantha (Burch.) Brenan

		As % of dry matter
	DM	CP	CF	Ash	EE	NFE	Ca	P	Ref.
Fresh leaves, Sudan	90.9	13.3	9.4	9.6	8.3	59.4	4.00	0.15	64
Pods, Tanzania		12.3	22.4	5.6	1.8	57.9	0.98	0.24	166
Pods, Kenya		17.8	17.5	8.4	1.7	54.6	1.34	0.36	129

		Digestibility (%)
	Animal	CP	CF	EE	NFE	ME	Ref
Pods	Cattle	46.2	42.0	74.0	76.6	2.30	166

Acacia tortilis (Forsk.) Hayne subsp. spirocarpa (Hochst. ex A. Rich) Brenan

Description

Medium umbrella-shaped tree 4–15 m tall, often with several trunks, reduced to a small wiry shrub less than 1 m tall under extremely arid conditions. Two types of thorns abound (1) long, straight, and white, and (2) small, hooked, and brownish. Leaves up to 2.5 cm long with 4–10 pairs of pinnae, each with ca 15 pairs of minute leaflets. Flowers white, aromatic, in small clusters. Pods flat, glabrose, coiled into a spring-like array.

Germplasm

Reported from North African and Middle Eastern Centers of Diversity, Umbrella Thorn, or cvs thereof, is reported to tolerate alkalinity, drought, heat, sand, slope, and stony soils. It seems to be more frost tolerant than Prosopis juliflora, still plants less than 2 years old are easily damaged by frost. Four subspecies are known in different ecological zones: subspecies tortilis—Sahel, Middle East; subspecies raddiana—Sudan, Middle East, Sahel(2n=104); subspecies spirocarpa—Eastern Africa, Sudan; and subspecies heteracantha—Southern Africa (2n= 52). The different subspecies seem to have different ecological tolerances, which is important to consider when choosing a subspecies for plantations. (2n= 52, 104)

Distribution

Native to much of Africa and the Middle East, this species has been introduced in many arid parts of the world. Ironically, it grows faster in the Rajastan Desert of India, where used for charcoal, firewood, and fodder, than in its native Israel (Kaplan, 1979). In Malawi, this species is already scorned by the rural public because it is thorny and difficult to work with. It is being tried for fencings (Nkaonja, 1980).

Ecology

Deemed the most promising of 56 Acacia species tried at Jodhpur, India. Probably ranging from Subtropical Desert to Dry through Tropical Desert Scrub to Very Dry Forest Life Zones, umbrella tree is reported to tolerate annual precipitation of 1 to 10 dm, estimated annual temperature of 18 to 28°C, and pH of 6.5 to 8.5. This species tolerates hot, arid climates with temperatures as high as 50°C subspecies raddiana grows where minimum temperatures are close to 0°C. It is best adapted to the lowlands. It thrives where rainfall is up to 1,000 mm. However, it is also extremely drought resistant and can survive in climates with less than 100 mm annual rainfall with long, erratic dry seasons. The tree favors alkaline soils. It grows fairly well in shallow soil, less than 0.25 m deep, though it develops long lateral roots that can become a nuisance in nearby fields, paths, and roadways. In shallow soil, the plants remain shrubby and must be widely spaced to allow for their lateral root growth.

Cultivation

For good seed germination, seeds should be treated with concentrated sulphuric acid for 30 minutes (Roy et al, 1973). Artificial regeneration aiming at large-scale nursery production requires full use of the germination capacity of the available seeds. This may be achieved by sulfuric acid pretreatment, which brings about the germination of all viable seeds. Treatment with boiling water is selective and mainly breaks the dormancy of bruchid-infested seeds, some of which are no longer able to germinate. Sowing of unripe seeds without pretreatment may be called for as an emergency measure in case of very severe infestation, to achieve at least partial success. Prior to storage, seeds should be fumigated to arrest progressing deterioration of seed viability by bruchids (Karschon, 1975). NAS (1980a) recommends dipping the seed in hot water to soak overnight. Seedlings require initial weeding to facilitate faster growth. Plantations can be spaced at 3 x 3 m.

Harvesting

Firewood harvested as needed, but 10-year rotations are suggested. In Jodhupr, flower initiation is ca May-June in 3-year old trees, fruits forming in July but ripening from November through February. Since the tree coppices well, there is no need to replant after every harvest.

Yields and Economics

Eleven-year old trees in deep sandy soils at Jodhpur averaged 6.4 m tall and 14 cm DBH. In shallow sandy loams over hardpan at Pali, India, 7-year old trees (98% survival) averaged 4.8 m tall, and 10 cm DBH. In sanddunes at Barmer, India, 5-year old trees averaged 3 m tall, 7 cm DBH. An average tree yields 6 kg pods of which 2.6 kg is clean seed. One tree is said to yield 14–18 kg pods and leaves per year in India (Muthana and Arora, 1980). Acacia tortilis has been reported to yield giraffe forage at 5 MT/ha/yr.

Energy

A 12-year-old plantation in India yielded 54 MT fuel , suggest, annual returns of 4.5 MT, not a bad return for the desert (NAS, 1980a). The heartwood has calorific value of 4,400 kcals/kg, making superior firewood and charcoal. It is one of the main firewood and charcoal sources in parts of Africa, e.g. around Khartoum. Nitrogen-fixing nodules are reported in South Africa and Zimbabwe.

Biotic Factors

Bruchids often damage or destroy the seeds, on the tree or after collecting. Herbivores, tame and wild alike, are liable to graze seedlings and innovations. Trees attacked by beetles, mimosoid blights, and caterpillars. The wood is susceptible to termites. In Tanzania, elephants which eat the bark are wiping out some park populations. In Israel, the native Acacias host several species (>40) of mostly monophagous insects, whereas on one exotic, Australian Acacia saligna, only a few polyphagous species occur (Halperin, 1980). Only Microcerotermes diversus and Kalotermes flavicollis, which feed on woody parts of both Acacias and Apate monachus (a beetle which tunnels the stems and branches, causing them to collapse in windblow), may seriously damage the tree. In nature, regeneration and spread of Acacias are probably limited by bruchids destroying much of the seed crop. Seedlings from natural regeneration may come from damaged seeds with a still intact embryo axis, since seedcoat dormancy is removed by the effect of exit holes permitting rapid water absorption and germination. Intact seeds with hard impermeable seedcoats may require a long time to germinate, and probably function as a reserve to ensure the survival of the species (Karschon, 1975).

References

Dalziel, J.M. 1937. The useful plants of west tropical Africa. The Whitefriars Press, Ltd., London and Tonbridge.
Gohl, B. 1981. Tropical feeds. Feed information summaries and nutritive values. FAO Animal Production and Health Series 12. FAO, Rome.
Halperin, J. 1980. Forest insects and protection in the arid zones of Israel. J. Israel For. Assoc. 30(3/4):68–72.
Kaplan, J. 1979. Some examples of successful use of Acacia for afforestation. J. Israel For. Assoc. 29(3/4):63–64.
Karschon, R. 1975. Seed germination of Acacia raddiana Savi and A. tortilis Rayne as related to infestation by bruchids. Ag. Res. Org. Leaflet 52. Bet Dagan.
Muthana, K.D. and Arora, G.D. 1980. Performance of Acacia tortilis (Forsk) under different habitats of the Indian arid zone. Ann. Arid Zone 19(1/2):110–118.
N.A.S. 1979. Tropical legumes: resources for the future. National Academy of Sciences, Washington, DC.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Nkaonja, R.S.W. 1980. Dryland afforestation problems in Malawi. J. Israel For. Assoc. 30(3/4):100–105.
Palmer, E. and Pitman, N. 1972. Trees of Southern Africa. 3 vols. A.A. Balkemia, Cape Town.
Roy, A.D., Kaul, R.N., and Gyanchand. 1973. Israeli babool a promising tree for arid and semiarid lands.

Acacia saligna (Labill.) H.Wendl

2010-08-02T23:16:00.001-07:00

Uses

Orange wattle is an extremely rugged tree, adaptable to barren slopes, derelict land, and exceptionally arid conditions in Australia and North Africa. It grows rapidly and is used for reclaiming eroded hillsides and wastelands and for stabilizing drift sands as well as for fuel. This is one of the best woody species for binding moving sand. It is useful for windbreaks, amenity plantings, beautification projects, and roadside stabilization in semiarid regions. The leaves, or phyllodes, are palatable to livestock when fresh or dried into hay, especially used as supplementary feed for sheep and goats. Crushed seeds have been fed to sheep without ill effects. Regrowth of established bushes is so good that Acacia saligna can be completely grazed off without harming the plants. The damaged bark exudes copious amounts of a very acidic gum that seems to show promise for use in pickles and other acidic foodstuffs (NAS, 1980).

Folk Medicine

No data observed.

Chemistry

Natal-grown bark contains up to 30.3% tannin compared to 19.1–23.0 at the Cape. The plant has given negative test for HCN.

Description

Dense, bushy shrub, usually 2–5 m tall; may grow treelike to 8 m tall with a single main stem (diameter to 30 cm). In spring its usually drooping branches are clad in beautiful and abundant yellow flowers (NAS, 1980a).

Germplasm

Reported from the Australian Center of Diversity, orange wattle, or cvs thereof, is reported to tolerate alkalinity, drought, heavy soil, poor soil, salinity, salt spray, sand, shade, slope, waterlogging, and weeds. (2n = 26)

Distribution

Acacia saligna is native to the southwestern corner of western Australia. It was introduced to South Africa in the 1840s in an attempt to stabilize the shifting sand dunes. It has also been planted in Uruguay, Mexico Israel, Iran, Iraq, Jordan, Syria, Greece, Cyprus, and North African countries (NAS, 1980a).

Ecology

Acacia saligna can grow throughout the tropical and the warm temperate regions of the world (NAS, 1980a). In its native habitat, the summer temperature ranges from about 23°–36°C, winter temperatures from 4°–9°C. The plant does not withstand frost and grows best where the winter and summer means are between 13° and 30°C respectively. Grows from near sea level to about 300 m, with isolated occurrences at higher elevations. Particularly drought hardy, it grows where annual rainfall is as low as 250 mm, though it probably does better with 350–600 mm. It grows well where annual rainfall is as high as 1,000 mm. Grows mainly on sandy, coastal plains, but is found from swampy sites and riverbanks to small, rocky hills (often granitic) and coastal slopes. It occurs on poor acid or calcareous sands, under the most dry and adverse soil conditions, in moderately heavy clays and a range of podzols (NAS, 1980a).

Cultivation

Seeds germinate readily; young plants can often be found under mature trees in the hundreds. Seedlings are easily raised in a nursery and established in the field. This species develops root suckers and coppices freely. Seeds are normally treated with boiling water, but nicking the seed coat, soaking in sulfuric acid, and exposing the seeds to dry heat are also effective (NAS, 1980a).

Harvesting

In Mediterranean countries, the fuelwood from this species is harvested on a coppice rotation system of 5–10 years (NAS, 1980).

Yields and Economics

Acacia saligna grows quickly, often reaching up to 8 m tall with a spread as great as its height in just 4 or 5 years. In very dry situations, growth rate is slower. Annual yields vary from 1.5 to 10 m³ per ha, depending on site. Because of its hardiness and profuse reproductive abilities, Acacia saligna has become a serious menace in parts of South Africa by invading and displacing indigenous vegetation. It infests water courses (sometimes decreasing the water available for irrigation), and has proved difficult to eradicate (NAS, 1980a).

Energy

Plantations for fuel have been established in some Mediterranean countries. But, according to one report from South Africa, the wood is "sappy, light, and not a popular fuelwood." The plant can withstand some shade and can be grown as an understory beneath pines or eucalypts in energy plantations or village fuel and fodder areas (NAS, 1980a). The annual litterfall of four Acacia species naturalized in the South African Cape, comprising 60% foliage and 30% reproductive structures, averages 7 MT/ha, double the value expected in evergreen scrub communities in winter rainfall regions.

Biotic Factors

Acacia saligna supports a diverse and abundant range of herbivores that cause damage to the plant. Among pests cited are Icerya purchasi (Hemiptera) and Euproctis fasciata (Lepidoptera) (NAS, 1980a) and Meloidgogyne sp. (Nematoda)

References

N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.

Acacia senegal (L.) Willd.

2010-08-02T23:16:00.000-07:00

Syn.: Acacia verek Guill. et Perr.
Mimosaceae
Gum Arabic, Senegal Gum, Sudan Gum Arabic, Kher, Kumta

Source: James A। Duke. 1983. Handbook of Energy Crops. unpublished.

Uses

Tree yields commercial gum arabic, used extensively in pharmaceutical preparations, inks, pottery pigments, water-colors, wax polishes, and liquid gum; for dressing fabrics, giving lustre to silk and crepe; for thickening colors and mordants in calico-printing; in confections and sweetmeats. Causing partial destruction of many alkaloids including atropine, hyoscyamine, scopolamine, homatropine, morphine, apomorphine, cocaine, and physostigmine, gum arabic might be viewed as a possible antidote. Pharmaceutically used mainly in the manufacture of emulsions and in making pills and troches (as an excipient); as demulcent for inflammations of the throat or stomach and as masking agent for acrid tasting substances such as capsicum; also as a film-forming agent in peel-off masks. Its major use is in foods, for example, as suspending or emulsifying agent, stabilizer, adhesive, flavor fixative, and to prevent crystallization of sugar, etc. Used in practically all categories of processed foods (candy, snack foods, alcoholic and nonalcoholic beverages, baked goods, frozen dairy desserts, gelatins, and puddings, imitation dairy products, breakfast cereals, and fats and oils). Use levels range from less than 0.004% (40 ppm) in soups and milk products, 0.7 to 2.9% in nonalcoholic beverages, imitation dairy, and snack foods, to as high as 45% in candy products (Leung, 1980). Strong rope made from bark fibers. White wood used for tool handles, black heartwood for weaver's shuttles. The long flexible strands of surface roots provide one of the strongest of local fibers, used for cordage, well-ropes, fishing nets, horsegirdles, footropes, etc. Seeds are dried and preserved for human consumption (NAS, 1980). Young foliage makes good forage. Plants useful for afforestation of arid tracts, soil reclamation, and windbreaks (Duke, 1981a). In modern pharmacy, it is commonly employed as a demulcent in preparations designed to treat diarrhea, dysentery, coughs, throat irritation, and fevers. It serves as an emulsifying agent and gives viscosity to powdered drug materials; is used as a binding agent in making pills and tablets and particularly cough drops and lozenges. Because of its enzyme, the gum is not suitable for use in products having readily oxidizable ingredients. For example, it reduces the vitamin A content of cod liver oil by 54% within three weeks. It is incompatible with aminopyrine, morphine, vanillin, phenol, thymol, a- and b-naphthol, guiacol, cresols, creosol, eugenol, apomorphine, eserine, epinephrine, isobarbaloin, gallic acid, and tannin; also with strongly alcoholic liquids, solutions of ferric chloride and lead subacetate and strong solutions of sodium borate. It was formerly given intravenously to counteract low blood pressure after hemorrhages and surgery and to treat edema associated with nephrosis, but such practices caused kidney and liver damage and allergic reactions and have been abandoned (Morton, 1977).

Folk Medicine

The demulcent, emollient gum is used internally in inflammation of intestinal mucosa, and externally to cover inflamed surfaces, as burns, sore nipples and nodular leprosy. Also said to be used for antitussive, astringent, catarrh, colds, coughs, diarrhea, dysentery, expectorant, gonorrhea, hemorrhage, sore throat, typhoid, urinary tract (Duke and Wain, 1981).

Chemistry

Gum acacia contains neutral sugars (rhamnose, arabinose, and galactose), acids (glucuronic acid and 4-methoxyglucuronic acid), calcium, magnesium, potassium, and sodium. Its complex structure is still not completely known. Its backbone chain consists of D-galactose units, and its side chains are composed of D-glucuronic acid units with l-rhamnose or l-arabinose as end units. The molecular weight has been reported to be between 200,000 to 300,000 and as high as 600,000 (Leung, 1980).

Toxicity

Ingested orally, acacia is nontoxic. However, some people are allergic to its dust and develop skin lesions and severe asthmatic attacks when in contact with it. Acacia can be digested by rats to an extent of 71%; guinea pigs and rabbits also seem to utilize it for energy, as does man to a certain extent. Gum arabic may actually elevate serum or tissue cholesterol levels in rats (Leung, 1980).

Description

Savanna shrub or tree, up to 20 m tall, over 1.3 m in girth, spiny; bark gray to brown or blackish, scaly, rough; young branchlets densely to sparsely pubescent, soon glabrescent, crown dense; stipules not spinescent; prickles just below the nodes, either in threes up to 7 mm long, with the middle one hooked downwards and the lateral ones curved upwards, or solitary with the laterals absent; leaves bioinnate, up to 2.5 cm long; leaf-axis finely downy with 2 glands; pinnae 6–20 pairs; leaflets small, 7–25 pairs, rigid, leathery, glabrous, linear to elliptic-oblong, ciliate on margins, pale glaucous-green, apex obtuse to subacute; flowers in spikes 5–10 cm long, not very dense, on peduncles 0.7–2 cm long, normally produced with the leaves; calyx bell-shaped, glabrous, deeply toothed; corolla white to yellowish, fragrant, sessile; pod straight or slightly curved, retrap-shaped, 7.5–18 cm long, 2.5 cm wide, thin, light brown or gray, papery or woody, firm, indehiscent, glabrous, 5–6-(-15) seeded; seeds greenish-brown. Fl. Jan.–Mar.; fr. Jan.–Apr., July, Aug. or Oct. (Duke, 1981a).

Germplasm

Tree with a single central stem and a dense flat-topped crown, bark without any papery peel, rough, gray or brown, with pubescent, rarely glabrous inflorescence, and pods variable in size, rounded to somewhat pointed but not rostrate or acuminate at apex. Variety rostrata Brenan is a shrub, branching at or close to base, or a small tree, with a single stem, 1–6 m tall, with dense flattened crown, bark normally with a flaking papery peel, creamy-yellow to yellow-green or gray-brown, inflorescence axis always pubescent and pods 2–3.5 times as long as wide, rostrate or acuminate at apex. Variety leiorhachis Brenan, is always a tree with central stem, and rounded or irregular with straggling branches; bark with conspicuous yellow papery peel, and inflorescence axis always glabrous. Variety pseudoglaucophylla occurs on fixed sand duned in Africa. Assigned to the African Center of Diversity, gum arabic is reported to exhibit tolerance to alkali, drought, fire, high pH, poor soil, sand, slope, and wind. (2n=26) (Duke, 1981a)

Distribution

Widespread in tropical Africa from Mozambique, Zambia to Somalia, Sudan, Ethiopia, Kenya, and Tanzania. Cultivated in India, Nigeria, and Pakistan.

Ecology

Thrives on dry rocky hills, in low-lying dry savannas, and areas where annual rainfall is 25–36 cm. This hardy species survives many adverse conditions, and seems to be favored by low rainfall and absence of frost. Ranging from Warm Temperate Thorn through Tropical Thorn to Tropical Dry Forest Life Zones, gum arabic is reported to tolerate annual precipitation of 3.8–22.8 dm (mean of 9 cases = 12.4 dm), annual mean temperature of 16.2–27.8°C (mean of 9 cases 23.8°C), and pH of 5.0–7.7 (mean of 7 cases = 6.4), but Cheema and Qadir (1973) report 7.4–8.2.

Cultivation

In Sudan, trees are cultivated over a very large area. Best propagated from seeds which are produced once every few years, grown in Sudan, in special "gum gardens." Elsewhere, it is collected from wild trees. In Pakistan, the best period for afforestation is the early monsoon season (Apr.–Jun.). Surface sowing is recommended in mildly alkaline sandy soils. Plants can also be reproduced by shoot cuttings. Trees coppice well (NAS, 1980).

Harvesting

Gum exudes froin cracks in bark of wild trees, mostly in the dry season, with little or none in the rainy season when flowers are out. In some areas, a long strip of bark is torn off and the gum allowed to exude. In Africa, it is regularly tapped from trees which are about 6 years old by making narrow transverse incisions in bark in February and March. In about a month, tears of gum form on surface and are gathered. Trees begin to bear between 4–18 years of age and are said to yield only when they are in unhealthy state due to poor soil, lack of moisture or damaged. Attempts to improve conditions tend to reduce yield. Gum from wild trees is variable and somewhat darker colored than that from cultivated plants. Collected gum is carefully freed of extraneous matter, sorted and sometimes ripened in sun before export. Gum arabic is oderless with a bland taste, yellowish and some tears are vermiform in shape. Ripened or bleached gum occurs in rounded or ovoid tears over 2.5 cm in diameter, and in broken fragments. Tears are nearly white or pale yellow and break readily with a glassy fracture. Gum is almost completely soluble in an equal volume of water and gives a translucent, viscous, slightly acid solution, but is insoluble in 90% alcohol. Kordofan (Sudan) Gum is yellow or pinkish, has fewer cracks and is more transparent (Duke, 1981a).

Yields and Economics

Annual yields from young trees may range from 188 to 2856 g (avg. 900 g), from older trees, 379 to 6754 g (avg. 2,000 g). Gum arabic is important export product for some areas in tropical Africa and Mauritania. From Africa some genuine gum is shipped to India then to Europe and America. Between 1940 and 1950, United States imports range from 3,179–8,989 MT (Duke, 1981a) Morton (1977) reports >11,000 MT more recently.

Energy

Considered the best firewood in Mauritius and Senegal, this is not a big yielder, annual running 0.5–5 m³/ha wood, with an energy value of ca 3,500 kcal/kg. A nitrogen,fixing species, it can be used to reestablish vegetation cover in degraded areas, as well as for sand-dune fixation and wind erosion control (NAS, 1980a).

Biotic Factors

Fungi reported on this crop are Cladosporium herbarum, Fusarum sp., Ravenelia acaciae-senegalae and R. acaciocola. Many insect visitors mimic the plant, the buffalo treehopper, Stictocephala bisonia, being a good example. Spiders (Cyclops sp.) may completely cover the young growing apex. Seedlings are often grazed by gazelles, goats, and pigs (Morton, 1977).

References

Cheema, M.S.Z.A. and Qadir, S.A. 1973. Autecology of Acacia senegal (L.) Willd. Vegetatio Vol. 27(1–3):131–162.
Duke, J.A. 1981a. Handbook of legumes of world economic importance. Plenum Press. NewYork.
Duke, J.A. and Wain, K.K. 1981. Medicinal plants of the world. Computer index with more than 85,000 entries. 3 vols.
Leung, A.Y. 1980. Encyclopedia of common natural ingredients used in food, drugs, and cosmetics. John Wiley & Sons. New York.
Morton, J.F. 1977. Major medicinal plants. C.C. Thomas, Springfield, IL.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.

New Arid Land Ornamentals

2010-08-02T23:15:00.000-07:00

Over the past decade, water conservation has become an increasingly important issue across the southwestern United States. This concern has led local horticulturists and landscape architects to explore the use of water-thrifty ornamentals from dry climates throughout the world. The Chihuahuan and Sonoran deserts in particular have yielded a vast array of successful landscape plants. Universities, growers, and plant enthusiasts have all participated in the collection, propagation, evaluation, and promotion of new plant introductions. A group of recent proven introductions, including trees, shrubs, ground covers, and perennials are included below with information on their origins, growth habits, cultural requirements, and potential uses in the landscape.

Acacia redolens Maslin, Desert Carpet^TM

Native to inland areas of Western Australia, Acacia redolens Maslin has been used extensively in southern California and Arizona to cover large areas inexpensively. Seedlings of Acacia redolens vary widely in their growth habits, often reaching heights in excess of 1.8 m (6 feet). The Desert Carpet™ clone was selected from the first Phoenix freeway plantings for its prostrate growth habit, and was released by Mountain States Wholesale Nursery in 1984. Since that time, this groundcover has performed consistently on many projects, and years after installation has maintained a height of only 0.6 m (24 inches). One plant can spread to a width of 3.6 m (12 feet), although we have observed that the cutting-grown Desert Carpet™ plants are slower to establish and reach their mature size than seedlings. The slower growth rate and prostrate nature of this clone should reduce maintenance costs, since pruning is not necessary to control vertical growth. Instead of true leaves, Acacia redolens has thick, leathery, gray-green phyllodes. This plant blooms in the spring with small yellow flowers. Freeway acacia will tolerate low temperatures of –11.1° to –9.4°C (12°–15°F), alkaline and slightly saline soils, and does not seem to be choosy about soil types. In coastal areas it requires little or no supplemental irrigation, but does require regular irrigation in hot desert regions. Desert Carpet^TM seems to be disease and pest free.

Baccharis hybrid 'Starn' (P.P.A.F.) Thompson^TM

When Dr. Tommy Thompson and Dr. Chi Won Lee of the University of Arizona released Baccharis hybrid 'Centennial', it filled a great void in our plant palette. Their research has been carried on, and now the improved Thompson™ clone is available. Since Baccharis 'Centennial' is a female plant, it has two undesirable characteristics. First, it produces pappus, or white "fluff," which litters the landscape and reduces the esthetic appearance of the plants for a short period of time. Also, since 'Centennial' is a female plant, it can be pollinated by nearby male Baccharis sarothroides Gray (Desert broom), and seedlings often result. This is why you sometimes see stands of 'Centennial' with taller Baccharis plants growing up through them. The Thompson^TM clone is a male plant, eliminating these two negative characteristics. Also, Thompson^TM was selected from the next generation after 'Centennial', and has 25% more Baccharis sarothroides for heat and disease resistance. The growth habits and uses of these two clones are essentially the same: both grow to about 0.9 m (3 feet) tall by 1.2–1.5 m (4-5) feet wide, are evergreen with bright green foliage and inconspicuous flowers, and provide a low-maintenance, long-lived alternative for difficult locations.

Cercidium species 'Desert Museum'

This hybrid palo verde is a three-way cross between Parkinsonia aculeata L., Cercidium microphyllum (Torr.) Rose & I.M. Johnst., and Cercidium floridum Benth. ex Gray, and seems to combine the best qualities of all three plants. 'Desert Museum' grows very rapidly to 6.1 m (20 feet) tall and wide in 3 to 5 years, after which it needs little or no irrigation. It is completely thornless, and produces very little litter, with few seed pods. It has a sturdy, upright growth habit which requires very little pruning or staking. It blooms over a long period of time, with the heaviest bloom from about mid-March to May 1. It also tends to bloom again in June and August. The yellow flowers are larger than any of its three "parents." It does not reseed like the messy Parkinsonia aculeata!

Chilopsis linearis (Cav.) Sweet, Lucretia Hamilton^TM

Desert willow trees occur along washes throughout the southwestern US and northern Mexico. This small deciduous tree has narrow, light green leaves that give it a weeping appearance. In the summer, the tree is covered with fragrant, trumpet-shaped flowers. In the wild, the flower colors range from white to purple, although a pale pink to lavender flower color is the most common. The Lucretia Hamilton^TM clone was selected for its intense, deep pink to purple flower color, as well as its small stature. While many desert willow trees can grow to 7.6 m (25 feet) tall and wide, this clone seems to stay below 5.4–6.1 m (18-20 feet) tall and wide. After flowering, long narrow seed pods are produced. Plant Chilopsis linearis in full sun and well-drained soil, and in regions where temperatures do not drop below –17.8°C (0°F).

Chrysactinia mexicana Gray (Damianita)

This small, compact shrub grows to 0.6 m (2 feet) tall and wide, and bears a very strong resemblance to turpentine bush, with needle-like green leaves and yellow daisy-like flowers. However, damianita blooms from March to September, while turpentine bush blooms from September to November. Combining the two plants would be a great way to prolong the color display! Damianita has wonderful-smelling foliage, and would be a great selection for sensory gardens. Damianita is a very tough, durable plant, tolerating extreme heat and cold, down to –17.8°C (0°F). Plant in full sun, and almost any soil. If this plant starts to look woody, prune it back severely in the early spring. Damianita ranges from New Mexico to west Texas and northeastern Mexico, at elevations of 609–2134 m (2000–7000 feet).

Dalea capitata Sierra Gold^TM

This well-behaved ground cover grows to about 20 cm (8 inches) tall by 0.9 m (3 feet) wide. Because of its compact size, Sierra Gold^TM is a good selection for tight planting areas, such as small planters or medians. Its fine-textured, light green foliage has a fresh, lemony scent. Rabbits seem to avoid it! Yellow flowers carpet Sierra Gold^TM in the spring and the fall. This plant is hardy to at least –15°C (5°F), but it will be deciduous at –3.9°C (25°F). The one drawback to this plant is that the whiteflies seem to like it, so some insecticide applications will be necessary in heavily infested areas around Phoenix. Plant in full sun for best results. No soil amendments should be necessary. In hot desert regions this plant requires some supplemental irrigation from spring to fall. Although most dales native to Arizona and Mexico tend to rot out if overwatered, we have observed this plant thriving right next to turfgrass, where it receives heavy irrigation. More testing is needed to determine if it will tolerate coastal areas, or regions with high rainfall.

Dasylirion longissimum

This user-friendly accent plant is a great selection for high-traffic areas such as walkways and near entries. This grasslike plant does well in containers, and its symmetrical form provides a striking focal point. Its thin, stiff green leaves are completely unarmed, and have smooth edges. Eventually, its single trunk can grow to 1.8 m (6 feet), topped by a 1.5 m- (5-foot-) wide rounded head of leaves. The older, bottom leaves can be trimmed off to expose the trunk. Dasylirion longissimum is native to Mexico, and is hardy to about –8.3°C (17°F).

Euphorbia biglandulosa Desf. (Gopher Plant)

This evergreen perennial or subshrub has a very unusual form and appearance. Its arching stems angle out and up, and can reach a length of 0.6 m (2 feet). The plant grows to 0.9 m (3 feet) tall by 1.2 m (4 feet) across; with narrow, fleshy grey-green leaves. Broad clusters of chartreuse flowers occur at the tips of the arching stems, usually in the late winter and early spring. Flowers are followed by small brown seed pods that explode upon ripening. The stems usually die back after fruiting, leaving a small clump of grey-green foliage near the ground. Plant Euphorbia biglandulosa in full sun or light shade, in a well-draining soil. It is cold hardy to –15°C (5°F).

Hesperaloe parviflora (Torr.) J. Coult., 'Yellow' (Yellow yucca)

A clumping perennial with long, gray-green leaves, Hesperaloe parviflora grows slowly to form a grasslike clump 1.0–1.2 m (3–4 feet) tall and wide. From spring through fall, it produces 1.5 m- (5-foot-) tall flower spikes. Red-flowering plants have been a staple in southwestern landscapes for many years. This is simply a yellow-flowering selection. Use this tough accent plant in full sun. Since it also tolerates reflected heat, yellow yucca is a reliable plant to use along sidewalks, in parking lots, etc. Tolerant of temperature extremes, yellow yucca is cold-hardy to at least –17.8°C (0°F). Once established, it requires little or no irrigation. All in all, yellow yucca is one of the toughest and most maintenance-free plants.

Hymenoxys acaulis (Pursh) K. Parker (Angelita Daisy)

This perennial is native to the southwestern US, where it occurs most often at elevations from 1219–2134 m (4000–7000 feet), on dry rocky slopes and mesas. Angelita daisy bears a strong resemblance to Baileya multiradiata Harv. & A. Gray ex Torr. (desert marigold). However, the foliage is green rather than gray, and the flower is a deeper gold color. Forming rounded clumps to fifteen inches tall and wide, Hymenoxys acaulis is a wonderful plant to use as a border in front of larger shrubs. I f water is available, it will naturalize in the landscape. In Phoenix, this plant blooms all year, with especially heavy bloom in the spring and fall months. This prolonged bloom period results in many dried flower stalks, which can make the plants look scruffy. We recommend cutting off the old flower spikes occasionally to rejuvenate the plant and initiate new flower production. Angelita daisy seems to prefer well-drained soils and full sun. It is very cold hardy, heat tolerant, and drought tolerant.

Leucophyllum candidum I.M. Johnst. Thunder Cloud^TM

As with all of the other Leucophyllum species, this clone blooms when the humidity is high. The silver, pubescent foliage is a perfect foil for the masses of indigo flowers that appear in the summer and fall months. Thunder Cloud^TM was selected and trademarked by Benny Simpson of Texas A&M University. His clone is highly valued because of its small, dense growth habit. Unlike most of the larger Leucophyllum species, Thunder Cloud^TM remains reliably small, to three feet tall and wide. This plant is cold hardy to at least –12.2°C (10°F). Plant all of the Leucophyllum species in full sun and well-drained soil. Avoid overwatering.

Leucophyllum langmaniae Rio Bravo^TM

Trademarked by Mountain States Nursery, this clone has a nice, compact growth habit very similar to L. frutescens 'Compacta'. Rio Bravo^TM has become very popular because of its bright green foliage and rounded, dense form. It has lavender flowers and will eventually grow to 1.5 m (5 feet) tall and wide. Like the L. candidum species, it requires well-drained soils and full sun. It is hardy to –12.2°C (10°F).

Muhlenbergia capillaris (Lam.) Trin. Regal Mist^TM

We feel that this ornamental grass shows great promise for many different regions of the country. Native to humid southeastern Texas, this grass has adapted extremely well to the hot, dry conditions of deserts in Arizona and Nevada. In fact, it has performed incredibly well in Las Vegas, which is cursed with poor soils, high winds, high summer temperatures, and cold winters. Regal Mist^TM is also happy in heavy soils, with ample irrigation. In short, it has worked everywhere it has been tried, so far! It is hardy to at least –17.8°C (0°F). Regal Mist^TM has narrow, dark green, glossy leaves. It grows quickly to form a rounded clump to 0.9 m (3 feet) tall and wide. The flower spikes on this grass have attracted a lot of attention... they form misty masses of pink to purple flowers in October and November. We recommend cutting this plant back in early spring to cut off the dead flower spikes and any dormant foliage.

Penstemon species

There are so many wonderful Penstemon species to try in the garden, that is difficult to select just a few. Most of the penstemons are perennials with a basal rosette of foliage, which send up spikes of tubular flowers in the spring and early summer. They add incredible color to the landscape, and attract hummingbirds as well! Penstemons come in a wide range of colors, including blue, purple, pink, and red. After they finish blooming, allow the flower spikes to dry on the plant. Then cut off the spikes and sprinkle the seed in the garden to increase next year's mass of color. There are two new species to try: Penstemon triflorus Heller, which has short, 46 cm (18 inch) spikes of dark pink-purple flowers which occur along the stem in clusters of three; and Penstemon clevelandii Gray, native to southern and Baja California, with spikes of clear, bright pink flowers to 0.6–0.8 m (2–2.5 feet) tall.

Acacia nilotica (L.) Del

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Uses

Some feel that the thorn bush of Exodus 3 was Acacia nilotica, the fire, the parasite Loranthus acaciae. Inner bark contains 18–23% tannin, used for tanning and dyeing leather black. Young pods produce a very pale tint in leather, notably goat hides (Kano leather). Pods were used by the ancient Egyptians. Young bark used as fiber, twigs esteemed for tooth brushes (chewsticks). Trees tapped for gum arabic. The gum arabic is still used in making candles, inks, matches, and paints (NAS, 1980). Tender pods and shoots used as vegetable, and used as forage for camels, sheep and goats, especially in Sudan, where it is said to improve milk from these animals. Seeds are a valuable cattle food. Roasted seed kernels, sometimes used for flavoring and when crushed provide the dye for black strings worn by Nankani women. Trees used in Sudan for afforestation of inundated areas. Sapwood is yellowish-white, heartwood reddish-brown, hard, heavy, durable, difficult to work, though taking a high polish. Because of its resins, it resists insects and water, and trees are harvested for the timber for boat-making, posts, buildings, water-pipes, well-planking, plows, cabinet-work, wheels, mallets and other implements. Wood yields excellent firewood and charcoal (Duke, 1981a). The aqueous extract of the fruit, rich in tannin (18–23%) has shown algicidal activity against Chroccoccus, Closteruim, Coelastrum, Cosmarium, Cyclotella, Euglena, Microcystis, Oscillatoria, Pediastrum, Rivularia, Spirogyra, and Spirulina (Ayoub, 1983).

Folk Medicine

Zulu take bark for cough, Chipi use root for tuberculosis. Masai are intoxicated by the bark and root decoction, said to impart courage, even aphrodisia, and the root is said to cure impotence. Astringent bark used for diarrhea, dysentery, and leprosy. Bruised leaves poulticed onto ulcers. According to Hartwell, the gum or bark is used for cancers and/or tumors (of ear, eye, or testicles) and indurations of liver and spleen, condylomas, and excess flesh. Said also to be used for cancer, colds, congestion, coughs, diarrhea, dysentery, fever, gallbladder, hemorrhage, hemorrhoids, leucorrhea, ophthalmia, sclerosis, smallpox, and tuberculosis. Bark, gum, leaves, and pods used medicinally in West Africa. Sap or bark, leaves, and young pods are strongly astringent due to tannin, and are chewed In Senegal as antiscorbutic; in Ethiopia as lactogogue. Bark decoction drunk for intestinal pains and diarrhea. Other preparations used for coughs, gargle, toothache, ophthalmia, and syphilitic ulcers. In Tonga, the root is used to treat tuberculosis. In Lebanon, the resin is mixed with orange-flower infusion for typhoid convalescence. Masai use the bark decoction as a nerve stimulant. In Italian Africa, the wood is used to treat smallpox. Egyptian Nubians believe that diabetics may eat unlimited carbohydrates as long as they also consume powdered pods (Duke, 1983a). Extracts are inhibitory to at least four species of pathogenic fungi (Umalkar et al, 1976).

Chemistry

Babul has been reported to contain l-arabinose, catechol, galactan, galactoaraban, galactose, N-acetyldjenkolic acid, N-acetyldjenkolic acid, sulphoxides pentosan, saponin, tannin. Seeds contain crude protein 18.6%, ether extract 4.4%, fiber 10.1%, nitrogen-free extract 61.2%, ash 5.7%, and silica 0.44%. Phosphorus 0.29% and calcium 0.90% of DM. When bullocks were given the seeds and bran (2:1) with dry pasture grass daily DM intakes were 1.82, 0.91, and 5.35 kg respectively. Total DM intake/100 kg bodyweight was 1.40 kg. The animals retained 20.8 g N and 7.4 g Ca daily but the P balance was slightly negative (Pande et al, 1981). Walker (1980) puts the CP content of the browse at 12.9%, the crude fiber at 15.2%

Description

Small tree, 2.5–14 m tall, quite variable in many aspects; bark of twigs not flaking off, gray to brown; branches spreading, with flat or rounded crown; bark thin, rough, fissured, deep red-brown; branchlets purple-brown, shortly or densely gray-pubescent, with lenticels; spines gray-pubescent, slightly recurved, up to 3 cm long; leaves often with 1–2 petiolar glands and other glands between all or only the uppermost pinnae; plnnae 2–11 (-17) pairs; leaflets 7–25 (-30) pairs, 1.5–7 mm long, 0.5–1.5 mm wide, glabrous or pubescent, apex obtuse; peduncles clustered at nodes of leafy and leafless branchlets; flowers bright yellow, in axillary heads 6–15 mm in diam.; involucel from near the base to about half-way up the peduncle, rarely somewhat higher; calyx 1–2 mm long, subglabrous to pubescent; corolla 2.5–3.5 mm long, glabrous or pubescent outside; pods especially variable, linear, indehiscent, 8–17 (-24) cm long, 1.3–2.2 cm broad, straight or curved, glabrous or gray-velvety, turgid, blackish, about 12-seeded; seeds deep blackish-brown, smooth, subcircular, compressed, areole 6–7 mm long, 4.5–5 mm wide. Fl. Oct.–Dec.; fr. Mar.–June (Duke, 1981a).

Germplasm

Acacia nilotica var. kraussiana (Benth.) Brenan is the most common form in east tropical Africa. Young branches more or less densely pubescent; pods not necklace-like, 1–1.8 cm wide, oblong, more or less pubescent all over at first with raised parts over seeds becoming glabrescent, shining and black when dry, margins shallowly crenate. Exhibits wide range of altitudinal and habitat requirements. Found in Botswana, Zambia, Rhodesia, Malawi, Tanzania, Angola, Mozambique, Transvaal, and Natal. A. nilotica var. tomentosa A. F. Hill (A. arabica var. tomentosa Benth.), has pods straight, constricted between seeds and densely tomentose; found in Senegal and northern Nigeria, to Sudan, Arabia and India. A. nilotica var. adansonii (Guill. et Perr.) Kuntze is a tree up to 17 m with dark reddish-brown bark deeply fissured, tomentose, reddish-brown twigs and gray fruits; commonest variety in West Africa, from Senegal to Nigeria and widespread in northern parts of Tropical Africa. Assigned to the African Center of Diversity, babul or cvs thereof is reported to exhibit tolerance to clay, drought, heat, heavy soil, high pH, poor soils, salt, savanna, and waterlogging. (2n=52.)

Distribution

Native from Egypt south to Mozambique and Natal; apparently introduced to Zanzibar, Pemba, and India; Arabia. Considered a serious weed in South Africa.

Ecology

Woodlands of various sorts, wooded grasslands, scrub and thickets. Thrives in dry areas, but endures floods. Grows 10–1,340 m altitude, in a wide range of conditions. Grows on a wide variety of soils, seemingly thriving on alluvial soils, black cotton soils, heavy clay soils, as well as even poorer soils (NAS, 1980). Ranging from Subtropical Desert to Subtropical Dry through Tropical Desert to Tropical Dry Forest Life Zones, babul is reported to tolerate annual precipitation of 3.8–22.8 dm (mean of 12 cases = 12.0 dm), annual mean temperature of 18.7–27.8°C (mean of 12 cases = 24.1°C), and pH of 5.0–8.0 (mean of 10 cases = 6.9) (Duke, 1981a).

Cultivation

Trees propagated in forest by seeds. Direct seeding is the common practice. Stored seed may require scarification. Young seedlings are said to "require full sun and frequent weeding" (NAS, 1980a).

Harvesting

Although there are other sources of gum arabic, trees are still tapped for the gum by removing a bit of bark 5–7.5 cm wide and bruising the surrounding bark with mallet or hammer. The resulting reddish gum, almost completely soluble and tasteless, is formed into balls. Though used in commerce to some extent, it is inferior to other forms of gum arabic, with which it is sometimes mixed.

Yields and Economics

Various products of the tree are used locally in tropical Africa, but none enter international markets. Trees usually add 2–3 cm in diameter each year (NAS, 1980a).

Energy

Extensively used, e.g. in India, for firewood and charcoal, this species has been used in locomotives and steamships as well as industry balers. It is cultivated for industrial fuel in the Sudan. The calorific value of the sapwood is 4,800 kcal/kg of the heartwood 4,950. The species does nodulate and fix nitrogen.

Biotic Factors

Wood borers may afflict the stems and bruchids may afflict the seeds. Following fungi have been reported on this plant: Ctyospora acaciae, Diatryphe acaciae, Diplodia acaciae, Fomes badius, F. endotheius, F. fastuosus, F. rimosus, Fusicoccum indicum, Phyllactinia acaciae, Ravenelia acaciae-arabicae, Septogloeum acaciae, Septoria mortolensis, Sphaerostilbe acaciae. Trees are also parasitized by Dendrophthoe falcata and Loranthus globiferus var. verrucosus (Duke, 1981). In a survey for phytophagous insects on Acacia nilotica, 43 species were recorded in Pakistan, of these, 16 appeared stenophagous. The more promising for biological control of the tree were: Anarsia sp. cf. acaciae, Pseudosterrha paulula, Azanus ubaldus, and Ceutholopha isidis feeding on flowers; Bruchidius sahlbergi and Sulcobruchus sp. damaging seeds; Ascalenia callynella, Gisilia stereodoxa and an unidentified gracillariid boring shoots; and Cydia sp. making stem galls (Mohyuddin, 1981).

Yields and Economics

Various products of the tree are used locally in tropical Africa, blit none enter international markets. Trees usually add 2–3 cm in diameter each year (NAS, 1980).

References

Ayoub, S.M.H. 1983. Algicidal properties of Acacia nilotica. Fitoterapia 53(5–6):175–8.
Duke, 1981.
Duke, J.A. 1981a. Handbook of legumes of world economic importance. Plenum Press. NewYork.
Duke, J.A. 1983a. Medicinal plants of the Bible. Trado-Medic Books, Owerri, NY.
Mohyuddin, A.I. 1981. Phytophages associated with Acacia nilotica in Pakistan and possibilities of their introduction into Australia. p. 161–166. Proceedings of the 5th International Symposium on Biological Control of Weeds. Australia Commonwealth Scientific and Industrial Research Organization.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Pande, M.B., Talpada, P.M., Patel, J.S., and Shukla, P.C. 1981. Note on the nutritive value of babul (Acacia nilotica L.) seeds (extracted). In: Indian J. Anim. Sci. 51(1):107–108.
Umalkar, C.V., Begum, S., Nehemiah, K.M.A. 1976. Inhibitory effect of Acacia nilotica extracts on pectolytic enzyme production by some pathogenic fungi. Indian Phytopath.: publ. 1977, 29(4):469–470.
Walker, B.H. 1980. A review of browse and its role in livestock production in southern Africa. p. 7–24. In: LeHouerou, H.N. (ed.), Browse in Africa. International Livestock Centre for Africa. Addis Ababa, Ethiopia.

Acacia mearnsii de Wild

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Uses

Tree of economic importance in South and East Africa, Rhodesia, India, and Rio Grande do Sul area of South America etc. for tanning of soft-leather. Ranging from 30–54 percent tannin in dried bark. Wood furnishes badly needed fuel and building material in some areas. Trees not only provide tannin and fuel, but also add nitrogen and organic material to improve the soil. Bark is used for wood adhesives and flotation agents (Duke, 1981a). The pulp is suitable for wrapping paper and hardboard. Some regard it as an attractive ornamental. Sometimes used for erosion control on poor sloping soils unsuitable for agriculture. Densely packed plantations are effective in preventing further erosion on 50° slopes. Some farmers claim that tobacco and vegetable yields are doubled in rotating with the black wattle. In places it is regarded as a "green cancer", spreading vigorously as a weed (NAS, 1980; Little, 1983).

Folk Medicine

Products are often used in folk medicine as styptics or astringents (Duke, 1981).

Chemistry

Black wattle bark contains (-)-robinetinidol and (+)-catechin; the biflavonoids (-)-fisetinidol-(+)-catechin (2 diastereoisomers), (-)-robinetinidol-(+)-catechin and (-)-robinetinidol-(+)-gallocatechin; triflavonoids and condensed tannins. The heartwood is rich in (+)-leucofisetinidin (mollisacacidin) together with (-)-fisetinidol, (+)-fustin, butin, fisetin, butein, and biflavonoid condensates (tannins) (Duke, 1981).

Description

Tree 6 to 20 m tall, 10 to 60 cm in diameter; crown conical or rounded; all parts except flowers usually pubescent or puberulous; stems without spines or prickles; leaves bipinnate, on petioles 1.5–2.5 cm long, with a gland above; rachis 4–12 cm long with numerous raised glands all along its upper side; pinnae in 8–30 pairs, pinnules in 16–70 pairs, linear-oblong, 1.5–4 mm long, 0.5–0.75 min wide; flowers in globose heads 5–8 mm in diameter, borne in panicles or racemes, on peduncles 2–6 mm long; pale yellow and fragrant; pods gray-puberulous, or sometimes glabrous, almost moniliform, dehiscing, usually 3–10 cm long, 0.5–0.8 cm wide, with 3–14 joints; seeds black, smooth, elliptic or compressed ovoid, 3–5 mm long, 2–3.5 mm wide; caruncle conspicuous; areole 3.5 mm long, 2 mm wide. Seeds 66,000 to 110,000/kg (Duke, 1981a).

Germplasm

Can be crossed with Acacia decurrens, hybrids show more sterility than parents. Meiosis is regular, with no gross cytological abnormalities, and sterility may be due to gene differentiation between species. There is little geographic overlap in the native Australian ranges of the species, and there are differences in phenology (flowering; seedset). Most of the characters that vary among the species are quantitative. The development of black wattle strains or of hybrids with enhanced vigor, better quality bark, outstanding stem form, or resistance to insect pests and disease would benefit the wattle industry. Assigned to the Australian Center of Diversity, black wattle or cvs thereof is reported to exhibit tolerance to drought, laterite, and poor soil (Duke, 1981). For an Acacia, it is relatively tolerant to frost, and its growth is slowed by high temperatures. (2n = 26.)

Distribution

Native to Southeast Australia (Victoria to New South Wales and southern Queensland) and Tasmania. Introduced and cultivated widely for afforestations. See Sherry (1971) for details.

Ecology

In Kenya grows on or near Equator at altitudes of 2,000–2,800 m, is well adjusted to the climate of East Africa. Grows well at 30°S Lat. in South America on rolling terrain at altitudes of 50–70 m. Thrives on poor, dry soils but favors deeper, moister, more fertile soils. In Australia, black wattle may occur on soils derived from shales, mudstones, sandstones, conglomerates, and alluvial deposits. In Kenya on podsols, krasnozems, sandy hills, lava flows or on mixtures of lava and contemporaneous volcanic tuffs and breccias. In South America, grown on red clay or sandy soils that have suffered from severe erosion and soil depletion (ferruginous clay loams with little or no free silica). In East Africa grows where annual rainfall is 1,041–1,321 mm, (about 75% between April and September). On the equator where black wattle is grown in South America, the rain pattern is nearly opposite, mean annual temperature range is 17–23°C; there is little seasonal variation, but considerable diurnal variation. At higher altitudes in South America, frost is a risk and heavy snows may break tree limbs. Tannin content varies inversely with precipitaton. Ranging from Warm Temperate Dry through Tropical Thorn to Tropical Moist Forest Life Zones, black wattle is reported to tolerate annual precipitation of 6.6–22.8 dm (mean of 6 cases=12.6), annual mean temperature of 14.7–27.8°C (mean of 6 cases=2.6°C), and pH of 5.0–7.2 (mean of 5 cases = 0.5).

Cultivation

Propagation by seed is easy. Seeds retain their viability for several years. For germination seed are covered with boiling water and allowed to stand until cool. This cracks the hard outer coat and facilitates germination. Seeds may be broadcast or sown in rows on any barren site. Usually they are sown about 5 cm apart in seedbeds, and are transplanted after 3–6 months. In South America, fields are usually plowed and harrowed in April or May. Seedlings are set out May–November, but usually in winter, June–August, after a rain. Plants are spaced 2 m each way, at rate of 2,500/ha. Propagation by cuttings is almost impossible without mist. Air layering is more promising. Two types of farmers grow acacia: the tanner or business man plants 200 ha or so entirely to black wattle, usually one section at a time so that he can plant and harvest within the same year and continue year after year; the farmer plants half or less of his land to black wattle and the rest to crops such as corn, beans, maniac, sugarcane, other vegetables, or pasture. He plants 2–6 hectares of acacian each year and thus evenly distributes work and production. Oxen may be useful for plowing, but most work is by hand. Usually only plows and hoes are used in Cultivation. Intercrops may be grown the first year during which trees grow about 4–5 m in height, and about 2.5 cm in diameter (Duke, 1981).

Harvesting

Trees provide bark 5–10 years after seeding (avg 7). Bark is stripped from lower part of tree, then tree is felled, the remaining bark removed, and tree and bark are cut into 1 m lengths. Thoroughly dried bark is arranged in bales of 75 to 80 kg when ready for transportation. Tanning power improves by 10–15% in bark carefully stored for a season. Percent tannin does not differ between barks harvested in dry and wet seasons. However, the amount of bark on trees may be less on poor than on rich soils. Tannin runs about 25–35% per kilo of dried bark, on either poor or rich soil. Acacia bark may be sold as baled bark, or bark powder. Dried bark may go first to commercial bark processors where it is ground or shredded in a hammermill, then sold in 40-kg sacks. Bark powder is sold in 60-kg sacks. Liquid extract is sold in 300-kg wooden barrels. In Rio Grande do Sul an estimated 5,000 MT of liquid extract is produced annually (Duke, 1981a).

Yields and Economics

Except for some mangrove species, black wattle in pure stand produces more tannin per hectare than most tanniniferous plants. In South Africa well-managed have produced the equivalent of 3 MT/ha tannin, about twice the average, when grown in rotations in excess of 12 years. One 7-yr-old tree produces 3–5 kg of dried bark. Twelve trees produce 1 cu m of firewood. The wood of debarked trees is dried and used for mine timbers, pulpwood, and fuel. Moisture loss is rapid in first 4 weeks after felling, then much slower. Wood weighs 708.7 kg/cu m. One tree can produce up to 10 cwt of bark or about 5 cwt stripped. One ton of black wattle bark is sufficient to tan 2,530 hides, best adapted for sole leather and other heavy goods; the leather is fully as durable as that tanned with oak bark. One ton of bark yields 4 cwt of extract tar. Destructive distillation of the wood yields 33.2% charcoal, 9.5% lime acetate, and 0.81 methyl alcohol. As a source of vegetable tannin, black wattle shares with quebracho and chestnut a large portion of the world market for vegetable tannins. According to Sherry (1971), plantation grown wattle in South Africa, Rhodesia, Tanzania, Kenya, and Brazil supplied about 38% of world demand for tannin. South Africa was the largest producer, with annual output of 72,000 MT of ca 120,000 MT on the world market. Eucalyptus grandis produces more wood than wattle, but it is inferior for fuel and charcoal. At one time in South Africa, 56% of the proceeds from wattle was from bark, the balance from timber (Duke, 1981a).

Energy

An efficient N-fixer, it is reported to annually yield 21–28 MT/ha wet leaves containing 245–285 kg N. If we put the information in our cultivation paragraph and our yields paragraph, we find the improbable 2,500 plants per hectare, with 12 producing 1 m³ firewood, suggesting a potential of more than 200 m³/ha for 7 year old trees, suggesting annual yields of ca 30 m³/ha. NAS (1980a) reports annual thickwood production of 10–25 m°3/ha and bark production of 0.8–4.0 MT. The dense wood (sp. grav. = 0.7–0.85) 3,500–4,000 kcal/kg (oven-dry Indonesian specimens 4,650 kcal/kg), its ash content ca 1.5%. The charcoal (sp. grav. = 0.3–0.5) has a calorific value of 6,600 kcal/kg, with an ash content of 0.4%.

Biotic Factors

The most serious disease is disback, caused by Phoma herbarum. Other fungi attacking black wattle include: Chaetomium cochliodes, Daldinia sp., and Trichoderma viride. In Rio Grande do Sul, disease and insects cause about 20% loss of trees. Principal insects attacking Brazilian wattle are Molippa sabina, Achryson surinamum, Placosternus cyclene, Eburodacrys dubitata, Neoclytus pusillus, Oncideres impluviata, Oncideres saga, and Trachyderes thoracica. Ants, termites, and borers are the most damaging. The sauva ant which attacks the leaves is fought constantly with arsenicals and carbon disulfide. Nematodes reported on this species include Meloidogyne arenaria, M. incognita acrita, and M. javanica (Golden, pers. commun. 1984).

References

Duke, J.A. 1981a. Handbook of legumes of world economic importance. Plenum Press. NewYork.
Little, E.L. Jr. 1983. Common fuelwood crops: a handbook for their identification. McClain Printing Co., Parsons, WV.
NAS, 1980.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Sherry, S.P. 1971. The black wattle (Acacia mearnsii de Wild.). University of Natal Press. Pietermatitzburg.

Acacia mearnsii de Wild

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Uses

Folk Medicine

Products are often used in folk medicine as styptics or astringents (Duke, 1981).

Chemistry

Description

Germplasm

Distribution

Native to Southeast Australia (Victoria to New South Wales and southern Queensland) and Tasmania. Introduced and cultivated widely for afforestations. See Sherry (1971) for details.

Ecology

Cultivation

Harvesting

Yields and Economics

Energy

Biotic Factors

References

Duke, J.A. 1981a. Handbook of legumes of world economic importance. Plenum Press. NewYork.
Little, E.L. Jr. 1983. Common fuelwood crops: a handbook for their identification. McClain Printing Co., Parsons, WV.
NAS, 1980.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Sherry, S.P. 1971. The black wattle (Acacia mearnsii de Wild.). University of Natal Press. Pietermatitzburg.

Acacia mearnsii de Wild

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Uses

Folk Medicine

Products are often used in folk medicine as styptics or astringents (Duke, 1981).

Chemistry

Description

Germplasm

Distribution

Native to Southeast Australia (Victoria to New South Wales and southern Queensland) and Tasmania. Introduced and cultivated widely for afforestations. See Sherry (1971) for details.

Ecology

Cultivation

Harvesting

Yields and Economics

Energy

Biotic Factors

References

Duke, J.A. 1981a. Handbook of legumes of world economic importance. Plenum Press. NewYork.
Little, E.L. Jr. 1983. Common fuelwood crops: a handbook for their identification. McClain Printing Co., Parsons, WV.
NAS, 1980.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Sherry, S.P. 1971. The black wattle (Acacia mearnsii de Wild.). University of Natal Press. Pietermatitzburg.

Acacia mangium Willd

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Uses

Regarded first as a rather productive timber tree, secondly for firewood (specific gravity = 0.65). The hard, light-brown wood is dense, with narrow sapwood and a straight, close grain. It makes excellent particle board and could possibly be useful for furniture, cabinetmaking, and perhaps even pulp and paper. Capable of being directly sown, the tree appears quite promising for erosion control where adapted (NAS, 1979). Some success is indicated in the use of the species to correct the problem of the Imperata grasslands (Tham, 1979). Sabah foresters have converted 1,200 ha of degraded Imperata grassland into productive forest lands.

Folk Medicine

No data available.

Chemistry

According to Anderson (1978) the gum contains 5.4% ash, 0.98% N, 1.49% methoxyl, and by calculation, 32.2% uronic acid. The sugar composition after hydrolysis: 9.0% 4-0-methylglucuronic acid, 23.2% glucuronic acid, 56% galactose, 10% arabinose, and 2% rhamnose.

Toxicity

Dust from pods pounded during seed extraction causes a respiratory reaction in some people. No hint of pollen allergies has been reported (NAS, 1983d).

Description

Tree to 30 m tall, bole often straight, to over half the total tree height. Branchlets, phyllodes and petioles glabrous or slightly scurfy. Phyllodes 5–10 cm broad, 2–4 times as long as broad, dark green, chartaceous when dry. The phyllodes have (3–)4 longitudinal main nerves which join on the dorsal margin at the base of the phyllode, secondary nerves fine and inconspicuous. Flowers in loose spikes to 10 cm long, solitary or paired in the upper axils. Flowers pentamerous, the calyx 0.6–0.8 mm long, with short obtuse lobes, the corolla twice as long as the calyx. Pods linear, glabrous, 3–5 mm broad, ca 7.5 cm long when green, woody, coiled and brackish-brown when mature, depressed between the seeds. Seeds lustrous, black, ellipsoid, ovate or oblong, 3.5 x 2.5 mm, the orangish funicle forming a fleshy aril beneath the seed.

Germplasm

Native to the Australian Center of Diversity, the mange tree has been reported to tolerate heavy soil, laterites, low pH, poor soil, slopes, and weeds (NAS, 1979, 1983d). Hybridizes naturally with Acacia auriculiformis, producing hybrids which grow faster than either parent, but tending to retain the poor form of A. auriculiformis.

Distribution

Largely Australian with disjunct distribution of small stands in New Guinea and the Moluccas, as well as in Cape York Peninsula. In Indonesia A. mangium occurs on Taliabu, the most western island, and Sanana, a southern island of the Sula Island Group and near Waesalan in the southwest of the main Ceran group. Introduced to Banglasesh, Cameroon, Costa Rica, Hawaii, Indonesia, Malaysia, Nepal, Papua, and the Philippines (NAS, 1983d).

Ecology

Often in grasslands and on margins of lowland primary forests at altitudes of 10–50 m. Probably capable of ranging from Tropical Very Dry to Moist through Subtropical Dry to Wet Forest Life Zones, this species has outperformed Albizia falcataria, Gmelina arborea (considered among the fastest-growing useful trees on earth, NAS, 1979), and Pinus caribaea on poor sites such as disturbed or burned sites, on degraded lateritic clay underlain with volcanic rock, on soils so worn out that even shifting cultivation had been abandoned, and on slopes infested with Eupatorium and/or Imperata species. Mangium apparently tolerates annual precipitation of 10 to 45 dm or more, mean maximum temperature of 31–34°C in summer, mean minimum temperature of 12–25°C in winter, and pH of 4.2–7.5 (NAS, 1983d). It is reported on entisols and ultisols.

Cultivation

Sometimes sown direstly. During the first two years growth in Sabah Imperata wastelands, trees required some weeding and occasionally insecticidal treatment. Beyond that, little tending is required. Trees coppice readily and flower and fruit profusely and "continuously" (NAS, 1979). Many more details are reported by NAS (1983d).

Harvesting

Large-diameter logs can be sawn or peeled. Viable seed can be harvested only 24 hours after planting (NAS, 1983d). Fourteen-year old trees yield a kilogram of seed.

Yields and Economics

Said to be a very fast growing species attaining 15 m height and 40 cm DBH in 3 years. They have attained 23 m tall in 9 years.

Energy

Yields as high as 30 m³/ha/yr have been reported, but 20 m³ has been reported on poor sites. The timber, recommended for testing as firewood, has potential for firewood and charcoal (NAS, 1983d). The wood has 4,800–4,900 kcal/kg. Untended 9-year old stands have yielded 415 m³ timber per ha, representing annual productivity of 46 m³ (NAS, 1979). The MAI in Sabah varies from 13.8–44.5 m³/ha.

Biotic Factors

There are problems with leaf insects. Mangium has symbioses with the bacterium Rhizobium and the fungus Thelephora. Specimens (ca 12%) in Sabah suffer from a heart rot and a "pink disease" (Corticium salmonicolor). Seedlings in Hawaiian nurseries are attacked by a powdery mildew (Oidium sp.). Three pinhole borers attack the tree in Sabah, especially on poorer sites. Carpenter ants (Camponotus sp.) form galleries in the heartwood of young trees. Wood borers of the genus Xystrocera may be a problem. Seedlings may be defoliated by Hypomeces squamosus. Scale insects and mealy bugs may also be problematic with young plants (NAS, 1983d).

References

Anderson, D.M.W. 1978. Chemotaxonomic aspects of the chemistry of acacia gum exudates. Kew Bull. 32(3):529–536.
N.A.S. 1979. Tropical legumes: resources for the future. National Academy of Sciences, Washington, DC.
N.A.S. 1983d. Mangium and other acacias of the humid tropics. National Academy Press, Washington, DC.
Tham, C.K. 1979. Trials of Acacia mangium Willd. as a plantation species in Sabah. Forest Genetic Resources Information 9. FAO Forestry Occasional Paper 1979 (No. 1).

Acacia tortilis (Forsk.) Hayne

2010-08-02T23:06:00.000-07:00

Uses

Folk Medicine

Chemistry

Nutritive tables (Gohl, 1981)

		As % of dry matter
	DM	CP	CF	Ash	EE	NFE	Ca	P	Ref.
Fresh leaves, South Africa		19.2	11.6	8.7	6.1	54.4	2.27	0.17	213
Pods, South Africa		17.3	24.8	5.7	3.1	49.1	0.79	0.34	213
Seeds, South Africa		37.8	10.9	5.9	6.0	39.7	0.56	0.73	213
Pod husks, South Africa		8.7	34.3	6.2	1.6	49.2	1.10	0.14	213

Acacia tortilis (Forsk.) Hayne subsp. heteracantha (Burch.) Brenan

		As % of dry matter
	DM	CP	CF	Ash	EE	NFE	Ca	P	Ref.
Fresh leaves, Sudan	90.9	13.3	9.4	9.6	8.3	59.4	4.00	0.15	64
Pods, Tanzania		12.3	22.4	5.6	1.8	57.9	0.98	0.24	166
Pods, Kenya		17.8	17.5	8.4	1.7	54.6	1.34	0.36	129

		Digestibility (%)
	Animal	CP	CF	EE	NFE	ME	Ref
Pods	Cattle	46.2	42.0	74.0	76.6	2.30	166

Acacia tortilis (Forsk.) Hayne subsp. spirocarpa (Hochst. ex A. Rich) Brenan

Description

Germplasm

Distribution

Ecology

Cultivation

Harvesting

Yields and Economics

Energy

Biotic Factors

References

Dalziel, J.M. 1937. The useful plants of west tropical Africa. The Whitefriars Press, Ltd., London and Tonbridge.
Gohl, B. 1981. Tropical feeds. Feed information summaries and nutritive values. FAO Animal Production and Health Series 12. FAO, Rome.
Halperin, J. 1980. Forest insects and protection in the arid zones of Israel. J. Israel For. Assoc. 30(3/4):68–72.
Kaplan, J. 1979. Some examples of successful use of Acacia for afforestation. J. Israel For. Assoc. 29(3/4):63–64.
Karschon, R. 1975. Seed germination of Acacia raddiana Savi and A. tortilis Rayne as related to infestation by bruchids. Ag. Res. Org. Leaflet 52. Bet Dagan.
Muthana, K.D. and Arora, G.D. 1980. Performance of Acacia tortilis (Forsk) under different habitats of the Indian arid zone. Ann. Arid Zone 19(1/2):110–118.
N.A.S. 1979. Tropical legumes: resources for the future. National Academy of Sciences, Washington, DC.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Nkaonja, R.S.W. 1980. Dryland afforestation problems in Malawi. J. Israel For. Assoc. 30(3/4):100–105.
Palmer, E. and Pitman, N. 1972. Trees of Southern Africa. 3 vols. A.A. Balkemia, Cape Town.
Roy, A.D., Kaul, R.N., and Gyanchand. 1973. Israeli babool a promising tree for arid and semiarid lands.

Acacia farnesiana (L.) Willd

2010-08-02T23:04:00.000-07:00

Uses

Cassie perfume is distilled from the flowers. Cassie absolute is employed in preparation of violet bouquets, extensively used in European perfumery. Cassie pomades are manufactured In Uttar Pradesh and the Punjab. Pods contain 23 percent tannin, a glucoside of ellagic acid, and are used for tanning leather. Bark also used for tanning and dying leather in combination with iron ores and salts. In Bengal and West Indies, pods are used for a black leather dye. Gummy substance obtained from pods used in Java as cement for broken crockery. Gum exuding from trunk considered superior to gum arabic in arts. Trees used as ingredient in Ivory Coast for arrow poison; elsewhere they are used as fences and to check erosion. Wood is hard and durable underground, used for wooden plows and for pegs. Trees often planted as an ornamental (Duke, 1981). Morton (1981) says that the seeds, containing an unnamed alkaloid, are used to kill rabid dogs in Brazil.

Folk Medicine

Bark is astringent and demulcent, and along with leaves and roots is used for medicinal purposes. Woody branches used in India as tooth brushes. The gummy roots also chewed for sore throat. Said to be used for alterative, antispasmodic, aphrodisiac, astringent, demulcent, diarrhea, febrifuge, rheumatism, and stimulant (Duke, 1981a). Morton (1981) notes that Guatemalans value the flower infusion as a stomachic. It is also used for dyspepsia and neuroses. Mexicans sprinkle powdered dried leaves onto wounds. The flowers are added to ointment, rubbed on the forehead for headache. Green pods are decocted for dysentery and inflammations of the skin and raucous membranes. Colombians bathe in the bark decoction for typhoid. Costa Ricans decoct rhe gum from the trunk for diarrhea, using the pod infusion for diarrhea, leucorrhea, and uterorrhagia. Panamanians and Cubans used the pod to treat conjunctivitis. Cubans use the pod decoction for sore throat. For rheumatic pains, West Indians bind bark strips to the afflicted joint. The root decoction has been suggested as a folk remedy for tubersulosis. According to Hartwell (1967–1971), the decoction of the root, used in hot baths, is said to help stomach cancer. A plaster, made from the pulp, is said to alleviate tumors.

Chemistry

Dried seeds of one Acacia sp. are reported to contain per 100 g: 377 calories, 7.0% moisture, 12.6 g protein, 4.6 g fat, 72.4 g carbohydrate, 9.5 g flber, and 3.4 g ash. Raw leaves of Acacia contain per 100 g: 57 calories, 81.4% moisture, 8.0 g protein, 0.6 g fat, 9.0 g carbohydrate, 5.7 g fiber, 1.0 g ash, 93 mg Ca, 84 mg P, 3.7 mg Fe, 12,255 mg b-carotene equivalent, 0.20 mg thiamine, 0.17 mg riboflavin, 8.5 mg niacin, and 49 mg ascorbic acid. Reporting 55% protein on a dryweight basis, Van Etten et al (1963) break down the amino acids as follows: lysine, 4.7 (g/16 g N); methionine, 0.9; arginine, 9.2; glycine, 3.4;. histidine, 2.3; isoleucine, 3.5; leucine, 7.5; phenylalanine, 3.5; tyrosine, 2.8; threonine, 2.5; valine, 3.9; alanine, 4.3; aspartic acid, 8.8; glutamic acid, 12.6; hydroxyproline, 0.0; proline, 5.1; serine, 4.1; with 76% of the total nitrogen as amino acids. Cassie has been reported to contain anisaldehyde, benzoic acid, benzyl alcohol, butyric acid, coumarin, cresol, cuminaidehyde, decyl aldehyde, eicosane, eugenol, farnesol, geraniol, hydroxyacetophenone, methyleugenol, methyl salicylate, nerolidol, palmitic acid, salicylic acid, and terpineol (Duke, 1981). The leaves contain lipids, carotenoids, alkaloids, and reducing and non-reducing sugars (Morton, 1981). El Sissi et al (1973) isolated and identified from pods, seven polyphenols (gallic acid, ellagic acid, m-digallic acid, methyl gallate, kaempferol, atomadendrin, and narigenin). Also they found narigenin-7-glucoside and naringenin-7-rhamnoglucoside (naringin), as well as naringenin, glucose, and gallic acid.

Description

Thorny bush or small tree, 8 m tall; bark light brown, rough; branches glabrous or nearly, purplish to gray, with very small glands; stipules spinescent, usually short, up to 1.8 cm long, rarely longer, never inflated; leaves twice pinnate, with a small gland on petiole and sometimes one on the rachis near top of pinnae; pinnae 2–8 pairs, leaflets 10–12 pairs, minute, 2–7 mm long, 0.75–1.75 mm wide, glabrous, leathery; flowers in axillary pedunculate heads, calyx and corolla glabrous, scented; pod indehiscent, straight or curved, 4–7.5 cm long, about 1.5 cm wide, subterete and turgid, dark brown to blackish, glabrous, finely longitudinally striate, pointed at both ends; seeds chestnut-brown, in 2 rows, embedded in a dry spongy tissue, 7–8 mm long, ca 5.5 mm broad, smooth, elliptic, thick, only slightly compressed; areole 6.5–7 mm long, 4 mm wide (Duke, 1981a).

Germplasm

Both A. farnesiana and its var cavenia are extensively cultivated in and around Cannes, southern France, which is the center for production of the perfume. The variety seems to be more resistant to drought and frost. Assigned to the South American Center of Diversity, cassie or cvs thereof is reported to exhibit tolerance to drought, high pH, heat, low pH, salt, sand, slope, and Savanna. (2n = 52, 104). (Duke, 1981a).

Distribution

Probably native to tropical America, but naturalized and cultivated all over the world, e.g. Africa (Rhodesia, Mozambique) and Australia. Planted in coastal areas of Ghana and elsewhere in tropical Africa. Grown throughout India, and often planted in gardens (Duke, 1981a).

Ecology

Thrives in dry localities and on loamy or sandy soils where it may serve as a sand binder. Will grow on loose sandy soil of river beds, on pure sand in plains of Punjab. Requires a dry tropical climate. Ranging from Warm Temperate Dry through Tropical Desert to Moist Forest Life Zones, cassie is reported to tolerate annual precipitation of 6.4–40.3 dm (mean of 20 cases 14.0 dm), annual mean temperature of 14.7–27.8°C (mean of 20 cases = 24.1°C), and pH of 5.0–8.0 (mean of 15 cases = 6.8) (Duke, 1981).

Cultivation

Propagated mainly from seed and cuttings. Seeds germinate readily and plants grow rapidly. Plants do not require much cultivation, watering or care (Duke, 1981a).

Harvesting

Trees begin to flower from the third year, mainly from November to March. Perfume is extracted from the flowers in form of concrete or pomade. Macerated flowers are placed in melted purified natural fat and allowed to stand for several hours. They are then replaced by fresh flowers and the process repeated until the fat is saturated with perfume. Fat is then melted, strained and cooled. This constitutes the pomade. Odor is that of violets but more intense. Absolute is prepared by mixing pomade with alcohol (2–3 kg to about 4 laters) and allowed to stand for 3–4 weeks at about -5°C. The alcohol is then separated and distilled over. The extract obtained is an olive-green liquid with strong odor of cassie flowers (Duke, 1981a).

Yields and Economics

Mature trees yield up to 1 kg of flowers per season. Southern France (Cannes and Grasse) is main production center for cassie flower perfume. India and other Eastern countries produce much for local use (Duke, 1981a).

Energy

Though omitted by the recent fuelwood books (NAS, 1980; Little, 1983), this species should be considered along with other Acacias for its energy potential. Other species yield fuelwood at rates of 5–20 m³/ha/yr, but lower yields may prevail in very humid environments. Of course the straggly bushy forms would not make very good fuel sources. Morton (1981) notes that the wood is used for fuel. Allen and Allen (1981) note that it fixes nitrogen.

Biotic Factors

Fungi reported on this plant include: Camptomeris albizziae, Clitocybe tabescens, Hypocrea borneensis, Lenzites palisoti, L. repanda, Phyllachora acaciae, Phymatotrichum omnivorum, Polystictus flavus, Ravenelia austris, R. hieronymi, R. siliquae, R. spegazziniana, Schizophyllum commune, Systingophora hieronymi, Tryblidiella rufula, and Uromycladium notabile. It may also be parasitized by the flowering plants Dendrophthoe falcata and Santalum album (Duke, 1981a).

References

Allen, O.N. and Allen, E.K. 1981. The Leguminosae. The University of Wisconsin Press. 812 p.
Duke, J.A. 1981.
Duke, J.A. 1981a. Handbook of legumes of world economic importance. Plenum Press. NewYork.
El Sissi, H.I., El Ansari, M.A., and El Negoumy, S.I. 1973. Phenolics of Acacia farnesiana. Phytochemical reports. Phytochemistry 12:2303.
Hartwell, J.L. 1967–1971. Plants used against cancer. A survey. Lloydia 30–34.
Little, E.L. Jr. 1983. Common fuelwood crops: a handbook for their identification. McClain Printing Co., Parsons, WV.
Morton, J.F. 1981. Atlas of medicinal plants of middle America. Bahamas to Yucatan. C.C. Thomas, Springfield, IL.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Van Etten, C.H., Wolff, I.A., and Jones, Q. 1963. Amino acid composition of seeds from 200 angiospermous plant species. J. Agr. Food Chem. 11(5):399–410.

Acacia mearnsii de Wild

2010-08-02T23:03:00.000-07:00

Uses

Folk Medicine

Products are often used in folk medicine as styptics or astringents (Duke, 1981).

Chemistry

Description

Germplasm

Distribution

Native to Southeast Australia (Victoria to New South Wales and southern Queensland) and Tasmania. Introduced and cultivated widely for afforestations. See Sherry (1971) for details.

Ecology

Cultivation

Harvesting

Yields and Economics

Energy

Biotic Factors

References

Duke, J.A. 1981a. Handbook of legumes of world economic importance. Plenum Press. NewYork.
Little, E.L. Jr. 1983. Common fuelwood crops: a handbook for their identification. McClain Printing Co., Parsons, WV.
NAS, 1980.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Sherry, S.P. 1971. The black wattle (Acacia mearnsii de Wild.). University of Natal Press. Pietermatitzburg.

Acacia cyclops A. Cunn. ex G. Don

2010-08-02T23:00:00.000-07:00

Uses

Producing a dense high quality firewood, this species has been recommended for stabilization of coastal dunes. Goats and antelope browse the phyllodes. The seeds and their oily funicles are eaten by birds, primates, and rodents, and if crushed, might be suitable for cattle.

Folk Medicine

With its high tannin content, the species could serve as an astringent.

Chemistry

Bark has yielded 6.5% tannin, or in Natal, up to 12.1%. Seed contains 10% of fixed oil, the aril or funicle 40%.

Description

Dense, evergreen bushy shrub, often multistemmed, or small tree 3 to 8 m tall, with a rounded crown . In windy coastal sites it forms a hedge less than 0.5 m high. The foliage comprises light green phyllodes, varnished when young, and growing in a downward vertical position. Pods, maturing in summer, are not shed, but remain on the tree, exposing the seeds to predators and dispersers.

Germplasm

Reported from the Australian Center of Diversity, Acacia cyclops is reported to tolerate drought, salt, sand, weed, and wind.

Distribution

Native to southwestern Australia, where it grows mostly on coastal sand dunes. Used for stabilization in South Africa, it is spreading on sand and sandstone into coastal bush and heathland. This is an extremely weedy species spread by birds into indigenous vegetation. Once established, it is difficult to remove or replace. There is little vegetation cover beneath an Acacia cyclops thicket. The seeds remain viable in the soil for many years. It is relatively slow growing.

Ecology

Acacia cyclops can grow in dry areas with annual precipitation less than 300 mm. Tolerating salt spray, wind, sand-blast, or salinity, it is useful for dune stabilization. This species has a high light demand; it will not survive in deep shade. Monthly temperature means within the distribution range of this species vary from 5°C in winter to 31°C in summer. It is slightly resistant to frost. The species is generally found below 300 m altitude where annual rainfall is 200 to 800 mm. It grows on quartzitic or calcareous sand or limestone. It also is found in drier sites such as dune crests (NAS, 1980a).

Cultivation

Direct sowing of pretreated seed is recommended (NAS, 1980a). Seed are treated with abrasion, acid, and hot water treatment.

Harvesting

Trees may be harvested as needed. This species rarely coppices, and mature trees do not survive felling. The pods are nondeciduous and are therefore not easily gathered. Unlike many Acacia species, it is not considered a valuable tannin or gum producer (NAS, 1980a).

Yields and Economics

Standing biomass of Acacia cyclops in the southwestern cape of Africa, where it is replacing indigenous Fynbos vegetation and coastal shrub communities, was 131 MT/ha. Of this, the litterfall was said to represent 7.4% of the total biomass, 21.2% of the canopy mass.

Energy

Recommended by the NAS (1980a) as a firewood source. The wood is dense, the logs rarely exceeding 20 cm in diameter. It is a very popular firewood in South Africa, sold regularly in Cape Town. The annual litterfall of four Acacia species naturalized in the South African Cape, comprising 60% foliage and 30% reproductive structures, averages 7 MT/ha, double the value expected in evergreen scrub communities in winter rainfall regions. Standing biomass in the Acacia thickets is ca 10 times greater than that of mature Fynbos (11–26 MT/ha) and shrublands in other Mediterranean climates (15–30 MT/ha). Acacias lose ca 10% of their standing crop annually as litter, at a rate 3–4 times that of the Mediterranean heath and shrub communities. The litter accumulates on the ground. In a mature thicket, the dry mass of the ground litter per unit area exceeds that of the living canopy. The ground litter layer runs 14–28 MT/ha, which is fairly average by world standards. "The annual nitrogen and phosphorus input by Acacia litter should be about nine times as great per unit area as that of Fynbos." Assuming an N content of 1.5% and a P content of 1.13%, Acacia litter would contribute 105 kg N/ha and 92 kg P. In an area where the annual precipitation averages between 500 and 750 mm/yr and the annual temperature average ranges between 16 and 18°C, with radiation averaging 450–500 Langleys/day (Capetown has an average annual precipitation of ca 600 mm, average temperature approaching 18°C), the total annual litterfall is 9,680 kg/ha, with 1.4% as flowers, 35.5% as pods, 5.3% as seed, 11.3% as twigs, 39.0% as phyllodes, and 7.7% unidentified fragments. The total standing biomass was 131 MT/ha DM, ˜±4% (Milton, 1981).

Biotic Factors

Most African Acacias are thought to be cross pollinated. Pests and diseases are not an important factor in South Africa; in fact, the lack of seed destroyers is partly responsible for the weediness of the species. Grazers may damage seedlings.

References

N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
Milton, S.J. 1981. Litterfall. of the exotic acacias in the southeastern cape. J. S. Afr. Bot. 47(2):147-155.

Acacia auriculiformis A. Cunn.

2010-08-02T22:57:00.000-07:00

Uses

Used for fuelwood plantations as an ornamental and shade tree, quite tolerant of heat, the Australian species is widely planted in Oceana and southeast Asia. The wood is also employed for making farm tools and furniture (NAS, 1983a). Recent Australian tests suggest that 10-year old trees can be pulped readily by the sulfate process, giving high pulp yields, with good strength properties. Also produces high quality pulp by the neutral sulfite semichemical process. The tannin produces a good quality leather, inclined to redden upon exposure to sunlight (NAS, 1980a). The plant is amazing in its ability to recolonize wastes, papermill sludge, pH ca 9.5; even uranium spoils, pH ca 3.0; the only tree found on 20-year old uranium spoil. Used for the cultivation of the lac insect in India.

Folk Medicine

No data available.

Chemistry

The gum contains 5.3% ash, 0.92% N, and 1.68% methoxyl, and ca 27.7% uronic acid. The sugar from the gum after hydrolysis, contained 10.1% 4-0-methylglucuronic acid, 17.6% glucuronic acid, 59% galactose, 8% arabinose, and 5% rhamnose (Anderson, 1978). Bark contains ca 13% water.

Description

Resilient, vigorously growing, crooked or gnarled deciduous or evergreen tree, possibly attaining 30 m height, 60 cm DBH. Leaves alternate, simple flattened phyllodes, lanceolate or oblong, arcuate, long-attenuate at both ends, 10–16 cm long, ca 1.5–2.5 cm broad, thick coriaceous, glabrous with several long parallel veins from the base. Spikes 5–8 cm long, paired at the leaf bases. Flowers sessile, ca 3 mm long, the calyx glabrous, 5-toothed, the 5 petals ca 2 mm long. Stamens numerous, filiform, ca 3 mm long. Ovary pubescent, the style filiform. Pods 6–8 cm long, 1–1.5 cm broad, flattened but coiled. Seeds several, flattened-ellipsoid, ca 5 mm long, with a reddish or orangish aril (Little, 1983). Seeds 53,000–62,000/kg.

Germplasm

Reported from the Australian Center of Diversity, Acacia auriculiformis, or cvs thereof, is reported to tolerate alkalinity, desiccation, drought, fire, high pH, laterite, poor soil, sand dunes, and savanna. It is intolerant of hurricane, shade, and weeds, at least in early stages. Once established, the tree is quite competitive with weeds. Though somewhat tolerant of fire, it is not so resistant as Eucalyptus. (2n = 26)

Distribution

Native to the savannas of New Guinea, islands of the Torres Strait, and northern Australia, it has been widely introduced, e.g. in Fiji, India, Indonesia, Java, Malaysia, Niger, Nigeria, Philippines, Tanzania, Thailand, the Soloman Islands, Uganda, and Zanzibar.

Ecology

Estimated to range from Subtropical Moist to Wet through Tropical Dry to Wet Forest Life Zones, Acacia auriculiformis is reported to tolerate annual precipitation of 7.5 to 27 dm, annual temperature of 26 to 30°C, and pH of 3.0 to 9.5. With practically no maintenance it will grow on a wide range of deep and shallow soils, compacted clays, coral soils, laterites, limestone, mica schist, mine spoil, podzols, even sand dunes and unstable slopes.

Cultivation

It has been suggested as an interplant with long-term timber Dalbergias, itself serving as a short-term but renewable firewood source. Seeds, storable for 18 months in airtight containers, should be soaked in hot water for 24 hours. Sow in full light, allowing 6 days for germination (ca 80% germination after 2–4 weeks). To reforest grassland, burn and plant in holes ca 36 x 30 x 30 cm, spaced at 1–2.5 or 1–3 m if intercropped with Cassia siamea. Recent spacings have been 2.5 x 2.5 m.

Harvesting

In Indomalaysia, stands are operated on 10–12 year rotations. Trees coppice poorly. Indonesians have gotten some coppice when trees are cut at least 50 cm above the ground. When trees are felled, there is usually a swarm of seedlings, so cutover stands regenerate readily.

Yields and Economics

With rainfall at 2700 mm, at 3 years, average height of a stand with 1010 trees/ha was 12.4 m, average diameter 12.2 cm, standing wood volume 73.2 m³/ha; at age 4, 13.1 m, 13.6 cm, and 96.1 m³/ha. Stemwood volume is ca 60% of total above ground biomass. Leaf biomass is important, the LAI being 7–8, good for shading out weeds. Average amount of dead litter is 4800 kg/ha. In Java, there may be 3 MT/ha leaves and 2 MT/ha twigs and branches beneath the trees (NAS, 1982a). On infertile abandoned sites in Papua, trees grew 6 m in 2 years, 17 m in 8 years. On shallow arid soils in West Bengal, yields were only 5m³/ha/yr at the 15th year. Under moister conditions 10 m³ is reported, 17–20 in Indonesia and Malaysia.

Energy

Wiersum and Ramlan report that yields can run higher than 20 m³/ha/yr on a 10–20 year rotation. On poor soils yields drop to 8–12 m³. On the Island of Madura, with annual rainfall 1700–1900 mm, 7–12 year old rotations run 7.6–9 m³/ha/yr, but on West Bengalese laterites with annual precipitation 1,000–14,000 mm, yields are only 2–6 m³/ha/yr in 10–20 year rotations. With its capacity to produce good fuelwood on poor soils, even where there are extended dry seasons, the species "merits large scale testing as a fuelwood species" (NAS, 1980). Wood has specific gravity of 0.6–0.75 and calorific value of 4,800–4,900 kcal/kg. Wood yields excellent charcoal that glows well and burns without smoke or sparks. Litter beneath the trees, both branches and dried leaves, annually adds up to 4.5–6 MT/ha, all used for fuel in China. Hawaiian grown material possesses N-fixing nodules.

Biotic Factors

While no pest or disease problems are reported in Indonesia, insects and nematodes have been reported to attack seedlings in Zanzibar. The rust Uromyces digitatus has been a problem in Java, where it is also occasionally infested with a rather inocuous black mildew, Meliola adenanphererae. In India, the root rots are Ganoderma lucidum and Ganoderma applanatum. Hypothenemus dimorphus has caused shoot fatality in Malaysia. The weevil Hypomeces squamosus can be a pest in India and Malaysia. Used to cultivate Kerria lacca in India. On Java, the ant Iridomyrmex rufoniger may protect the plant from some phytophagous insects.

References

Anderson, D.M.W. 1978. Chemotaxonomic aspects of the chemistry of acacia gum exudates. Kew Bull. 32(3):529–536.
Little, E.L. Jr. 1983. Common fuelwood crops: a handbook for their identification. McClain Printing Co., Parsons, WV.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
N.A.S. 1982. Priorities in biotechnology research for international development. Proceedings of a Workshop. National Academy Press, Washington, DC.
N.A.S. 1983a. Producer gas: another fuel for motor transport. National Academy Press, Washington, DC.

Acacia albida Del.

2010-08-02T22:56:00.000-07:00

Uses

Acacia albida is a widely used tree well documented for increasing the yields of crops grown under it. According to VITA (1977) "A. albida is highly valued in conservation efforts. It is the only species which loses its leaves during the rainy season; therefore, farming under these trees is not only possible but profitable." It is held sacred by the Africans of the Transvaal. In Nigeria, the pod is used as camel food. The gum that exudes spontaneously from the trunk is sometimes collected like gum arabic. The timber, though straight grained, close, and weighty, is soft, fibrous, and unsuitable for agricultural implements (Watt & Breyer-Brandwijk, 1962). One writer even questions its value for fuel wood. Masai use it as the soft flat wood upon which the firestick is twirled to make fire. Wood is used for canoes, mortars, and pestles. The bark is pounded in Nigeria and used as a packing material on pack animals. Ashes of the wood are used in making soap and as a depilatory and tanning agent for hides. VITA (1977) says the wood is used for carving; the thorny branches useful for a natural barbed fence. Pods and foliage are highly regarded as livestock fodder. Some 90% of Senegalese farmers interviewed by Felker (1981) collected, stored, and rationed Acacia alba pods to livestock. Rhodesians use the pods to stupefy fish. Humans eat the boiled seeds in times of scarcity in Rhodesia. Apparently it is erroneously taken as an indicator of a shallow well site.

Folk Medicine

Reported to serve as an emetic in fevers (Masai), taken for diarrhea in Tanganyika. Also used for colds, diarrhea, hemorrhage, and ophthalmia in West Africa. The bark of the Ana tree is a folk remedy for diarrhea among several tribes. On the Ivory Coast it is used for leprosy. The bark decoction curtails nausea. A liniment, made by steeping the bark, is used for bathing and massage in pneumonia. The bark infusion is used for difficult delivery, and is used as a febrifuge for cough (Irvine, 1961). Pods worn as charm by African women and children to avert smallpox.

Chemistry

The following table is reproduced, with permission from FAO's Tropical Feeds (1981):

Nutritive Table (Gohl, 1981)

		As % of dry matter
	DM	CP	CF	Ash	EE	NFE	Ca	P
Fresh flowers, Sudan	17.8	19.0	12.5	9.7	1.6	57.2
Fresh whole leaves, Niger		19.7	19.6	7.2	1.6	51.9	1.00	0.23
Fresh leaflets, Sudan	36.3	17.1	12.4	8.4	2.3	59.8
Pods, Tanzania		8.8	24.4	3.7	1.4	61.7	0.65	0.23
Pods, Niger		14.3	24.7	6.3	1.5	53.2	1.11	0.14

		Digestibility
	Animal	CP	CF	EE	NFE	ME
Pods	Cattle	51.0	16.5	71.4	74.8	2.09

Bark contains 2–28% tannin, the fruit 5–13%.

Description

A large thorny tree up to 20 m high and >2 m in diameter; bole forming up to 1/3 of height of tree; bark dull grey, fissured when old, crown dense; tree puts out leaves during dry season and sheds them during rains; branchlets light grey, spiny only at nodes, spines straight, up to 1 in. long; leaves pale and glaucous, bluish grey, glabrous or pubescent, 2-pinnate, 9 to numerous pairs of pinnae, cup-like glands on rachis, each pinna with 12 or more pairs of leaflets, leaflets oblong, up to 1 cm long, hairy, unequal at base; flowers (Jan., Apr., Nov.) in yellow spikes 10–12.5 cm long; fruits (Jan., May, Nov.) bright yellowish green when dry, up to 12–15 x 4 cm, slightly curved, ends rounded (Irvine, 1961).

Germplasm

Reported from the African Center of Diversity, the Ana Tree, or cvs thereof, is reported to tolerate poor soil, drought, savanna, and some waterlogging (VITA, 1977). Back in 1978, when Senegalese farmers wanted seedlings, none were available. There is great variability in the morphology and pod yields. Selection of wild plants for pod yield and/or fast growth would be a worthwhile contribution to arid developing countries. (2n = 26)

Distribution

Native to the Transvaal and Southwest Africa, through West and North Africa to Egypt, East Africa.

Ecology

Probably ranging from Tropical Thorn to Subtropical Moist Forest Life Zones, the Ana Tree is reported to tolerate annual precipitation of 3 to 6dm. Irvine (1961) describes it as the largest thorn tree in Savanna Forest, especially in inhabited areas; often left untouched, sometimes gregarious. In more mesic Sahelian regions (400–600 mm/yr), yields of millet, peanuts, and sorghum are increased from ca 500 to ca 900 kg/ha/yr by growing under the canopy of Acacia albida (Felker, 1978). Does best in sandy soils, growing well where millet grows. Though faring best on sandy soils, it will tolerate heavier soils with some waterlogging.

Cultivation

As late as 1978, techniques for establishing new seedlings had not been worked out, according to Felker (1978). Seeds devoid of bruchid holes should be scarified and started in deep containers to accomodate development of the tap root. Good-sized plants develop in 10–14 weeks, but frequent root pruning is advised. Transplants from the wild are usually unsuccessful because of the long tap root. VITA (1977) has a novel approach, feeding the seed to livestock, which then graze the desired areas, eliminating seeds with their manure. Nursery plantings, spaced at 10 x 10 m may require watering at first, and protection from grazing animals for 5–8 years.

Harvesting

Peasants gather pods to feed to their cattle, or lop the foliage in the dry season, when most other trees are leafless.

Yields and Economics

According to FAO (1980) a full grown tree can produce more than 100 kg pod/yr. Felker (1978) notes that pod yields range from 6–135 kg/tree. Some scientists believe that yields could be managed to a much higher level than those of the grasses and annual crops grown under the tree. Trees have reached 2 to 4 m after only 3 or 4 years growth.

Energy

Related species such as Acacia tortilis have been reported to yield giraffe forage to the tune of 5 MT/ha/yr. Yield increases under Acacia albida correlate with a several fold increase in soil N and organic matter, coupled with improved soil water-holding capacity. Acacia albida has been shown to nodulate and reduce acetylene. While Acacias cannot be recommended for cold and/or humid or everwet climates, they are suggested by the NAS (1980a) as firewood sources in developing countries. Among the species they consider are Acacia arabica, auriculiformis, brachystachya, cambagei, cyanophylla, cyclops, dealbata, decurrens, ehrenbergiana, fistula, heteracantha, holosericea, lysiophloia, mangium, mearnsii, mollissima, nilotica, nubica, raddiana, saligna, senegal, seyal, spirocarpa, tortilis, and verek. The Ana Tree was not recommended for firewood.

Biotic Factors

Caterpillars, locusts, and grazing animals may destroy the seedlings.

References

FAO Handbooks in Press (FAO, 1982)
1. Taxonomy of Acacia spp.
2.Seed Collection, Handling, Storage and Treatment of Acacia spp.
3. Seed Insects in Acacia spp.

FAO. 1980a. 1979. Production yearbook. vol. 33. FAO, Rome.
Felker, P. 1981. Uses of tree legumes in semiarid regions. Econ. Bot. 35(2):174–186.
Felker, P. 1978. State of the art: Acacia albida as a complementary intercrop with annual crops. USAID Information Services. Washington.
Gohl, B. 1981. Tropical feeds. Feed information summaries and nutritive values. FAO Animal Production and Health Series 12. FAO, Rome.
Irvine, F.R. 1961. Woody plants of Ghana. Oxford University Press. London.
N.A.S. 1980a. Firewood crops. Shrub and tree species for energy production. National Academy of Sciences, Washington, DC.
VITA. 1977. Reforestation in arid lands. VITA Publications. Manual Series 37E.
Watt, J.M. and Breyer-Brandwijk, M.G. 1962. The medicinal and poisonous plants of southern and eastern Africa. 2nd ed. E.&S. Livingstone, Ltd., Edinburgh and London.

Acacia

2010-08-02T22:55:00.000-07:00

Acacia is the second largest genus in Australia comprising more than 700 species (Harden 1991; Morrison and Davies 1991) and occurs in almost all habitat types. Species range in size from small shrubs to large trees and are ecologically important as 'pioneer' species where they rapidly establish cover following major natural disturbances such as fire (Christensen et al. 1981). Acacia species are commonly known simply as acacias or as wattles and Acacia pycnantha has been adopted as the Australian national floral emblem. Wattles are frequently grown as ornamentals, some are harvested for timber, while others are a source of gums or bark used in various tanning processes. Like the majority of legumes, acacias utilize rhizobia to fix atmospheric nitrogen in the soil enabling them to grow in relatively poor soils (Harden 1991).

BOTANY

In Australia there are two commonly accepted schools of thought regarding the taxonomy of legumes (order Fabales) and their treatment varies with institution and state. For example, The Flora of Australia (George, 1981) recognizes three distinct families, Mimosaceae, Caesalpiniaceae, and Fabaceae while the Flora of New South Wales (Harden 1991) recognizes a single family, Fabaceae (sometimes still referred to as Leguminosae by some workers) with three subfamilies, Faboideae (or Papilionoideae), Caesalpinioideae, and Mimosoideae. There has also been some debate about the placement of Australian wattles in the genus Acacia. Between 1977 and 1989, Pedley of the Queensland herbarium proposed splitting Acacia into several segregate genera supported by findings of workers in France during the late 1960s and 1970s (Pedley 1987). Pedley also proposed the reinstatement of the genus Racosperma for the majority of Australian wattles. To date, this has not been accepted, based on the argument that the name Racosperma was not validly published in 1835 (Hall and Johnson 1993) and the need for further research into the systematics of this large taxon (Maslin 1989).

THE ETHNOBOTANY OF ACACIA IN AUSTRALIA

Wattleseed, an Historical Perspective

Archaeological evidence demonstrates the presence of Aboriginal people in Australia for at least 50000 years (Flood 1990) and during this time there has been considerable change in the spatial distribution of vegetation. This has resulted, not only from a changing climate, but also as a consequence of megaherbivore extinction and Aboriginal burning practices (Flannery 1994). This unnatural, increased fire frequency has favored those species able to cope with such a regime. The proportions of grasses, "pioneer" species, annuals and pyrophilic species have increased compared with fire sensitive taxa (Flannery 1994). Such fire adaptive plants usually produce large quantities of seed and increasing the population size of those plants utilized for their seed will naturally increase the food supply. Aborigines deliberately burnt areas to achieve this aim (Flannery 1994; Latz 1995).

Seeds form a staple food among many indigenous peoples and plants native to Australia are no exception. Of all the plant foods in central Australia, seeds are by far the most important. Seeds are usually high in proteins, carbohydrates, and fats and are easily collected, providing a high energy food for the expenditure of relatively small amounts of energy (Latz 1995). Although Australian plants generally produce small seeds they are produced in large quantities. In arid Australia, seed supply is widely available, somewhat predictable and dependable (Flood 1990). These plant products form the dietary staple in that they represent greater than 50% of the total diet and often would constitute 70% to 80%. Hiatt's data compiled from several sources, and describing the proportions of hunting, gathering and fishing performed by various indigenous peoples, lists three central Australian linguistic groups, the Dieri, Arrernte, and Walpiri (Hiatt 1978). In all three cases, 70% of the diet consists of gatherable foods and 30% from hunting. Women are the sole providers of gatherable foods and men the sole hunters and as such, women provide 70% of the total diet of these people in arid Australia. The northern half of the Northern Territory possesses some 40 species of Acacia and although 19 species are useful to Aboriginal people, only one species, A. difficilis has seed that is eaten (Brock 1988). There are other more readily available carbohydrate sources such as yams that require less preparation.

Many grasses provide large amounts of soft seed and have been heavily utilized as a staple food by Aboriginal people, especially throughout arid and semi-arid Australia. The grain was collected, ground to a flour using millstones and water was added to form a paste which was eaten raw or cooked as a damper (unleavened bread) in the ashes. Particular wattle seed was similarly collected, prepared and eaten throughout central Australia. Although these skills still survive (Nganyintja 1985), the use of processed wheat flour has largely replaced these traditional practices (Bryce 1983). These seed grinding practices appear to be a relatively recent technological development. Archaeological excavations in central Australia at Puntutjarpa date the oldest millstones to 3500 years; at Puritjarra they are present for the last 2000 years and at Intirtekwerle, they constitute 10 percent of the artifacts in the last 700 years of deposits. The stratigraphy at two of these sites suggests a massive build-up in the level of the sandplain, the sediments having originated in the Simpson Desert dunefield. This suggests that sites in central Australia older than 5000 years may be deeply buried (Flood 1990). Furthermore, this indicates that Aboriginal people in central Australia have been grinding grass or wattle seed for no more than 4000 years. There are older sites closer to the coast in semi-arid country where the development of such practices became a possibility as a result of the drier climate and in creasing fire frequency. Archaeological evidence from the earliest of these sites, Lake Mungo, in the Willandra Lakes system in western New South Wales, demonstrates the presence of a seed grinding economy over the last 16000 years (Flood 1990).

Of the sixty or so species of Acacia in central Australia, Latz (1995) states that some 50% were, or still are, eaten by Aboriginal people and it is not only the seed which is consumed. Several species exude an edible sugary gum from wounds in the stem or branches which supplies a source of energy. Others are fed upon by insects which themselves secrete an edible substance while species such as A. kempeana are the host for various edible grubs (Kalotas and Goddard 1985) often referred to by non-Aboriginal people as witchetty grubs.

Toxicity

Not all wattleseed was used for food. Many coastal and some arid species contain toxic compounds. A. longifolia is one of the few species recorded as having been eaten in coastal eastern Australia (Kohen 1992), similarly, Acacia georginae seed reportedly contains sodium fluoroacetate the major constituent of 1080, a widely used rodenticide (P. Latz pers. commun.).

A. ligulata, umbrella bush, is a widespread and common semi-arid species. A. Kalotas (pers. comm. 1994) noted that there are mixed reports of the consumption of this seed. During his research near Warburton (eastern Western Australia_approx. 750 km WSW of Alice Springs) with Ngaanyatjara people in 1981-82, this species was recorded as one, the seed of which was commonly consumed. Anecdotal evidence from Yankunytjatjara speakers (approx. 600 km ESE of Warburton), suggests it was a species only eaten when no other seed was available as it caused hair loss, the hair regrowing sometime later (Kalotas 1985). Pintupi people (approx. 400 km north of Warburton) also say it was regularly consumed but said nothing of hair loss (A. Kalotas pers. commun. 1994). It may be that the alopecia (hair loss) resulted from a combination of factors rather than the action of A. ligulata seed alone. If it was consumed amongst the Yankunytjatjara only when other foods were scarce, then malnourishment may have played a role in the loss of hair. The tropical American legume genera, Leucaena and Mimosa, both closely related to Acacia, cause hair loss, when consumed, as a result of the presence of the amino acid, mimosine (Mabberley 1987; Windholz et al. 1983). When Leucaena was first used as a stock feed in northern Australia it caused problems with cattle. This was remedied when a bacterium was isolated from the gut of cattle in Java and introduced into drinking troughs in Australia (A. Kalotas pers. commun. 1994). It is possible that similar toxic compounds are present in Australian acacias and care needs to be taken in the choice of species and their subsequent screening as a part of any development of a new crop. Brand and Maggiore (1991) state that testing for the presence of toxic compounds is mandatory if these plants are to be developed as new food products. Many legume seeds contain a variety of toxic compounds that are usually denatured by the application of heat. These compounds, if untreated, can disrupt intestinal absorption of nutrients and produce growth retardation (Brand and Maggiore 1991).

Non-Food Uses

Although the main use of wattles is as a food source (Goddard 1992; Kalotas and Goddard 1985; Isaacs 1987; Kean 1991; Kohen 1992; Latz 1982,1995; Meggitt 1962; Tindale 1972) they have a number of other uses. These include provision of shelter (Nganyintj a 1985), preparations used as medicine (Anon. 1993), and the manufacture of various tools, musical instruments and weapons (Meggitt 1962; Moyle 1979; Brokensha 1978). Today they are largely used for artifact manufacture (Brokensha 1978) and more recently in various revegetation practices (Last 1990).

Linguistics

Until the mid 1900s, an apparent lack of collaborative research between anthropologists, botanists and zoologists led to difficulties in understanding Aboriginal natural resource use and management. Little traditional ecological knowledge was recorded, but much attention was paid to recording traditional botanical and zoological nomenclature. Anthropologists such as Meggitt (1962) recorded the use of particular plants or animals and the indigenous names for each, but it appears specimens were not collected for accurate identification by botanists or zoologists at a later date. As Aboriginal languages were oral, there was no standard spelling, and so anthropologists and linguists made attempts at recording such names phonetically. Older texts will spell the languages discussed here as "Alyawara" for Alyawerre; "Anmatjarra" and "Anmadjarra" for Anmatyerre; "Aranda" and "Arunta" for Arrernte; "Bindubi" and "Pintubi" for Pintupi; "Bidjandjara", "Pidjandjara", "Pitjandjara" and "Pitjantjara" for Pitjantjatjara; and "Walbiri" for Walpiri, with many other minor variants. There are several sounds for which there are no English equivalents and although spelling standards were established, they were, at times, inadequate and have been revised several times. Pitjantjatjara, for example, has been written since the early 1940s and despite this being a comparatively recent development, there are still inconsistencies in the way some of the sounds are written (Eckert and Hudson 1988). There are various lists of Aboriginal names for plants and animals which do not necessarily match with currently recorded names and so identifying species from these early records is problematic. We have managed to identify wattles that Meggitt (1962) recorded as being used by Walpiri people by cross referencing modern names and taking into account changes in the spelling conventions of linguists during this time (Table 1).

Table 2 indicates the number of species of acacia used as a seed food by particular language groups and, conversely, the number of language groups utilizing each species, in central Australia. There are many names for particular species in common between languages, the main reason being the linguistic affinities represented in the table. The Alyawarre, Anmatyerre and Arrernte languages all belong to the Arandic group while Pintupi and Pitjantjatjara are of the Western Desert group. The Walpiri is a member of the Ngarrkic Group but even so, Walpiri names for Acacia aneura, A. kempeana, A. murrayana, A. stipuligera and A. tetragonophylla are similar to Pintupi and Pitjantjatjara names. The name for A. coriacea, pangkuna or pungkuna, is common amongst all the languages. A. adsurgens and A. stipuligera are very similar in appearance, as are A. pachyacra and A. murrayana, and bear the same Alyawerre and Pitjantjatjara names, respectively. Although A. macdonelliensis is common throughout central Australia, only the Alyawerre used it, while A. maitlandii is widespread but rare and was never used by the Walpiri (Latz 1995). Of the 30 species and languages listed, both the Arandic and Western Desert groups ate 20 species, while the Ngarrkic group ate 21 species. A. aneura, A. coriacea, A. cuthbertsonii, A. estrophiolata, A. kempeana, A. murrayana, A. tetragonophylla and A. victoriae are the most common and more widespread species and are, therefore, the most widely consumed species. A. victoriae is present throughout the entire area, is common and used by all language groups.

THE BUSHFOOD INDUSTRY & CROP POTENTIAL

In recent years, there has been an upsurge of interest in novel food products and in particular those products branded as "bushfoods." Bushfoods can be defined as native plant or animal products used by indigenous Australians as either a traditional or contemporary foodstuff. This interest has led to the widespread use of bushfoods in the restaurant industry both in Australia and overseas. In some instances, these products have become souvenir items, marketed as "uniquely Australian cuisine" or as having been "wild collected by Aboriginal people on their traditional homelands, just as they have done so for thousands of years." Some of these products such as emu are now farmed commercially to meet growing demands.

Wattleseed is in high demand for use as a ground product in pastries and breads and also as a flavoring in desserts, especially ice-cream. It is also used to produce a high quality coffee-like beverage. Wattleseed is one bushfood product collected almost exclusively by Aboriginal people from wild populations throughout its natural range. The species most commonly collected is Acacia victoriae Benth. as it is generally regarded as having a superior flavor. A. victoriae is widespread over much of central Australia and fruits during December and January. Yield is unpredictable and is influenced by climatic conditions and, as such, is extremely variable. Wattleseed is not yet grown on a commercial scale and the demand far exceeds the supply. Despite this, small quantities of wattleseed are exported to the U.S., Canada, UK, France, Japan and SE Asia.

Several species of Acacia indigenous to central Australia are planted to revegetate or rehabilitate degraded land predominantly on Aboriginal communities throughout central Australia. Species commonly used throughout Pitjantjatjara Lands include A. victoriae, A. murrayana and A. kempeana (pers. obs. 1995). These are relatively fast growing species adapted to low rainfall and extreme temperatures and are planted to provide windbreaks, reduce erosion and to revegetate damaged sites. As the plants reach maturity they are often used for other purposes such as firewood or artifact manufacture (Last 1990) but less commonly for food. Edible grubs (maku) are extracted from the roots of A. kempeana at any opportunity but seed is not usually collected for food (M. Last pers. commun. 1995). These plants have potential as an informal crop, in that they possess a variety of uses which could form an additional source of seed for the bushfoods industry.

Nutritional Analysis

Acacia seeds are highly nutritious and contain 26% protein, 26% available carbohydrate, 32% fiber and 9% fat (Brand and Maggiore 1992). The fat content is higher than most legumes with the aril providing the bulk of fatty acids present. These fatty acids are largely unsaturated which is a distinct health advantage although it presents storage problems as such fats readily oxidize (Brand and Maggiore 1992). The mean total carbohydrate content of 55.8±13.7% is lower than that of lentils, but higher than that of soybeans while the mean fiber content of 32.3±14.3% is higher than that of other legumes such as lentils with a level of 11.7% (Brand and Maggiore 1992). The energy content is high in all species tested, averaging 1480±270 kJ per 100 g. Wattle seeds are low glycaemic index foods. The starch is digested and absorbed very slowly, producing a small, but sustained rise in blood glucose and so delaying the onset of exhaustion in prolonged exercise (Brand and Maggiore 1992).

Research at UWSH

The research at UWS-Hawkesbury is centered upon two species, Acacia victoriae and A. murrayana F. Muell ex Benth. The main aim is to develop quality plants with higher and more consistent yields and with an ease of cultivation that will allow Aboriginal people in arid areas to cultivate, harvest, process and market wattleseed to the world. In addition to this, we are seeking to gain an understanding of the agronomy of these plants through greenhouse and field trials.

A. murrayana is being studied as it has a very different growth habit to A. victoriae. Unlike A. victoriae, it is a spineless species which is a distinct advantage when harvesting seed by hand. In addition, it has potential for soil stabilization and land rehabilitation projects as it is a species capable of regeneration from its roots. This means it can regenerate vegetatively following fire or clearing. The possibility also exists that if crop yields fall due to senescence, the plants could be cut back to ground level without disturbing the soil and the subsequent regrowth should retain the growth and yield characteristics for which it was originally selected.

Work thus far has been aimed primarily at establishing field trials to examine the variation within these plants and the plants' responses to irrigation and fertilizers. Experiments to determine how the plants respond to nitrogen and potassium fertilization and rhizobial innoculation are also in progress.

There are two field trials planted on campus with another to be located at Umuwa in the Musgrave Ranges of northern South Australia. A visit was made to Umuwa in April 1995 to select a site for planting in collaboration with the Pitjantjatjara community.

Studies concerning floral and fruit development and also pollination are planned. Genetic analysis will be performed as part of the examination of variation within these species.

CONCLUSION

Acacia seed in Australia was, and in some areas still is, used as a food source by Aboriginal people. It is now popular with the emergence of the bush foods industry as a new product with a variety of culinary applications. Wild populations are harvested for their seed, but the plants have potential as a commercial crop. It is hoped that the production of seed for food use is adopted by Aboriginal communities. Roasted Acacia seeds offer an exciting new flavor for pastries and ice-creams and a caffeine free beverage.

REFERENCES

Aboriginal Communities of the Northern Territory. 1993. Traditional Aboriginal medicines in the Northern Territory of Australia. Conservation Commission of the Northern Territory of Australia, Darwin.
Brand, J and P. Maggiore. 1992. The nutritional composition of Australian Acacia seeds. In: A.P.N. House and C.E. Harwood (eds.), Australian Dry-zone Acacias for Human Food Proceedings of a workshop held at Glen Helen, Northern Territory, 7-10 Aug. 1991, CSIRO Division of Forestry & Australian Tree Seed Centre, Canberra.
Brock, J. 1988. Top End native plants. A comprehensive guide to the trees and shrubs of the Top End of the Northern Territory, John Brock Publ., Darwin.
Brokensha, P. 1978. The Pitjantjatjara and their crafts. Aboriginal Arts Board Australia Council, Sydney.
Bryce, S. 1983. The role of bush tucker in nutrition education. In: O'Dea, K. (ed.), Proc. Aboriginal Bushfoods Workshop. p. 20-23.
Christensen, P., H. Recher, and J. Hoare. 1991. Responses of open forests (dry sclerophyll forests) to fire regimes. p. 367-393. In: A.M. Gill, R.H. Groves, and I.R. Noble. (eds.), Fire and the Australian Biota. Australian Academy of Science, Canberra.
Eckert, P. and J. Hudson. 1988. Wangka Wiru: A handbook for the Pitjantjatjara language learner. Univ. of South Australia, Adelaide.
Flannery, T.F. 1994. The future eaters: an ecological history of the Australasian lands and people. Reed Books, NSW, Australia.
Flood, J. 1990. The riches of ancient Australia. University of Queensland Press, Queensland.
George, A.S. (ed.), 1981. Flora of Australia Volume 1, Introduction. Australian Government Publishing Service, Canberra.
Goddard, C. 1992. Pitjantjatjara/Yankunytjatjara to English Dictionary. Institute for Aboriginal Development, Alice Springs, NT, Australia.
Hall, N. and L.A.S. Johnson. 1993. The names of acacias of New South Wales with a guide to pronunciation of botanical names. Royal Botanic Gardens, Sydney, Australia.
Harden, G.J. (ed.). 1991. Flora of New South Wales, Vol. 2. New South Wales Univ. Press, NSW, Australia.
Hiatt, B. 1978. Woman the gatherer. In: F. Gale, Woman's role in Aboriginal society (ed.), Australian Institute of Aboriginal Studies, Canberra.
Isaacs, J. 1987. Bush food. Aboriginal food and herbal medicine. Weldons, Sydney, Australia.
Kalotas, A. and C. Goddard. 1985. Punu, Yankunytjatjara plant use. Institute for Aboriginal Development, Alice Springs, NT, Australia.
Kean, J. 1991. Aboriginal-acacia relationships in central Australia. Records of the South Australian Museum, 24(2):111-124.
Kohen, J.L. and A.J. Downing. 1992. Aboriginal use of plants on the western Cumberland Plain. Sydney Basin Naturalist, No. 1, p. 1-8. Australasian Naturalist Pub., Sydney, Australia.
Latz, P.K. 1982. Bushfires and Bushtucker: Aborigines and Plants in Central Australia. MA (Hons) thesis, Univ. of New England, NSW.
Latz, P.K. 1995. Bushfires and bushtucker: Aboriginal plant use in Central Australia. IAD Press, Alice Springs, NT, Australia.
Mabberley, D.J. 1987. The plant-book. A portable dictionary of the higher plants. Cambridge Univ., Cambridge.
Meggitt, M.J. 1962. Desert people: A study of the Walbiri Aborigines of Central Australia. Angus and Robertson Publishers, Australia.
Morrison, D.A. and S.J. Davies. 1991. Acacia. p. 327-328. In: G.J. Harden, (ed.), Flora of New South Wales, vol. 2. New South Wales Univ. Press, Australia.
Moyle, R.M. 1979. Songs of the Pintupi: Musical life in a central Australian society. Australian Institute of Aboriginal Studies, Canberra.
Nganyintja. 1985. Mayi Wiru, Part 1, Winter foods. Angatja Video in association with Riverbed Productions, South Australia.
Pedley, L. 1987. Generic status of Acacia sensu lato, Australian Systematic Botany Society Newsletter, 53(Dec. 1987):87-91.
Tindale, N.B. 1972. The Pitjandjara. p. 217-268. In: M.G. Bicchieri (ed.), Hunters and gatherers today. Holt, Rinehart & Winston, London.
Windholz, M., S. Budavari, R.F. Blumetti, and E.S. Otterbein (eds.). 1983. The Merck index. An encyclopedia of chemicals, drugs and biologicals. 10th ed. Merck & Co., Rahway, NJ.

*Funding to establish the trial at Umuwa has been made available from a grant by the University of Technology Sydney-Jumbunna Centre for Australian Indigenous Studies, Education and Research for which we are most grateful.

Table 1. Aboriginal names given to Acacia species used by the Walpiri as listed by Meggitt (1962) with nomenclatural additions and corrections (Latz 1995). Species names in bold are those identified and/or corrected by the authors. One species remains unidentified and the identity of Meggitt's "waralga" as A. ligulata is uncertain.

	Aboriginal names
Acacia species	Former spelling^z	Current spelling^y	Uses^z
ancistrocarpa	birauru	pirraru	No use recorded
aneura	mandja	manja	Edible seeds; wood for implements
coriacea	bangguna	pangkuna	Edible seeds; wood for implements
dictyophleba	bilbirinba	pilpirrinpa	Leaves used medicinally
estrophiolata	jadanbi	yajarnpi	Wood for implements and sacred objects
farnesiana	budunari	putunarri	No use recorded
kempeana	ngalgiri	ngalkirdi	Edible seeds; trunk harbours witchetty grubs
notabilis syn. pruinocarpa^x	mandala	marntarla	Edible seeds, gum; wood for implements
dictyophleba	badudu	patutu	Wood for spear shafts
unidentified	bilingarba		No use recorded
adsurgens	budjubanda	puju-parnta	Edible seeds
cowleana	ganalarambi	kanarlarrampi	Wood for spear shafts
aff. aneura^x	jabiljaru	yapilyardu	Trunk harbours witchetty grubs
adsurgens or tenuissima	minjana	minyana	Edible seeds; wood for implements
ligulata?	waralga	wardarrka?	No use recorded
spondylophylla	bundalji	puntaltji	Trunk harbours witchetty grubs
tetragonophylla	gurara	kurara	Edible seeds
victoriae	ganabargu	kanaparlku	No use recorded

^zMeggitt 1962.
^yLatz 1982, 1985.
^xNomenclature based on Latz 1995.

Table 2. Acacia species traditionally used as edible seed by various central desert linguistic groups and their traditional names. The names are given only where the species was used for food as determined by Latz (1982, 1995); Goddard (1992); Kalotas and Goddard (1985); Meggitt (1962) and Tindale (1972). The lack of use of an otherwise edible species can be due to the absence of that species within that particular linguistic area and does not necessarily suggest the species was regarded as inedible, toxic or of inferior quality. NIA indicates the species is not in the area. Alternative spellings for Alyawarre (Alyawerr), Anmatyerre (Anmatyerr) and Arrernte words are included for the benefit of readers with limited access to recent Australian linguistic works.

	Aboriginal linguistic group
Acacia species	Alyawarre	Anmatyerre	Arrernte	Arrernte (southern)	Pintupi	Pitjantjatjara	Walpiri
acradenia	ampwey mpwiya		NIA	NIA	NIA	NIA	ngardurrkura ngarulkurra
adsurgens	ilkirta ilkert ilwerreny alirrinya	atiyipinha ateyepenh ilwerreny lirrinytja	NIA	NIA	NIA	NIA	minyana puju-parnta mintirlpiri kulaki
ammobia (syn. doratoxylon)	NIA	NIA	NIA	NIA	NIA	utjalpara	NIA
ancistrocarpa							wartarurru pirraru
aff. aneura			ititja-		lililiyi		yarlpiyardu
(?syn. aneura var. latifolia)			ilpatjata irtetye-irlpelharte
aneura (syn. brachystachya)	artitja artety	artitja artety	ititja irtetye manytja		wanari manytja kurrku mantja	wanari kurku kalpilya puyukara wintalyka	yulnantji? wartiji manja wanajiti
colei (syn. holosericea)	alerrey aliriya alyari	alkart alkarta	NIA	NIA	kuna-kuna?	kilkiti kuna-kuna?	kalkardi
coriacea	awenth ntjirrima	akiyrlpirra awenth ntjirrima	pungkuna		irrkili yirrkili pangkuna	kunapuka mulupuka	pangkuna kunarnturu wakirlpirri
cowleana	aliriya alerrey	alkarta alkart	NIA	NIA	kilkiti	NIA	kanarlarrampi kalkardi parrapi
cuthbertsonii	alhanker irley pirley	pilhi perley ulyuya lywey			yalpirri piliyi	alpiri kalirma	pirliyi
dictyophleba	ulupula ulunkurra alhanker alhepalh	ulkurnarra lkwernarr paturta partwert		ilpakilparra ilpakilparre	minytju mulyati yurrtjanpa utjanypa	mintju ngarkalya	wurpardi yinjirtingu yurrpardi pilpirrinpa patutu matutu marlarntarrpa
estrophiolata	athiyimpa athimp athinga atheng	tjarnpa tywarnpe atjarnpa atyarnp athenga tunga	tjwarnpa tywarnpe		walakarri	utjanypa tjau	walirri yajarnpi wajarnpi ajarnpa
hemignosta	NIA	NIA	NIA	NIA	NIA	NIA	mirrirn-mirrirnpa? luwiluwilta
inaequalatera (syn.pyrifolia)	NIA	NIA	NIA	NIA	NIA	NIA	janjirnngi janjinki
jennerae	NIA	lalkirrika lalkerrek	NIA	NIA	NIA	NIA	walalyirrki
kempeana	atnyima atnyem	utnyima atnyem	tnyima tnyeme		yilykuwarra ilykuwarra iripili piyanpa	ilykuwara	ngarlkirdi yiripili
ligulata				nyukurrka? watarka	watarrka

lysiphloia	awurrnga awernng	NIA	NIA	NIA	NIA	NIA	murlurrpa
macdonelliensis	irrara irrar
maitlandii (syn. patens)			ilupa-lupa lwepe-lwepe
murrayana (syn.frumentacea)	arrilya arrely	arrilya arrely	irrilya irrelye		nyurrinpa	tjuntala tjuntjula	juntala
olgana						kaliwara	NIA
oswaldii						wilpiya waltari
pachyacra						tjuntala
pruinocarpa (syn. notabilis)	NIA	NIA				itawara
ramulosa	NIA	NIA	NIA	NIA	NIA	pakuta palpa	NIA
stipuligera	mpwiya ampwey	NIA	NIA	NIA	tjilpirinpa tjirrpirinypa wilpurra	NIA	jirrpirinypa kurapuka wirlpurpa ngirnti-yirrpi
tenuissima	antjulinya antywerleny artepwel	antjulinya antywerleny	NIA	NIA		NIA	minyana kuwiyangayi watiyawarnu kulaki nyintirriyilpi watiyawarnu
tetragonophylla	alkitjirra arlketyerr	alkitjirra arlketyerr	ilkitjirra arlketyerre		wakalpuka	wakalpuka kurara kurungantiri	kurarra
victoriae	arlupa arlep	arlupa arlep	tupurla urlupa urlepe	tuperle	pulkuru	aliti ngatunpa	kanaparlku yalupu yarlirti

Last update June 6, 1997 aw

Wormwood

2010-08-02T22:54:00.000-07:00

Artemisia absinthium L.

Figure 124.—Wormwood (Artemisia absinthium)

Other common names.—Absinthium, absinth, madderwort, mingwort, old woman, warmot.

Habitat and range.—Wormwood, naturalized from Europe and mostly escaped from gardens in this country, is found in waste places and along roadsides from Newfoundland to New York and westward. It is cultivated in some localities, especially in Michigan and Indiana, for the production of the volatile oil* which it contains.

Description.—This shrubby, aromatic, much-branched plant grows from 2 to 4 feet in height. The growing shoots are silvery white with fine silky hairs; and the grayish-green leaves, which are from 2 to 5 inches long, are divided into small leaflets The flower clusters, appearing from July to October, consist of numerous small, insignificant, drooping, yellow heads. The plant has an aromatic odor and an exceedingly bitter taste.

Part used.—The leaves and tops, which should be collected when the plant is in flower.

*Sievers, A.F. Methods of extracting volatile oils from plant material and the production of such oils in the United States. U.S. Dept. Agr. Tech. Bul. 16, 36 p. illus. 1928.

Abiu

2010-08-02T22:53:00.000-07:00

A minor member of the Sapotaceae, the abiu, Pouteria caimito Radlk. (syns. Lucuma caimito Roem. & Schult.; Achras caimito Ruiz & Pavón), has acquired few vernacular names. In Colombia, it is called caimito, caimito amarilla, caimo or madura verde; in Ecuador, luma or cauje; in Venezuela, temare; in Brazil, abiu, abi, abio, abieiro or caimito. It is called yellow star apple in Trinidad.

Plate LVII: ABIU, Pouteria caimito

Description

The tree has a pyramidal or rounded crown; is generally about 33 ft (10 m) high but may reach 115 ft (35 m) in favorable situations. A gummy latex, white or reddish, exudes from wounds in the bark. The leaves are alternate and highly variable; may be ovate-oblong, obovate or elliptic; 4 to 8 in (10-20 cm) long, 1 1/4 to 2 3/8 in (3-6 cm) wide; short-pointed at the apex, sometimes long-tapering at the base; smooth or with a few scattered hairs. The flowers, borne singly or in groups of 2 to 5 in the leaf axils, are cylindrical, 4- to 5-lobed, white or greenish; 1/6 to 1/3 in (4-8 mm) long. The fruit, downy when young, is ovoid, elliptical or round; 1 1/2 to 4 in (4-10 cm) long, sometimes having a short nipple at the apex; with smooth, tough, pale-yellow skin when ripe and fragrant, white, mucilaginous, translucent, mild-flavored, sweet or insipid pulp containing 1 to 4 oblong seeds, brown, with a pale hilum on one side. Until fully ripe, the fruit is permeated with latex and is very gummy and astringent.

Fig. 109: The pale-yellow abiu (Poutertai caimito) as sold in the native market of Buenaventura, Colombia. The fruit is gummy with latex until it becomes fully ripe.

Origin and Distribution

The abiu is a denizen of the headwaters of the Amazon. It grows wild on the lower eastern slopes of the Andes from southwestern Venezuela to Peru. It is often cultivated around Iquitos, Peru. In Ecuador, it is common in the Province of Guayas and the fruits are sold in the markets of Guayaquil. It is much grown around Pará, Brazil; less frequently near Rio de Janeiro, and to a limited extent at Bahia. In Colombia, it is fairly common in the regions of Caquetá, Meta and Vaupés and it abounds in the adjacent areas of Amazonas, Venezuela. It has been growing for many years in Trinidad.

The plant explorers, Dorsett, Shamel and Popenoe, collected seeds for the United States Department of Agriculture in Bahia in 1914 (S.P.I. #37929). In 1915, seeds were received from Lavoras, Minas, Brazil (S.P.I. #41003). This species has been planted several times at the Agricultural Research and Education Center, Homestead, Florida, but most of the young plants have been killed by winter cold. A few trees planted in 1953 fruited in 1962.

Varieties

There is much variation in the form, size and quality of the fruits of seedling trees, some having firm flesh, some soft; and some are insipid, while others have agreeable flavor. At Puerto Ospina, along the Putamayo River in Colombia, there is a type that fruits in 4 years. The fruit is round and large. Near the River Inirida, in Vaupés, Colombia, there is a type that bears in one year from seed, but the fruits are small with little pulp.

Climate

The abiu is strictly tropical or near-tropical. It thrives best in a year-around warm and moist climate, yet Popenoe noted that it does well in somewhat cooler Rio de Janeiro. In Peru it has not been found above 2,000 ft (650 m), though in Colombia, it can be grown up to an elevation of 6,000 ft (1,900 m).

Soil

The tree is naturally suited to fertile, wet soil. It is subject to chlorosis in the limestone of southern Florida.

Season

The fruits are in season in March and April in Ecuador. They are sold in some Brazilian markets from September to April but only a few are seen in the much shorter season of February and March at Bahia. Fruits have matured in October in Florida. The abiu can be picked while underripe and firm for transport to markets.

Propagation and Culture

In Brazil, the washed seeds are dried in the shade and then planted, 3 together and 2 in (5 cm) deep in enriched soil. They will germinate in 15 to 20 days. When the seedlings are 4 in (10 cm) high, the 2 weakest are removed. The strong one is set out when 12 to 16 in (30-40 cm) high. Spacing is 17 x 20 ft (6 x 5 m). One year later, the lower branches are pruned. Fruiting will begin in 3 years; will be substantial in 5 years.

Pests and Diseases

Actually, the fruit has little value commercially because it is commonly damaged by small insects (bichos in Spanish and Portuguese). In Brazil, the chief pests are said to be fruit flies.

Food Uses

In Colombia, people who wish to eat the abiu. are advised to grease their lips beforehand to keep the gummy latex from clinging to them. It is mostly eaten out-of-hand but, in Pará, some types are used to make ices and ice cream.

Food Value Per 100 g of Edible Portion*
Calories	95
Moisture	74.1 g
Protein	2.1 g
Lipids	1.1 g
Glycerides	22.0 g
Fiber	3.0 g
Ash	0.7 g
Calcium	96.0 mg
Phosphorus	45.0 mg
Iron	1.8 mg
Vitamin B,	0.2 mg
Vitamin B2	0.2 mg
Niacin	3.4 mg
Ascorbic Acid	49.0 mg
Amino Acids (mg per g of nitrogen [N 6.25])
Lysine	316 mg
Methionine	178 mg
Threonine	219 mg
Tryptophan	57 mg

*According to analyses made in Brazil.

Other Uses

Wood: The wood is dense and heavy, hard, and valued for construction.

Medicinal Uses: In Brazil, the pulp, because of its mucilaginous nature, is eaten to relieve coughs, bronchitis and other pulmonary complaints. The latex is given as a vermifuge and purge and is applied on abscesses.

Amyl nitrite

2010-08-02T22:52:00.001-07:00

PHARMACOLOGIC CATEGORY
Antidote
Vasodilator

DOSING: ADULTS
Angina: Inhalation: 1-6 inhalations from 1 crushed ampul; may repeat in 3-5 minutes

Cyanide poisoning: Inhalation: Inhale the vapor from a 0.3 mL crushed ampul every minute for 15-30 seconds until I.V. sodium nitrite infusion is available

DOSING: ELDERLY — Refer to adult dosing.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Vapor for inhalation [crushable covered glass capsules]: Amyl nitrite USP (0.3 mL)

DOSAGE FORMS: CONCISE
Vapor for inhalation [crushable covered glass capsules]: Amyl nitrite USP (0.3 mL)

GENERIC EQUIVALENT AVAILABLE — Yes

ADMINISTRATION — Administer nasally. Patient should not be sitting. Crush ampul in woven covering between fingers and then hold under patient's nostrils.

USE — Coronary vasodilator in angina pectoris; adjunct in treatment of cyanide poisoning; produce changes in the intensity of heart murmurs

ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.

Cardiovascular: Postural hypotension, cutaneous flushing of head, neck, and clavicular area, palpitations, tachycardia, sinus tachycardia, vasodilation

Central nervous system: Headache, incoherent speech, restlessness

Dermatologic: Contact dermatitis

Gastrointestinal: Nausea, colitis, vomiting

Genitourinary: Penile erection enhanced, retarded ejaculation

Hematologic: Heinz body hemolysis/hemolytic anemia

Ocular: Increased intraocular pressure, blurred vision

Respiratory: Tracheobronchitis

CONTRAINDICATIONS — Hypersensitivity to nitrates; severe anemia; head injury; angle-closure glaucoma; postural hypotension; head trauma or cerebral hemorrhage; pregnancy

WARNINGS / PRECAUTIONS
Disease-related concerns: Cardiovascular disease: Use with caution in patients with coronary artery disease and patients with hypotension. Increased intracranial pressure: Use with caution in patients with increased intracranial pressure.

Special populations: Pediatrics: Safety and efficacy have not been established in children.

DRUG INTERACTIONS — There are no known significant interactions.

PREGNANCY RISK FACTOR — C (show table)

LACTATION — Excretion in breast milk unknown/not recommended

MONITORING PARAMETERS — Monitor blood pressure during therapy

INTERNATIONAL BRAND NAMES — Amyl Nitrite (NZ)

MECHANISM OF ACTION — Relaxes vascular smooth muscle; decreased venous ratios and arterial blood pressure; reduces left ventricular work; decreases myocardial O2 consumption; in cyanide poisoning, amyl nitrite converts hemoglobin to methemoglobin that binds with cyanide to form cyanate hemoglobin

PHARMACODYNAMICS / KINETICS
Onset of action: Angina: Within 30 seconds

Duration: 3-15 minutes

PATIENT INFORMATION — Lie down during administration. Crush ampul between fingers and then inhale through nostrils. May cause dizziness. Call paramedics or have someone take you to the hospital immediately if pain is not relieved after 3 doses.

Anagrelide

2010-08-02T22:52:00.000-07:00

MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Anagrelide may be confused with anastrozole

U.S. BRAND NAMES — Agrylin®

PHARMACOLOGIC CATEGORY
Phospholipase A2 Inhibitor

DOSING: ADULTS — Thrombocythemia: Oral: Initial: 0.5 mg 4 times/day or 1 mg twice daily (most patients will experience adequate response at dose ranges of 1.5-3 mg/day)

Note: Maintain initial dose for ≥ 1 week, then adjust to the lowest effective dose to reduce and maintain platelet count <600,000/µl>0.5 mg/day in any 1 week; maximum dose: 10 mg/day or 2.5 mg/dose

DOSING: PEDIATRIC — Thrombocythemia: Oral: Initial: 0.5 mg/day (range: 0.5 mg 1-4 times/day); see "Note" in adult dosing.

DOSING: ELDERLY — Refer to adult dosing.

DOSING: RENAL IMPAIRMENT — No adjustment required in renal insufficiency.

DOSING: HEPATIC IMPAIRMENT
Moderate impairment: Initial: 0.5 mg once daily; maintain for at least 1 week with careful monitoring of cardiovascular status; the dose must not be increased by >0.5 mg/day in any 1 week.

Severe impairment: Contraindicated

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule: 0.5 mg, 1 mg
Agrylin®: 0.5 mg

DOSAGE FORMS: CONCISE
Capsule: 0.5 mg, 1 mg
Agrylin®: 0.5 mg

GENERIC EQUIVALENT AVAILABLE — Yes

ADMINISTRATION — May be administered without regard to food.

USE — Treatment of thrombocythemia associated with myeloproliferative disorders (eg, chronic myelogenous leukemia, essential thrombocythemia, polycythemia vera, myeloid metaplasia with myelofibrosis, or other myeloproliferative disorder)

ADVERSE REACTIONS SIGNIFICANT
>10%:
Cardiovascular: Palpitation (26%), edema (21%)
Central nervous system: Headache (44%), dizziness (15%), pain (15%)
Gastrointestinal: Diarrhea (26%), nausea (17%), abdominal pain (16%)
Neuromuscular & skeletal: Weakness (23%)
Respiratory: Dyspnea (12%)

1% to 10%:
Cardiovascular: Peripheral edema (9%), chest pain (8%), tachycardia (8%), angina, arrhythmia, HF, hypertension, postural hypotension, syncope, thrombosis, vasodilatation
Central nervous system: Fever (9%), malaise (6%), amnesia, chills, confusion, depression, insomnia, migraine, nervousness, somnolence
Dermatologic: Rash (8%), pruritus (6%), alopecia, bruising, photosensitivity, urticaria
Endocrine & skeletal: Dehydration
Gastrointestinal: Flatulence (10%), vomiting (10%), anorexia (8%), dyspepsia (5%), aphthous stomatitis, constipation, eructation, gastritis, GI distress, GI hemorrhage, melena
Genitourinary: Dysuria
Hematologic: Thrombocytopenia (9%; grades 3/4: 5%), anemia, hemorrhage
Hepatic: Liver enzymes increased
Neuromuscular & skeletal: Back pain (6%), paresthesia (6%), arthralgia, leg cramps, myalgia
Ocular: Amblyopia, diplopia, visual field abnormality
Otic: Tinnitus
Renal: Renal abnormality (1% to <5%), renal failure (1%), hematuria
Respiratory: Pharyngitis (7%), cough (6%), asthma, bronchitis, epistaxis, pneumonia, rhinitis, sinusitis
Miscellaneous: Flu-like syndrome, lymphadenopathy

Frequency not defined: Atrial fibrillation, cardiomegaly, cardiomyopathy, cerebrovascular accident, complete heart block, deep vein thrombosis, gastric/duodenal ulceration; interstitial lung disease (allergic alveolitis, eosinophilic pneumonia, interstitial pneumonitis); leukocyte count increased, MI, myelofibrosis, pancreatitis, pericarditis, pericardial effusion, pleural effusion, polycythemia, pulmonary fibrosis, pulmonary hypertension, pulmonary infiltrates, seizure, stroke, transient ischemic attack

CONTRAINDICATIONS — Severe hepatic impairment

WARNINGS / PRECAUTIONS
Concerns related to adverse effects: Pulmonary disorders: Interstitial lung disease (including allergic alveolitis, eosinophilic pneumonia, and interstitial pneumonitis) has been associated with use. Onset is from 1 week to several years, usually presenting with progressive dyspnea with lung infiltrations; symptoms usually improve after discontinuation. Renal abnormalities: Renal abnormalities (including renal failure) have been observed with anagrelide use; may be associated with pre-existing renal impairment, although dosage adjustment due to renal insufficiency was not required. Monitor closely in patients with renal insufficiency.

Disease-related concerns: Cardiovascular disease: Use with caution in patients with known or suspected heart disease; tachycardia, orthostatic hypotension, and heart failure have been reported. Pretreatment cardiovascular evaluation and careful monitoring during treatment is recommended. Hepatic impairment: Use with caution in patients with mild-to-moderate hepatic impairment; dosage reduction and careful cardiovascular monitoring are required for moderate impairment; use is contraindicated in severe hepatic impairment.

METABOLISM / TRANSPORT EFFECTS — Substrate of CYP1A2 (minor)

DRUG INTERACTIONS
Anticoagulants: Antiplatelet Agents may enhance the anticoagulant effect of Anticoagulants. Risk C: Monitor therapy

Antiplatelet Agents: May enhance the anticoagulant effect of other Antiplatelet Agents. Risk C: Monitor therapy

Dasatinib: May enhance the anticoagulant effect of Antiplatelet Agents. Risk C: Monitor therapy

Drotrecogin Alfa: Antiplatelet Agents may enhance the adverse/toxic effect of Drotrecogin Alfa. Bleeding may occur. Risk D: Consider therapy modification

Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Antiplatelet Agents. Bleeding may occur. Risk D: Consider therapy modification

Ibritumomab: Antiplatelet Agents may enhance the adverse/toxic effect of Ibritumomab. Both agents may contribute to impaired platelet function and an increased risk of bleeding. Risk C: Monitor therapy

MAO Inhibitors: May enhance the orthostatic effect of Orthostasis Producing Agents. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May enhance the adverse/toxic effect of Antiplatelet Agents. An increased risk of bleeding may occur. Nonsteroidal Anti-Inflammatory Agents may diminish the cardioprotective effect of Antiplatelet Agents. This interaction is likely specific to aspirin, and not to other antiplatelet agents. Risk C: Monitor therapy

Omega-3-Acid Ethyl Esters: May enhance the antiplatelet effect of Antiplatelet Agents. Risk C: Monitor therapy

Pentosan Polysulfate Sodium: May enhance the adverse/toxic effect of Antiplatelet Agents. Specifically, the risk of bleeding may be increased by concurrent use of these agents. Risk C: Monitor therapy

Pentoxifylline: May enhance the antiplatelet effect of Antiplatelet Agents. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the antiplatelet effect of Antiplatelet Agents. Risk C: Monitor therapy

Salicylates: Antiplatelet Agents may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result. Risk C: Monitor therapy

Thrombolytic Agents: Antiplatelet Agents may enhance the anticoagulant effect of Thrombolytic Agents. Risk C: Monitor therapy

Tositumomab and Iodine I 131 Tositumomab: Antiplatelet Agents may enhance the adverse/toxic effect of Tositumomab and Iodine I 131 Tositumomab. Specifically, the risk of bleeding-related adverse events may be increased. Risk C: Monitor therapy

ETHANOL / NUTRITION / HERB INTERACTIONS
Ethanol: May increase CNS adverse effects.

Food: No clinically significant effect on absorption.

Herb/Nutraceutical: Avoid herbs with anticoagulant/antiplatelet properties (alfalfa, anise, bilberry, bladderwrack, bromelain, cat's claw, celery, chamomile, coleus, cordyceps, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng [American], ginseng [Panax], ginseng [Siberian], grape seed, green tea, guggul, horse chestnut seed, horseradish, licorice, prickly ash, red clover, reishi, SAMe [S-adenosylmethionine], sweet clover, turmeric, white willow); may enhance the adverse effect of antiplatelets agents.

PREGNANCY RISK FACTOR — C (show table)

PREGNANCY IMPLICATIONS — Teratogenic effects were not observed in animal studies; however, decreased pup survival was noted. Use of anagrelide during pregnancy is limited. The manufacturer recommends effective contraception in women of childbearing potential. Use during pregnancy only if potential benefit to mother outweighs possible risk to the fetus.

LACTATION — Excretion in breast milk unknown/not recommended

DIETARY CONSIDERATIONS — May be taken without regard to food.

PRICING — (data from drugstore.com)
Capsules (Agrylin)
0.5 mg (50): $270.99
1 mg (50): $546.00

Capsules (Anagrelide HCl)
0.5 mg (30): $79.55
1 mg (50): $100.00

MONITORING PARAMETERS — Platelet count (every 2 days during the first week of treatment and at least weekly until the maintenance dose is reached); CBC with differential, ALT, AST, BUN, and serum creatinine (monitor closely during first weeks of treatment); blood pressure; cardiovascular exam (pretreatment; monitor during therapy). Monitor for thrombosis or bleeding.

CANADIAN BRAND NAMES — Agrylin®; Dom-Anagrelide; Mylan-Anagrelide; PHL-Anagrelide; PMS-Anagrelide; Sandoz-Anagrelide

INTERNATIONAL BRAND NAMES — Agrelid (AR); Agrylin (AU, HK, ID, IL, KP, PH, TW); Thromboreductin (HK, ID, MY); Xagrid (AT, BE, BG, CH, CZ, DE, DK, ES, FI, FR, GB, GR, HN, IE, IT, NL, NO, PT, RU, SE, TR)

MECHANISM OF ACTION — Anagrelide appears to inhibit cyclic nucleotide phosphodiesterase and the release of arachidonic acid from phospholipase, possibly by inhibiting phospholipase A2. It also causes a dose-related reduction in platelet production, which results from decreased megakaryocyte hypermaturation (disrupts the postmitotic phase of maturation).

PHARMACODYNAMICS / KINETICS
Onset of action: Initial: Within 7-14 days; complete response (platelets ≤ 600,000/mm3): 4-12 weeks

Duration: 6-24 hours; upon discontinuation, platelet count begins to rise within 4 days

Metabolism: Hepatic; to RL603 and 3-hydroxy anagrelide

Half-life elimination, plasma: 1.3 hours

Time to peak, serum: 1 hour

Excretion: Urine (<1% as unchanged drug)

Amsacrine

2010-08-02T22:51:00.000-07:00

PHARMACOLOGIC CATEGORY
Antineoplastic Agent

DOSING: ADULTS — Details concerning dosing in combination regimens should also be consulted.

Acute leukemia: I.V.:
Induction: 75-125 mg/m2/day for 5 days every 3-4 weeks (125 mg/m2/day is preferred; two courses may be necessary to achieve induction; increase dose by 20% in second and subsequent cycles if marrow hypoplasia not achieved and in absence of significant toxicity in previous course.)
Maintenance: Once remission has been achieved, maintenance dose should be ~50% of induction dose, administered every 4-8 weeks, depending on blood counts and marrow recovery

DOSING: ELDERLY — Refer to adult dosing.

DOSING: RENAL IMPAIRMENT
Dosage reduction recommended; specific guidelines from the manufacturer are not available; the following guidelines have been used by some clinicians:

Hall, 1983:
Serum creatinine 1.2-1.8 mg/dL: No adjustment recommended
Serum creatinine 2-3 mg/dL, oliguric patients: Administer 60% to 70% of dose; may increase subsequent dose based on toxicity.

Hornedo, 1985: BUN >20 mg/dL or serum creatinine >1.5 mg/dL: Administer 75% of dose

DOSING: HEPATIC IMPAIRMENT — Bilirubin >2 mg/dL: Dosage reduction recommended; specific guidelines from the manufacturer are not available; the following guidelines have been used by some clinicians:

Hall, 1983: Bilirubin >2 mg/dL: Administer 60% to 70% of dose; may increase subsequent dose based on toxicity.

Hornedo, 1985: Bilirubin >2 mg/dL: Administer 75% of dose

Koren, 1992: Severe hepatic dysfunction: Administer ≤ 50% of dose

DOSING: ADJUSTMENT FOR TOXICITY — Consider decreasing dose by 20% if life-threatening infection or hemorrhage occurred in previous cycle; delay second and subsequent cycles until recovery from myelosuppression or evidence of leukemic infiltrate is evident.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [CAN] = Canadian brand name

Injection, solution [preservative free]:
AMSA PD [CAN]: 50 mg/mL (1.5 mL) [supplied with L-lactic acid 0.0353 M 13.5 mL] [not available in the U.S.]

DOSAGE FORMS: CONCISE
Injection, solution [preservative free]:
AMSA PD [CAN]: 50 mg/mL (1.5 mL) [not available in the U.S.]

GENERIC EQUIVALENT AVAILABLE — No

ADMINISTRATION — I.V.: Infuse over 60-90 minutes; avoid extravasation.

COMPATIBILITY — Stable in D5W; incompatible with BNS, D5NS, D51/4NS, D51/2NS, D5LR, D10NS, NSS, LR, chloride ion. Amsacrine forms an immediate precipitate in the presence of chloride ion; do not mix with drugs that are chloride or hydrochloride salts.

Y-site administration: Compatible: Amikacin, chlorpromazine, clindamycin, cytarabine, dexamethasone, diphenhydramine, famotidine, fludarabine, gentamicin, granisetron, haloperidol, hydrocortisone sodium succinate, hydromorphone, lorazepam, morphine, prochlorperazine, promethazine, ranitidine, sodium bicarbonate, tobramycin, vancomycin. Incompatible: Acyclovir, amphotericin, aztreonam, calcium chloride, ceftazidime, ceftriaxone, cephalothin, cimetidine, cisplatin, filgrastim, furosemide, ganciclovir, heparin, methylprednisolone, metoclopramide, ondansetron, potassium chloride, sargramostim.

Compatibility when admixed: Compatible: Sodium bicarbonate, bleomycin

USE — Canada: Refractory acute leukemia

USE - UNLABELED / INVESTIGATIONAL — Acute myeloid leukemia (AML)

ADVERSE REACTIONS SIGNIFICANT
>10%:
Gastrointestinal: Nausea (>10%), vomiting (>10%), stomatitis (>10%), diarrhea (>10%), perirectal abscess (>10%), abdominal pain (>10%)
Hematologic: Myelosuppression, leukopenia (nadir: 11-13 days; recovery: days 17-25)

Frequency not defined:

Cardiovascular: Atrial tachyarrhythmia, atrial tachycardia, atrial fibrillation, bradycardia, cardiomyopathy (rare), cardiopulmonary arrest, CHF (rare); ECG changes (QT prolongation, nonspecific ST segment or T wave changes); ejection fraction decreased, hypotension, sinus tachycardia, tachycardia, ventricular arrhythmia, ventricular extrasystoles, ventricular fibrillation, ventricular tachyarrhythmia

Central nervous system: Confusion, dizziness, emotional lability, fever, headache, hypoesthesia, lethargy, seizure

Dermatologic: Alopecia, cutaneous inflammatory reaction, dermatologic reaction, purpura, rash (purpuric or maculopapular), urticaria

Gastrointestinal: Anorexia, dysphagia, gingivitis, gum hemorrhage, hematemesis, weight changes

Genitourinary: Orange-red discoloration of the urine

Hematologic: Anemia, granulocytopenia, hemorrhage, pancytopenia, thrombocytopenia

Hepatic: Alkaline phosphatase increased, AST increased, bilirubin increased, hepatic insufficiency, hepatitis, hepatotoxicity, jaundice, progressive liver failure

Local: Injection site inflammation, phlebitis

Neuromuscular & skeletal: Musculoskeletal pain, paresthesia, weakness

Renal: BUN increased, creatinine increased, hematuria, proteinuria, renal failure

Respiratory: Dyspnea

Miscellaneous: Allergic reaction, infection

CONTRAINDICATIONS — Hypersensitivity to amsacrine, acridine derivatives, or any component of the formulation; pre-existing bone marrow suppression due to chemotherapy or radiation therapy

WARNINGS / PRECAUTIONS
Special handling: Hazardous agent: Use appropriate precautions for handling and disposal.

Concerns related to adverse effects: Bone marrow suppression: Myelosuppression, including transient leukopenia, is a common toxicity; prolonged marrow aplasia may occur. May require dose reduction, therapy interruption or treatment delay. Cardiovascular effects: Acute cardiotoxicity, including arrhythmia, ECG changes, and rarely, cardiomyopathy and CHF, have been reported with use, although generally not considered to be a cumulative dose effect. Risk factors for cardiotoxicity may include hypokalemia and a history of anthracycline therapy. Correct fluid and electrolyte imbalance prior to treatment initiation. Use with caution in patients with underlying cardiovascular disease. Tumor lysis syndrome: Tumor lysis syndrome may occur; adequate hydration and prophylactic uric acid reduction should be considered prior to or during treatment; monitor closely.

Disease-related concerns: Hepatic impairment: Use with caution in patients with significant hepatic impairment (bilirubin >2 mg/dL); toxicity may be increased. Hepatic metabolism and biliary excretion are major routes of elimination. Dosage reductions may be recommended. Evaluate hepatic function prior to and during treatment. Hypokalemia: Serum potassium should be >4 mEq/L prior to administration (Arlin, 1988). The risk for arrhythmia is decreased by ensuring normal potassium levels. Renal impairment: Use with caution in patients with significant renal impairment (BUN >20 mg/dL; serum creatinine >1.2 mg/dL); toxicity may be increased. Dosage reductions may be recommended. Evaluate renal function prior to and during treatment.

Concurrent drug therapy issues: Anthracyclines: Use with caution in patients who have received high cumulative doses of anthracyclines (may increase the risk for cardiotoxicity). Vaccinations: Avoid vaccination with live virus vaccines during treatment.

RESTRICTIONS — Not available in U.S.

DRUG INTERACTIONS
Cardiac Glycosides: Antineoplastic Agents may decrease the absorption of Cardiac Glycosides. This may only affect digoxin tablets. Exceptions: Digitoxin. Risk C: Monitor therapy

Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification

Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification

Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination

Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy

Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Risk C: Monitor therapy

Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Risk X: Avoid combination

Vitamin K Antagonists (eg, warfarin): Antineoplastic Agents may enhance the anticoagulant effect of Vitamin K Antagonists. Antineoplastic Agents may diminish the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

PREGNANCY IMPLICATIONS — Animal reproduction studies have not been conducted. Women of childbearing potential should avoid becoming pregnant while receiving treatment.

LACTATION — Excretion in breast milk unknown/not recommended

BREAST-FEEDING CONSIDERATIONS — Breast-feeding should be discontinued prior to treatment.

MONITORING PARAMETERS
CBC with differential, bone marrow studies, serum potassium, hepatic function, renal function; ECG (during and after infusion)

CANADIAN BRAND NAMES — AMSA PD

INTERNATIONAL BRAND NAMES — Amekrin (DK, SE); Amsidine (BE, NL); Amsidyl (AU)

MECHANISM OF ACTION — Amsacrine has been shown to inhibit DNA synthesis by binding to, and intercalating with, DNA; inhibits topoisomerase II activity.

PHARMACODYNAMICS / KINETICS
Distribution: Vd: 1.67 L/kg; minimal CNS penetration

Protein binding: 96% to 98%

Metabolism: Hepatic, to inactive metabolites (major metabolite is 5' glutathione conjugate)

Half-life elimination: 1.4-5 hours; Terminal: 8-9 hours

Excretion: Bile; urine (35%; 20% as unchanged drug)

PATIENT INFORMATION — This drug may cause darkening or discoloration of the urine for 24-48 hours. Watch for fever, malaise, bleeding, bruising, sore throat or mouth, difficulty swallowing, or for pain, redness, or swelling at the injection site.

Ampicillin and sulbactam

2010-08-02T22:50:00.000-07:00

U.S. BRAND NAMES — Unasyn®

PHARMACOLOGIC CATEGORY
Antibiotic, Penicillin

DOSING: ADULTS — Doses expressed as ampicillin/sulbactam combination.

Susceptible infections: I.M., I.V.: 1.5-3 g every 6 hours (maximum: Unasyn® 12 g)

Amnionitis, cholangitis, diverticulitis, endometritis, endophthalmitis, epididymitis/orchitis, liver abscess, osteomyelitis (diabetic foot), peritonitis: I.V.: 3 g every 6 hours

Endocarditis: I.V.: 3 g every 6 hours with gentamicin or vancomycin for 4-6 weeks

Orbital cellulitis: I.V.: 1.5 g every 6 hours

Parapharyngeal space infections: I.V.: 3 g every 6 hours

Pasteurella multocida(human, canine/feline bites): I.V.: 1.5-3 g every 6 hours

Pelvic inflammatory disease: I.V.: 3 g every 6 hours with doxycycline

Peritonitis (CAPD): Intraperitoneal:
Anuric, intermittent: 3 g every 12 hours
Anuric, continuous: Loading dose: 1.5 g; maintenance dose: 150 mg

Pneumonia:
Aspiration, community-acquired: I.V.: 1.5-3 g every 6 hours
Hospital-acquired: I.V.: 3 g every 6 hours

Urinary tract infections, pyelonephritis: I.V.: 3 g every 6 hours for 14 days

DOSING: PEDIATRIC

(For additional information see "Ampicillin and sulbactam: Pediatric drug information")
Susceptible infections: Children ≥ 1 year: I.V.: 100-400 mg ampicillin/kg/day divided every 6 hours (maximum: 8 g ampicillin/day, 12 g Unasyn®). Note: The American Academy of Pediatrics recommends a dose of up to 300 mg/kg/day for severe infection in infants >1 month of age.

Epiglottitis: Children ≥ 1 year: I.V.: 100-200 mg ampicillin/kg/day divided in 4 doses

Mild-to-moderate infections: Children ≥ 1 year: I.V.: 100-200 mg ampicillin/kg/day (150-300 mg Unasyn®) divided every 6 hours (maximum: 8 g ampicillin/day, 12 g Unasyn®)

Peritonsillar and retropharyngeal abscess: Children ≥ 1 year: I.V.: 50 mg ampicillin/kg/dose every 6 hours

Severe infections: Children ≥ 1 year: I.V.: 200-400 mg ampicillin/kg/day divided every 6 hours (maximum: 8 g ampicillin/day, 12 g Unasyn®)

DOSING: ELDERLY — Refer to adult dosing.

DOSING: RENAL IMPAIRMENT
Clcr 15-29 mL/minute: Administer every 12 hours

Clcr 5-14 mL/minute: Administer every 24 hours

Hemodialysis: Give dose after hemodialysis

Continuous ambulatory peritoneal dialysis (CAPD): 3 g every 24 hours

Continuous renal replacement therapy (CRRT): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug levels in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 L/hour) and should not supersede clinical judgment:
CVVH: 3 g every 12 hours
CVVHD/CVVHDF: 3 g every 8 hours

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, powder for reconstitution: 1.5 g: Ampicillin 1 g and sulbactam 0.5 g [contains sodium 115 mg (5 mEq)/1.5 g)]; 3 g: Ampicillin 2 g and sulbactam 1 g [contains sodium 115 mg (5 mEq)/1.5 g)]; 15 g: Ampicillin 10 g and sulbactam 5 g [bulk package; contains sodium 115 mg (5 mEq)/1.5 g]
Unasyn®:
1.5 g: Ampicillin 1 g and sulbactam 0.5 g [contains sodium 115 mg (5 mEq)/1.5 g)]
3 g: Ampicillin 2 g and sulbactam 1 g [contains sodium 115 mg (5 mEq)/1.5 g)]
15 g: Ampicillin 10 g and sulbactam 5 g [bulk package; contains sodium 115 mg (5 mEq)/1.5 g)]

DOSAGE FORMS: CONCISE
Injection, powder for reconstitution: 1.5 g [ampicillin 1 g and sulbactam 0.5 g]; 3 g [ampicillin 2 g and sulbactam 1 g]; 15 g [ampicillin 10 g and sulbactam 5 g]
Unasyn®: 1.5 g [ampicillin 1 g and sulbactam 0.5 g]; 3 g [ampicillin 2 g and sulbactam 1 g]; 15 g [ampicillin 10 g and sulbactam 5 g]; 15 g [ampicillin 10 g and sulbactam 5 g

GENERIC EQUIVALENT AVAILABLE — Yes

ADMINISTRATION — Administer around-the-clock to promote less variation in peak and trough serum levels. Administer by slow injection over 10-15 minutes or I.V. over 15-30 minutes. Ampicillin and gentamicin should not be mixed in the same I.V. tubing.

Some penicillins (eg, carbenicillin, ticarcillin, and piperacillin) have been shown to inactivate aminoglycosides in vitro. This has been observed to a greater extent with tobramycin and gentamicin, while amikacin has shown greater stability against inactivation. Concurrent use of these agents may pose a risk of reduced antibacterial efficacy in vivo, particularly in the setting of profound renal impairment. However, definitive clinical evidence is lacking. If combination penicillin/aminoglycoside therapy is desired in a patient with renal dysfunction, separation of doses (if feasible), and routine monitoring of aminoglycoside levels, CBC, and clinical response should be considered.

COMPATIBILITY — Stable in NS; variable stability (consult detailed reference) in D51/2NS, D5W, LR.

Y-site administration: Compatible: Amifostine, aztreonam, cefepime, docetaxel, enalaprilat, etoposide, famotidine, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, granisetron, heparin, insulin (regular), linezolid, meperidine, morphine, paclitaxel, remifentanil, tacrolimus, teniposide, theophylline, thiotepa. Incompatible: Aminoglycosides (gentamicin, tobramycin), amphotericin B cholesteryl sulfate complex, ciprofloxacin, idarubicin, ondansetron, sargramostim. Variable (consult detailed reference): Cisatracurium, diltiazem, vancomycin.

Compatibility when admixed: Compatible: Aztreonam. Incompatible: Aminoglycosides.

USE — Treatment of susceptible bacterial infections involved with skin and skin structure, intra-abdominal infections, gynecological infections; spectrum is that of ampicillin plus organisms producing beta-lactamases such as S. aureus, H. influenzae, E. coli, Klebsiella, Acinetobacter, Enterobacter, and anaerobes

ADVERSE REACTIONS SIGNIFICANT — Also see Ampicillin.

>10%: Local: Pain at injection site (I.M.)

1% to 10%:
Dermatologic: Rash
Gastrointestinal: Diarrhea
Local: Pain at injection site (I.V.), thrombophlebitis
Miscellaneous: Allergic reaction (may include serum sickness, urticaria, bronchospasm, hypotension, etc)

<1% (Limited to important or life-threatening): Abdominal distension, candidiasis, chest pain, chills, dysuria, edema, epistaxis, erythema, facial swelling, fatigue, flatulence, glossitis, hairy tongue, headache, interstitial nephritis, itching, liver enzymes increased, malaise, mucosal bleeding, nausea, pseudomembranous colitis, seizure, substernal pain, throat tightness, thrombocytopenia, urine retention, vomiting

CONTRAINDICATIONS — Hypersensitivity to ampicillin, sulbactam, penicillins, or any component of the formulations

WARNINGS / PRECAUTIONS
Concerns related to adverse effects: Anaphylactoid/hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity, history of sensitivity to multiple allergens, or previous IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria). Use with caution in asthmatic patients. Rash: Appearance of a rash should be carefully evaluated to differentiate a nonallergic ampicillin rash from a hypersensitivity reaction; rash occurs in 5% to 10% of children and is a generalized dull red, maculopapular rash, generally appearing 3-14 days after the start of therapy. It normally begins on the trunk and spreads over most of the body. It may be most intense at pressure areas, elbows, and knees. Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns: Infectious mononucleosis: A high percentage of patients with infectious mononucleosis have developed rash during therapy; ampicillin-class antibiotics not recommended in these patients. Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.

Special populations: Pediatrics: Safety and efficacy have not been established in children <1 year of age.

DRUG INTERACTIONS
Allopurinol: May enhance the potential for allergic or hypersensitivity reactions to Ampicillin. Risk C: Monitor therapy

Atenolol: Ampicillin may decrease the bioavailability of Atenolol. Risk C: Monitor therapy

Fusidic Acid: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Methotrexate: Penicillins may decrease the excretion of Methotrexate. Risk C: Monitor therapy

Mycophenolate: Penicillins may decrease serum concentrations of the active metabolite(s) of Mycophenolate. This effect appears to be the result of impaired enterohepatic recirculation. Risk C: Monitor therapy

Tetracycline Derivatives: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification

Uricosuric Agents: May decrease the excretion of Penicillins. Risk C: Monitor therapy

PREGNANCY RISK FACTOR — B (show table)

PREGNANCY IMPLICATIONS — Adverse events have not been observed in animal studies; therefore, ampicillin/sulbactam is classified as pregnancy category B. Both ampicillin and sulbactam cross the placenta. When used during pregnancy, pharmacokinetic changes have been observed with ampicillin alone (refer to the Ampicillin monograph for details).

LACTATION — Enters breast milk/use caution

BREAST-FEEDING CONSIDERATIONS — Ampicillin and sulbactam are both excreted into breast milk in low concentrations. The manufacturer recommends that caution be used if administering to lactating women. Nondose-related effects could include modification of bowel flora and allergic sensitization of the infant. The maternal dose of sulbactam does not need altered in the postpartum period. Also refer to the Ampicillin monograph.

DIETARY CONSIDERATIONS — Sodium content of 1.5 g injection: 115 mg (5 mEq)

MONITORING PARAMETERS — With prolonged therapy, monitor hematologic, renal, and hepatic function; monitor for signs of anaphylaxis during first dose

CANADIAN BRAND NAMES — Unasyn®

INTERNATIONAL BRAND NAMES — Ampibactan (VE); Amplisul (EC); Ansulina (TW); Baccillin (KP); Bactacin (KP); Bactesyn (ID); Easyn (MY); Picyn (ID); Prixin (PY); Rukasyn (KP); Sulbaccin (TH); Sulbacin (IN, KP, MY, PH); Sultamicilina (AR); Ubacillin (KP); Ubactam (KP); Unacid (DE); Unacim (FR); Unasyn (AE, AT, BF, BH, BJ, BR, CI, CL, CN, CO, CR, CY, CZ, EC, EE, EG, ET, GH, GM, GN, GT, HK, HN, ID, IL, IQ, IR, IT, JO, KE, KP, KW, LB, LR, LY, MA, ML, MR, MU, MW, MY, NE, NG, NI, OM, PA, PE, PH, QA, SA, SC, SD, SL, SN, SV, SY, TN, TW, TZ, UG, YE, ZA, ZM, ZW); Unasyna (AR, UY)

MECHANISM OF ACTION — The addition of sulbactam, a beta-lactamase inhibitor, to ampicillin extends the spectrum of ampicillin to include some beta-lactamase-producing organisms; inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

PHARMACODYNAMICS / KINETICS
Ampicillin: See Ampicillin.

Sulbactam:
Distribution: Bile, blister, and tissue fluids
Protein binding: 38%
Half-life elimination: Normal renal function: 1-1.3 hours
Excretion: Urine (~75% to 85% as unchanged drug) within 8 hours

Ampicillin

2010-08-02T22:48:00.000-07:00

MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Ampicillin may be confused with aminophylline

PHARMACOLOGIC CATEGORY
Antibiotic, Penicillin

DOSING: ADULTS
Usual dosage range:
Oral: 250-500 mg every 6 hours
I.M., I.V.: 250-500 mg every 6 hours

Actinomycosis: I.V.: 50 mg/kg/day for 4-6 weeks then oral amoxicillin

Cholangitis (acute): I.V.: 2 g every 4 hours with gentamicin

Diverticulitis: I.M., I.V.: 2 g every 6 hours with metronidazole

Endocarditis:
Infective: I.V.: 12 g/day via continuous infusion or divided every 4 hours
Prophylaxis: Dental, oral, or respiratory tract procedures: I.M., I.V.: 2 g within 30-60 minutes prior to procedure in patients not allergic to penicillin and unable to take oral amoxicillin. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications. Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur.
Prophylaxis in total joint replacement patient: I.M., I.V.: 2 g 1 hour prior to the procedure
Genitourinary and gastrointestinal tract procedures: I.M., I.V.:
High-risk patients: 2 g within 30 minutes prior to procedure, followed by ampicillin 1 g (or amoxicillin 1g orally) 6 hours later; must be used in combination with gentamicin. Note: As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Moderate-risk patients: 2 g within 30 minutes prior to procedure

Group B strep prophylaxis (intrapartum): I.V.: 2 g initial dose, then 1 g every 4 hours until delivery

Listeria infections: I.V.: 2 g every 4 hours (consider addition of aminoglycoside)

Sepsis/meningitis: I.M., I.V.: 150-250 mg/kg/day divided every 3-4 hours (range: 6-12 g/day)

Urinary tract infections (enterococcus suspected): I.V.: 1-2 g every 6 hours with gentamicin

DOSING: PEDIATRIC

(For additional information see "Ampicillin: Pediatric drug information")
Usual dosage range: Infants and Children:
Oral: 50-100 mg/kg/day in doses divided every 6 hours (maximum: 2-4 g/day)
I.M., I.V.: 100-400 mg/kg/day in divided doses every 6 hours (maximum: 12 g/day)

Endocarditis prophylaxis: Infants and Children: I.M., I.V.:
Dental, oral, or respiratory tract procedures: 50 mg/kg within 30-60 minutes prior to procedure in patients not allergic to penicillin and unable to take oral amoxicillin. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications.
Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur.
Genitourinary and gastrointestinal tract procedures:
High-risk patients: 50 mg/kg (maximum: 2 g) within 30 minutes prior to procedure, followed by ampicillin 25 mg/kg (or amoxicillin 25 mg/kg orally) 6 hours later; must be used in combination with gentamicin. Note: As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Moderate-risk patients: 50 mg/kg within 30 minutes prior to procedure.

Mild-to-moderate infections: Infants and Children:
Oral: 50-100 mg/kg/day in doses divided every 6 hours (maximum: 2-4 g/day)
I.M., I.V.: 100-150 mg/kg/day in divided doses every 6 hours (maximum: 2-4 g/day)

Severe infections/meningitis: Infants and Children: I.M., I.V.: 200-400 mg/kg/day in divided doses every 6 hours (maximum: 6-12 g/day)

DOSING: ELDERLY — Administer usual adult dose unless renal function is markedly reduced.

DOSING: RENAL IMPAIRMENT
Clcr >50 mL/minute: Administer every 6 hours

Clcr 10-50 mL/minute: Administer every 6-12 hours

Clcr <10 mL/minute: Administer every 12-24 hours

Hemodialysis: Moderately dialyzable (20% to 50%); administer dose after dialysis

Peritoneal dialysis: Moderately dialyzable (20% to 50%)
Administer 250 mg every 12 hours

Continuous arteriovenous or venovenous hemofiltration effects: Dose as for Clcr 10-50 mL/minute; ~50 mg of ampicillin per liter of filtrate is removed

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule: 250 mg, 500 mg

Injection, powder for reconstitution, as sodium: 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g

Powder for oral suspension: 125 mg/5 mL (100 mL, 200 mL); 250 mg/5 mL (100 mL, 200 mL)

DOSAGE FORMS: CONCISE
Capsule: 250 mg, 500 mg

Injection, powder for reconstitution: 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g

Powder for oral suspension: 125 mg/5 mL, 250 mg/5 mL

GENERIC EQUIVALENT AVAILABLE — Yes

ADMINISTRATION — Administer around-the-clock to promote less variation in peak and trough serum levels.

Oral: Administer on an empty stomach (ie, 1 hour prior to, or 2 hours after meals) to increase total absorption.

I.V.: Administer over 3-5 minutes (125-500 mg) or over 10-15 minutes (1-2 g). More rapid infusion may cause seizures. Ampicillin and gentamicin should not be mixed in the same I.V. tubing.

Some penicillins (eg, carbenicillin, ticarcillin, and piperacillin) have been shown to inactivate aminoglycosides in vitro. This has been observed to a greater extent with tobramycin and gentamicin, while amikacin has shown greater stability against inactivation. Concurrent use of these agents may pose a risk of reduced antibacterial efficacy in vivo, particularly in the setting of profound renal impairment. However, definitive clinical evidence is lacking. If combination penicillin/aminoglycoside therapy is desired in a patient with renal dysfunction, separation of doses (if feasible), and routine monitoring of aminoglycoside levels, CBC, and clinical response should be considered.

COMPATIBILITY — Incompatible in D5W, D5NS, D10W, fat emulsion 10%, hetastarch 6%, LR; variable stability (consult detailed reference) in NS.

Y-site administration: Compatible: Acyclovir, amifostine, aztreonam, clarithromycin, cyclophosphamide, docetaxel, doxorubicin liposome, enalaprilat, esmolol, etoposide, famotidine, filgrastim, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, heparin, heparin with hydrocortisone sodium succinate, insulin (regular), labetalol, levofloxacin, linezolid, magnesium sulfate, melphalan, meperidine, morphine, multivitamins, ofloxacin, perphenazine, phytonadione, potassium chloride, propofol, remifentanil, tacrolimus, teniposide, theophylline, thiotepa, tolazoline, vitamin B complex with C. Incompatible: Amphotericin B cholesteryl sulfate complex, epinephrine, fluconazole, hydralazine, midazolam, ondansetron, sargramostim, verapamil, vinorelbine. Variable (consult detailed reference): Calcium gluconate, cisatracurium, diltiazem, hetastarch, hydromorphone, vancomycin.

Compatibility in syringe: Compatible: Chloramphenicol, colistimethate, diatrizoate meglumine 52%, diatrizoate sodium 8%, diatrizoate sodium 60%, heparin, iohexol, iopamidol, iothalamate meglumine 60%, ioxaglate meglumine 39.3%, ioxaglate 19.6%, procaine. Incompatible: Erythromycin lactobionate, gentamicin, hydromorphone, kanamycin, lincomycin, metoclopramide. Variable (consult detailed reference): Lidocaine, polymyxin B sulfate, streptomycin.

Compatibility when admixed: Compatible: Clindamycin, erythromycin lactobionate, floxacillin, furosemide. Incompatible: Amikacin, chlorpromazine, dopamine, gentamicin, hydralazine, prochlorperazine. Variable (consult detailed reference): Aztreonam, cefepime, cimetidine, heparin, hydrocortisone sodium succinate, metronidazole, metronidazole with sodium bicarbonate, ranitidine, sodium bicarbonate, verapamil.

USE — Treatment of susceptible bacterial infections (nonbeta-lactamase-producing organisms); treatment or prophylaxis of infective endocarditis; susceptible bacterial infections caused by streptococci, pneumococci, nonpenicillinase-producing staphylococci, Listeria, meningococci; some strains of H. influenzae, Salmonella, Shigella, E. coli, Enterobacter, and Klebsiella

ADVERSE REACTIONS SIGNIFICANT — Frequency not defined.

Central nervous system: Fever, penicillin encephalopathy, seizure

Dermatologic: Erythema multiforme, exfoliative dermatitis, rash, urticaria
Note: Appearance of a rash should be carefully evaluated to differentiate (if possible) nonallergic ampicillin rash from hypersensitivity reaction. Incidence is higher in patients with viral infection, Salmonella infection, lymphocytic leukemia, or patients that have hyperuricemia.

Gastrointestinal: Black hairy tongue, diarrhea, enterocolitis, glossitis, nausea, pseudomembranous colitis, sore mouth or tongue, stomatitis, vomiting, oral candidiasis

Hematologic: Agranulocytosis, anemia, hemolytic anemia, eosinophilia, leukopenia, thrombocytopenia purpura

Hepatic: AST increased

Renal: Interstitial nephritis (rare)

Respiratory: Laryngeal stridor

Miscellaneous: Anaphylaxis, serum sickness-like reaction

CONTRAINDICATIONS — Hypersensitivity to ampicillin, any component of the formulation, or other penicillins

WARNINGS / PRECAUTIONS
Concerns related to adverse effects: Anaphylactoid/hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity, history of sensitivity to multiple allergens, or previous IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria). Use with caution in asthmatic patients. Rash: Appearance of a rash should be carefully evaluated to differentiate a nonallergic ampicillin rash from a hypersensitivity reaction; rash occurs in 5% to 10% of children and is a generalized dull red, maculopapular rash, generally appearing 3-14 days after the start of therapy. It normally begins on the trunk and spreads over most of the body. It may be most intense at pressure areas, elbows, and knees. Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns: Infectious mononucleosis: A high percentage of patients with infectious mononucleosis have developed rash during therapy; ampicillin-class antibiotics not recommended in these patients. Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.

DRUG INTERACTIONS
Allopurinol: May enhance the potential for allergic or hypersensitivity reactions to Ampicillin. Risk C: Monitor therapy

Atenolol: Ampicillin may decrease the bioavailability of Atenolol. Risk C: Monitor therapy

Fusidic Acid: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Methotrexate: Penicillins may decrease the excretion of Methotrexate. Risk C: Monitor therapy

Mycophenolate: Penicillins may decrease serum concentrations of the active metabolite(s) of Mycophenolate. This effect appears to be the result of impaired enterohepatic recirculation. Risk C: Monitor therapy

Tetracycline Derivatives: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification

Uricosuric Agents: May decrease the excretion of Penicillins. Risk C: Monitor therapy

ETHANOL / NUTRITION / HERB INTERACTIONS — Food: Food decreases ampicillin absorption rate; may decrease ampicillin serum concentration.

PREGNANCY RISK FACTOR — B (show table)

PREGNANCY IMPLICATIONS — Adverse events have not been observed in animal studies; therefore, ampicillin is classified as pregnancy category B. Ampicillin crosses the human placenta, providing detectable concentrations in the cord serum and amniotic fluid. Most studies have not identified a teratogenic potential for ampicillin use during pregnancy. Two possible associations (congenital heart disease and cleft palate) have been noted; each of these was observed in a single study, was not substantiated by other studies, and may have been chance associations. Ampicillin is recommended for use in pregnant women for the management of premature rupture of membranes. Ampicillin is considered an acceptable alternative to penicillin for the prevention of early-onset Group B Streptococcal (GBS) disease in newborns.

The volume of distribution of ampicillin is increased during pregnancy and the half-life is decreased. As a result, serum concentrations in pregnant patients are approximately 50% of those in nonpregnant patients receiving the same dose. Higher doses may be needed during pregnancy. Although oral absorption is not altered during pregnancy, oral ampicillin is poorly-absorbed during labor.

LACTATION — Enters breast milk/use caution

BREAST-FEEDING CONSIDERATIONS — Ampicillin is excreted in breast milk. The manufacturer recommends that caution be exercised when administering ampicillin to nursing women. Due to the low concentrations in human milk, minimal toxicity would be expected in the nursing infant. Nondose-related effects could include modification of bowel flora and allergic sensitization.

DIETARY CONSIDERATIONS — Take on an empty stomach 1 hour before or 2 hours after meals.

Sodium content of 5 mL suspension (250 mg/5 mL): 10 mg (0.4 mEq)

Sodium content of 1 g: 66.7 mg (3 mEq)

PRICING — (data from drugstore.com)
Capsules (Ampicillin)
250 mg (30): $12.99
250 mg (90): $31.95
500 mg (100): $49.99

MONITORING PARAMETERS — With prolonged therapy, monitor renal, hepatic, and hematologic function periodically; observe signs and symptoms of anaphylaxis during first dose

CANADIAN BRAND NAMES — Apo-Ampi®; Novo-Ampicillin; Nu-Ampi

INTERNATIONAL BRAND NAMES — Alphacin (AU, NZ); Alphapen (MX); Ambiopi (ID); Amcopen (PK); Amfipen (AE, BH, CY, EG, GB, IE, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Amipenix (JP); Ampecu (EC); Ampen (VE); Ampenolet (GR); Ampiblan (CO); Ampicher (EC); Ampicil (BR); Ampicilina (EC); Ampicillin (PL); Ampicin (PH); Ampiclox (SG); Ampico (PH); Ampicyn (AU); Ampidar (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Ampifen (NL); Ampiflex (PE); Ampiger (BR); Ampilag (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW); Ampilin (IN); Ampillin (MY); Ampimedin (PY); Ampipen (IN, ZA); Ampitenk (AR); Ampitrex (PH); Ampivral (CO); Ampliblan (CO); Ampolin (TW); Amsapen (MX); Ancillin (TW); Binotal (AT, BR, CO, EC, MX, UY); Biocil (MY); Bridopen (PH); Brupen (MX); Camicil (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW); Cilisod (TW); Citicil (IT); Clovillin (PH); Dhacillin (HK, MY); Dibacilina (MX); Doktacillin (SE); Duacillin (MY); Eurocin (PH); Excillin (PH); Extrapen (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Flamicina (MX); Gramcil (PH); Ibimycin (AU); Intramed (ZA); Iwacillin (JP); Julphapen (PE); Magnapen (PE); Marovilina (MX); Maxipen (CO); Microcilin (PH); Omnipen (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, MX, OM, PE, QA, SA, SY, YE); Pamecil (BF, BJ, CI, ET, GH, GM, GN, HK, KE, LR, MA, ML, MR, MU, MW, MY, NE, NG, SC, SD, SG, SL, SN, TN, TZ, UG, ZA, ZM, ZW); Panacta (PH); Pelitin (TW); Penbritin (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, HK, IE, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, MX, MY, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Penibrin (IL); Pentrexyl (BE, BF, BJ, CI, DK, ET, GB, GH, GM, GN, GR, IT, KE, LR, MA, ML, MR, MU, MW, MX, NE, NG, NL, NO, PE, SC, SD, SL, SN, TH, TN, TZ, UG, ZA, ZM, ZW); Petercillin (ZA); Picaplin (TW); Polypen (PH); Primapen (ID); Promecilina (MX); Radiocillina (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Rimacillin (AE, BB, BF, BH, BJ, BM, BS, BZ, CI, CY, EG, ET, GH, GM, GN, GY, IL, IQ, IR, JM, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, NL, OM, QA, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, YE, ZA, ZM, ZW); Roscillin (IN); Sanpicillin (ID); Semicillin (HN); Shacillin (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Sintelin (PE); Standacillin (AE, BG, BH, CY, EE, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Standcillin (MY); Synthocilin (IN); Totapen (FR); Tricil (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW); Trifalicina (AR); Trilaxin (PH); Vacillin (TH); Viccillin (ID); Vidopen (GB, IE); Virucil (CO); Winpicillin (TW)

MECHANISM OF ACTION — Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

PHARMACODYNAMICS / KINETICS
Absorption: Oral: 50%

Distribution: Bile, blister, and tissue fluids; penetration into CSF occurs with inflamed meninges only, good only with inflammation (exceeds usual MICs)
Normal meninges: Nil; Inflamed meninges: 5% to 10%

Protein binding: 15% to 25%

Half-life elimination:
Children and Adults: 1-1.8 hours
Anuria/end-stage renal disease: 7-20 hours

Time to peak: Oral: Within 1-2 hours

Excretion: Urine (~90% as unchanged drug) within 24 hours

PATIENT INFORMATION — Report diarrhea promptly; take entire course of medication; females should report onset of symptoms of candidal vaginitis

Amphotericin B lipid complex

2010-08-02T22:46:00.000-07:00

MEDICATION SAFETY ISSUES
Safety issues:
Lipid-based amphotericin formulations (Abelcet®) may be confused with conventional formulations (Amphocin®, Fungizone®)
Large overdoses have occurred when conventional formulations were dispensed inadvertently for lipid-based products. Single daily doses of conventional amphotericin formulation never exceed 1.5 mg/kg.

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

U.S. BRAND NAMES — Abelcet®

PHARMACOLOGIC CATEGORY
Antifungal Agent, Parenteral

DOSING: ADULTS — Note: Premedication: For patients who experience infusion-related immediate reactions, premedicate with the following drugs 30-60 minutes prior to drug administration: A nonsteroidal anti-inflammatory agent +/- diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered.

Usual dosage: I.V.: 2.5-5 mg/kg/day as a single infusion

DOSING: PEDIATRIC — Refer to adult dosing.

(For additional information see "Amphotericin B lipid complex: Pediatric drug information")

DOSING: ELDERLY — Refer to adult dosing.

DOSING: RENAL IMPAIRMENT — The effects of renal impairment on drug pharmacokinetics or pharmacodynamics are currently unknown. The dose of amphotericin B lipid complex may be adjusted or drug administration may have to be interrupted in patients with acute kidney dysfunction to reduce the magnitude of renal impairment.

Hemodialysis: Supplemental dose is not necessary.

Peritoneal dialysis: Supplemental dose is not necessary.

Continuous renal replacement therapy (CRRT): No supplemental dosage necessary

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, suspension [preservative free]:
Abelcet®: 5 mg/mL (20 mL)

DOSAGE FORMS: CONCISE
Injection, suspension [preservative free]:
Abelcet®: 5 mg/mL (20 mL)

GENERIC EQUIVALENT AVAILABLE — No

ADMINISTRATION — For patients who experience nonanaphylactic infusion-related reactions, premedicate 30-60 minutes prior to drug administration with a nonsteroidal anti-inflammatory agent +/- diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered.

Administer at an infusion rate of 2.5 mg/kg/hour (over 2 hours). Invert infusion container several times prior to administration and every 2 hours during infusion if it exceeds 2 hours.

COMPATIBILITY
Incompatible with any blood products, intravenous drugs, or intravenous fluids other than D5W when admixed or as Y-site administration.

USE — Treatment of aspergillosis or any type of progressive fungal infection in patients who are refractory to or intolerant of conventional amphotericin B therapy

USE - UNLABELED / INVESTIGATIONAL — Effective in patients with serious Candida species infections

ADVERSE REACTIONS SIGNIFICANT — Nephrotoxicity and infusion-related hyperpyrexia, rigor, and chilling are reduced relative to amphotericin deoxycholate.

>10%:
Central nervous system: Chills, fever
Renal: Serum creatinine increased
Miscellaneous: Multiple organ failure

1% to 10%:
Cardiovascular: Hypotension, cardiac arrest
Central nervous system: Headache, pain
Dermatologic: Rash
Endocrine & metabolic: Bilirubinemia, hypokalemia, acidosis
Gastrointestinal: Nausea, vomiting, diarrhea, gastrointestinal hemorrhage, abdominal pain
Renal: Renal failure
Respiratory: Respiratory failure, dyspnea, pneumonia

CONTRAINDICATIONS — Hypersensitivity to amphotericin or any component of the formulation

WARNINGS / PRECAUTIONS
Concerns related to adverse effects: Anaphylaxis: Has been reported with amphotericin B-containing drugs; facilities for cardiopulmonary resuscitation should be available during administration due to the possibility of anaphylactic reaction. If severe respiratory distress occurs, the infusion should be immediately discontinued; during the initial dosing, the drug should be administered under close clinical observation. Infusion reactions: Acute reactions (including fever and chills) may occur 1-3 hours after starting an intravenous infusion. These reactions are usually more common with the first few doses and generally diminish with subsequent doses.

Special populations: Neutropenic patients: Pulmonary reactions may occur in neutropenic patients receiving leukocyte transfusions; separation of the infusions as much as possible is advised.

DRUG INTERACTIONS
Aminoglycosides: Amphotericin B may enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy

Antifungal Agents (Azole Derivatives, Systemic): May diminish the therapeutic effect of Amphotericin B. Risk C: Monitor therapy

Colistimethate: Amphotericin B may enhance the nephrotoxic effect of Colistimethate. Risk D: Consider therapy modification

Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

CycloSPORINE: Amphotericin B may enhance the nephrotoxic effect of CycloSPORINE. Risk C: Monitor therapy

Flucytosine: Amphotericin B may enhance the adverse/toxic effect of Flucytosine. This may be related to the adverse effects of amphotericin B on renal function. Risk C: Monitor therapy

Gallium Nitrate: Amphotericin B may enhance the nephrotoxic effect of Gallium Nitrate. Risk X: Avoid combination

Saccharomyces boulardii: Antifungal Agents may diminish the therapeutic effect of Saccharomyces boulardii. Risk D: Consider therapy modification

PREGNANCY RISK FACTOR — B (show table)

LACTATION — Enters breast milk/contraindicated

BREAST-FEEDING CONSIDERATIONS — Due to limited data, consider discontinuing nursing during therapy.

MONITORING PARAMETERS — Renal function (monitor frequently during therapy), electrolytes (especially potassium and magnesium), liver function tests, temperature, PT/PTT, CBC; monitor input and output; monitor for signs of hypokalemia (muscle weakness, cramping, drowsiness, ECG changes, etc)

CANADIAN BRAND NAMES — Abelcet®; Amphotec®

INTERNATIONAL BRAND NAMES — Abelcet (AR, AT, BE, BR, CZ, DK, FI, FR, GB, GR, HN, IE, NL, NO, NZ, SE); Ambisome (AU, FR, HK, IL, KP); Ampholip (IN)

MECHANISM OF ACTION — Binds to ergosterol altering cell membrane permeability in susceptible fungi and causing leakage of cell components with subsequent cell death. Proposed mechanism suggests that amphotericin causes an oxidation-dependent stimulation of macrophages.

PHARMACODYNAMICS / KINETICS
Distribution: Vd: Increases with higher doses; reflects increased uptake by tissues (131 L/kg with 5 mg/kg/day)

Half-life elimination: ~24 hours

Excretion: Clearance: Increases with higher doses (5 mg/kg/day): 400 mL/hour/kg

Amphotericin B cholesteryl sulfate complex

2010-08-02T22:40:00.000-07:00

MEDICATION SAFETY ISSUES
Safety issues:
Lipid-based amphotericin formulations (Amphotec®) may be confused with conventional formulations (Amphocin®, Fungizone®)
Large overdoses have occurred when conventional formulations were dispensed inadvertently for lipid-based products. Single daily doses of conventional amphotericin formulation never exceed 1.5 mg/kg.

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

U.S. BRAND NAMES — Amphotec®

PHARMACOLOGIC CATEGORY
Antifungal Agent, Parenteral

DOSING: ADULTS
Note: Premedication: For patients who experience chills, fever, hypotension, nausea, or other nonanaphylactic infusion-related immediate reactions, premedicate with the following drugs 30-60 minutes prior to drug administration: A nonsteroidal (eg, ibuprofen, choline magnesium trisalicylate) with or without diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered.

Usual dosage: I.V.: 3-4 mg/kg/day (infusion of 1 mg/kg/hour); maximum: 7.5 mg/kg/day
A regimen of 6 mg/kg/day has been used for treatment of life-threatening invasive mold infections in immunocompromised patients; maximum: 7.5 mg/kg/day.
Initially infuse at 1 mg/kg/hour. Rate of infusion may be increased with subsequent doses to 3 mg/kg/hour as patient tolerance allows. Treatment should continue as patient tolerance allows, until complete resolution of microbiologic and clinical evidence of fungal disease.

DOSING: PEDIATRIC — Refer to adult dosing.

DOSING: ELDERLY — Refer to adult dosing.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, powder for reconstitution:
Amphotec®: 50 mg, 100 mg

DOSAGE FORMS: CONCISE
Injection, powder for reconstitution:
Amphotec®: 50 mg, 100 mg

GENERIC EQUIVALENT AVAILABLE — No

ADMINISTRATION — Avoid injection faster than 1 mg/kg/hour. For a patient who experiences chills, fever, hypotension, nausea, or other nonanaphylactic infusion-related reactions, premedicate with the following drugs 30-60 minutes prior to drug administration: A nonsteroidal (eg, ibuprofen, choline magnesium trisalicylate) with or without diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered. If severe respiratory distress occurs, the infusion should be immediately discontinued.

COMPATIBILITY — Stable in D5W; incompatible with NS.

Y-site administration: Compatible: Acyclovir, aminophylline, cefoxitin, ceftizoxime, clindamycin, dexamethasone sodium phosphate, fentanyl, furosemide, ganciclovir, granisetron, hydrocortisone sodium succinate, ifosfamide, lorazepam, mannitol, methotrexate, methylprednisolone sodium succinate, nitroglycerin, sufentanil, trimethoprim/sulfamethoxazole, vinblastine, vincristine, zidovudine. Incompatible: Alfentanil, amikacin, ampicillin, ampicillin/sulbactam, atenolol, aztreonam, bretylium, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, cefazolin, cefepime, cefoperazone, ceftazidime, ceftriaxone, chlorpromazine, cimetidine, cisatracurium, cisplatin, cyclophosphamide, cyclosporine, cytarabine, diazepam, digoxin, diphenhydramine, dobutamine, dopamine, doxorubicin, doxorubicin liposome, droperidol, enalaprilat, esmolol, famotidine, fluconazole, fluorouracil, gatifloxacin, gentamicin, haloperidol, heparin, hydromorphone, hydroxyzine, imipenem/cilastatin, labetalol, leucovorin, lidocaine, magnesium sulfate, meperidine, mesna, metoclopramide, metoprolol, metronidazole, midazolam, mitoxantrone, morphine, nalbuphine, naloxone, ofloxacin, ondansetron, paclitaxel, pentobarbital, phenobarbital, phenytoin, piperacillin, piperacillin/tazobactam, potassium chloride, prochlorperazine, promethazine, propranolol, ranitidine, remifentanil, sodium bicarbonate, ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin, vecuronium, verapamil, vinorelbine.

USE — Treatment of invasive aspergillosis in patients who have failed amphotericin B deoxycholate treatment, or who have renal impairment or experience unacceptable toxicity which precludes treatment with amphotericin B deoxycholate in effective doses.

USE - UNLABELED / INVESTIGATIONAL — Effective in patients with serious Candida species infections

ADVERSE REACTIONS SIGNIFICANT
>10%: Central nervous system: Chills, fever

1% to 10%:
Cardiovascular: Hypotension, tachycardia
Central nervous system: Headache
Dermatologic: Rash
Endocrine & metabolic: Hypokalemia, hypomagnesemia
Gastrointestinal: Nausea, diarrhea, abdominal pain
Hematologic: Thrombocytopenia
Hepatic: LFT change
Neuromuscular & skeletal: Rigors
Renal: Creatinine increased
Respiratory: Dyspnea

Note: Amphotericin B colloidal dispersion has an improved therapeutic index compared to conventional amphotericin B, and has been used safely in patients with amphotericin B-related nephrotoxicity; however, continued decline of renal function has occurred in some patients.

CONTRAINDICATIONS — Hypersensitivity to amphotericin B or any component of the formulation

WARNINGS / PRECAUTIONS
Concerns related to adverse effects: Anaphylaxis: Has been reported with amphotericin B-containing drugs; facilities for cardiopulmonary resuscitation should be available during administration due to the possibility of anaphylactic reaction. If severe respiratory distress occurs, the infusion should be immediately discontinued. During the initial dosing, the drug should be administered under close clinical observation. Infusion reactions: Sometimes severe, usually subside with continued therapy - manage with decreased rate of infusion and pretreatment with antihistamines/corticosteroids.

Special populations: Neutropenic patients: Pulmonary reactions may occur in neutropenic patients receiving leukocyte transfusions; separation of the infusions as much as possible is advised.

DRUG INTERACTIONS
Aminoglycosides: Amphotericin B may enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy

Antifungal Agents (Azole Derivatives, Systemic): May diminish the therapeutic effect of Amphotericin B. Risk C: Monitor therapy

Colistimethate: Amphotericin B may enhance the nephrotoxic effect of Colistimethate. Risk D: Consider therapy modification

Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

CycloSPORINE: Amphotericin B may enhance the nephrotoxic effect of CycloSPORINE. Risk C: Monitor therapy

Flucytosine: Amphotericin B may enhance the adverse/toxic effect of Flucytosine. This may be related to the adverse effects of amphotericin B on renal function. Risk C: Monitor therapy

Gallium Nitrate: Amphotericin B may enhance the nephrotoxic effect of Gallium Nitrate. Risk X: Avoid combination

Saccharomyces boulardii: Antifungal Agents may diminish the therapeutic effect of Saccharomyces boulardii. Risk D: Consider therapy modification

PREGNANCY RISK FACTOR — B (show table)

LACTATION — Excretion in breast milk unknown/contraindicated

BREAST-FEEDING CONSIDERATIONS — Due to limited data, consider discontinuing nursing during therapy.

MONITORING PARAMETERS — Liver function tests, electrolytes, BUN, Cr, temperature, CBC, I/O, signs of hypokalemia (muscle weakness, cramping, drowsiness, ECG changes)

CANADIAN BRAND NAMES — Amphotec®

INTERNATIONAL BRAND NAMES — Amphocil (AT, AU, BR, CZ, DK, FI, GB, HK, HN, IL, IT, MX, MY, NL, SE, TH, TW)

MECHANISM OF ACTION — Binds to ergosterol altering cell membrane permeability in susceptible fungi and causing leakage of cell components with subsequent cell death. Proposed mechanism suggests that amphotericin causes an oxidation-dependent stimulation of macrophages (Lyman, 1992).

PHARMACODYNAMICS / KINETICS
Distribution: Vd: Total volume increases with higher doses, reflects increasing uptake by tissues (with 4 mg/kg/day = 4 L/kg); predominantly distributed in the liver; concentrations in kidneys and other tissues are lower than observed with conventional amphotericin B

Half-life elimination: 28-29 hours; prolonged with higher दोसेस.

Amphotericin B (conventional)

2010-08-02T22:39:00.000-07:00

MEDICATION SAFETY ISSUES
Safety issues:
Conventional amphotericin formulations (Amphocin®, Fungizone®) may be confused with lipid-based formulations (AmBisome®, Abelcet®, Amphotec®).
Large overdoses have occurred when conventional formulations were dispensed inadvertently for lipid-based products. Single daily doses of conventional amphotericin formulation never exceed 1.5 mg/kg.

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication (intrathecal administration) among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

PHARMACOLOGIC CATEGORY
Antifungal Agent, Parenteral

DOSING: ADULTS — Note: Premedication: For patients who experience infusion-related immediate reactions, premedicate with the following drugs 30-60 minutes prior to drug administration: NSAID (with or without diphenhydramine) or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered.

Test dose: I.V.: 1 mg infused over 20-30 minutes. Many clinicians believe a test dose is unnecessary.

Susceptible fungal infections: I.V.: Adults: 0.05-1.5 mg/kg/day; 1-1.5 mg/kg over 4-6 hours every other day may be given once therapy is established; aspergillosis, rhinocerebral mucormycosis, often require 1-1.5 mg/kg/day; do not exceed 1.5 mg/kg/day
Aspergillosis, disseminated: I.V.: 0.6-0.7 mg/kg/day for 3-6 months
Bone marrow transplantation (prophylaxis): I.V.: Low-dose amphotericin B 0.1-0.25 mg/kg/day has been administered after bone marrow transplantation to reduce the risk of invasive fungal disease.
Candidemia (neutropenic or non-neutropenic): I.V.: 0.5-1 mg/kg/day until 14 days after last positive blood culture and resolution of signs and symptoms (Pappas, 2009)
Candidiasis, chronic, disseminated: I.V.: 0.5-0.7 mg/kg/day for 3-6 months and resolution of radiologic lesions (Pappas, 2009)
Dematiaceous fungi: I.V.: 0.7 mg/kg/day in combination with an azole
Endocarditis: I.V.: 0.6-1 mg/kg/day (with or without flucytosine) for 6 weeks after valve replacement; Note: If isolates susceptible and/or clearance demonstrated, guidelines recommend step-down to fluconazole; also for long-term suppression therapy if valve replacement is not possible (Pappas, 2009)
Endophthalmitis, fungal:
Intravitreal (unlabeled use): 10 mcg in 0.1 mL (in conjunction with systemic therapy)
I.V.: 0.7-1 mg/kg/day (with or without flucytosine) for at least 4-6 weeks (Pappas, 2009)
Esophageal: I.V.: 0.3-0.7 mg/kg/day for 14-21 days after clinical improvement
Histoplasmosis: Chronic, severe pulmonary or disseminated: I.V.: 0.5-1 mg/kg/day for 7 days, then 0.8 mg/kg every other day (or 3 times/week) until total dose of 10-15 mg/kg; may continue itraconazole as suppressive therapy (lifelong for immunocompromised patients)
Meningitis:
Candidal: I.V.: 0.7-1 mg/kg/day (with or without flucytosine) for at least 4 weeks; Note: Liposomal amphotericin favored by IDSA guidelines based on decreased risk of nephrotoxicity and potentially better CNS penetration (Pappas, 2009)
Cryptococcal or Coccidioides: I.T.: Initial: 25-300 mcg every 48-72 hours; increase to 500 mcg to 1 mg as tolerated; maximum total dose: 15 mg has been suggested
Histoplasma: I.V.: 0.5-1 mg/kg/day for 7 days, then 0.8 mg/kg every other day (or 3 times/week) for 3 months total duration; follow with fluconazole suppressive therapy for up to 12 months
Meningoencephalitis, cryptococcal: I.V.:
HIV positive: 0.7-1 mg/kg/day (plus flucytosine 100 mg/kg/day) for 2 weeks, then change to oral fluconazole for at least 10 weeks; alternatively, amphotericin and flucytosine may be continued uninterrupted for 6-10 weeks
HIV negative: 0.5-0.7 mg/kg/day (plus flucytosine) for 2 weeks
Oropharyngeal candidiasis: I.V.: 0.3 mg/kg/day for 7-14 days (Pappas, 2009)
Osteoarticular candidiasis: I.V.: 0.5-1 mg/kg/day for several weeks, followed by fluconazole for 6-12 months (osteomyelitis) or 6 weeks (septic arthritis)
Penicillium marneffei: I.V.: 0.6 mg/kg/day for 2 weeks
Pneumonia: Cryptococcal (mild-to-moderate): I.V.:
HIV positive: 0.5-1 mg/kg/day
HIV negative: 0.5-0.7 mg/kg/day (plus flucytosine) for 2 weeks
Sporotrichosis: Pulmonary, meningeal, osteoarticular or disseminated: I.V.: Total dose of 1-2 g, then change to oral itraconazole or fluconazole for suppressive therapy
Urinary tract candidiasis (Pappas, 2009):
Fungus balls: I.V.: 0.5-0.7 mg/kg/day with or without flucytosine 25 mg/kg 4 times daily
Pyelonephritis: I.V.: 0.5-0.7 mg/kg/day with or without flucytosine 25 mg/kg 4 times daily for 2 weeks
Symptomatic cystitis: I.V.: 0.3-0.6 mg/kg/day for 1-7 days
Bladder irrigation: Irrigate with 50 mcg/mL solution instilled periodically or continuously for 5-10 days or until cultures are clear for fluconazole-resistant Candida

DOSING: PEDIATRIC — Note: Premedication: For patients who experience infusion-related immediate reactions, premedicate with the following drugs 30-60 minutes prior to drug administration: NSAID (with or without diphenhydramine) or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered.

(For additional information see "Amphotericin B (conventional): Pediatric drug information")

Test dose: I.V.: Infants and Children: 0.1 mg/kg/dose to a maximum of 1 mg; infuse over 30-60 minutes. Many clinicians believe a test dose is unnecessary.

Susceptible fungal infections: I.V.: Infants and Children: Maintenance dose: 0.25-1 mg/kg/day given once daily; infuse over 2-6 hours. Once therapy has been established, amphotericin B can be administered on an every-other-day basis at 1-1.5 mg/kg/dose; cumulative dose: 1.5-2 g over 6-10 weeks
Note: Duration of therapy varies with nature of infection: Usual duration is 4-12 weeks or cumulative dose of 1-4 g.

Meningitis, coccidioidal or cryptococcal: I.T.: Children: 25-100 mcg every 48-72 hours; increase to 500 mcg as tolerated

DOSING: ELDERLY — Refer to adult dosing.

DOSING: RENAL IMPAIRMENT
If renal dysfunction is due to the drug, the daily total can be decreased by 50% or the dose can be given every other day. I.V. therapy may take several months.

Poorly dialyzed; no supplemental dose is necessary when using hemo- or peritoneal dialysis or continuous renal replacement therapy (CRRT).

Administration in dialysate: 1-2 mg/L of peritoneal dialysis fluid either with or without low-dose I.V. amphotericin B (a total dose of 2-10 mg/kg given over 7-14 days). Precipitate may form in ionic dialysate solutions.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, powder for reconstitution, as desoxycholate: 50 mg

DOSAGE FORMS: CONCISE
Injection, powder for reconstitution: 50 mg

GENERIC EQUIVALENT AVAILABLE — Yes

ADMINISTRATION — May be infused over 4-6 hours. For a patient who experiences chills, fever, hypotension, nausea, or other nonanaphylactic infusion-related reactions, premedicate with the following drugs 30-60 minutes prior to drug administration: A nonsteroidal (eg, ibuprofen, choline magnesium trisalicylate) with or without diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone 50-100 mg. If the patient experiences rigors during the infusion, meperidine may be administered. Bolus infusion of normal saline immediately preceding, or immediately preceding and following amphotericin B may reduce drug-induced nephrotoxicity. Risk of nephrotoxicity increases with amphotericin B doses >1 mg/kg/day. Infusion of admixtures more concentrated than 0.25 mg/mL should be limited to patients absolutely requiring volume contraction.

COMPATIBILITY
Solution compatibility:
Compatible: Heparin sodium, hydrocortisone, sodium bicarbonate.
Incompatible: Ampicillin, calcium gluconate, carbenicillin, cimetidine, dopamine, gentamicin, lidocaine, potassium chloride, sodium chloride, tetracycline, verapamil.

USE — Treatment of severe systemic and central nervous system infections caused by susceptible fungi such as Candida species, Histoplasma capsulatum, Cryptococcus neoformans, Aspergillus species, Blastomyces dermatitidis, Torulopsis glabrata, and Coccidioides immitis; fungal peritonitis; irrigant for bladder fungal infections; used in fungal infection in patients with bone marrow transplantation, amebic meningoencephalitis, ocular aspergillosis (intraocular injection), candidal cystitis (bladder irrigation), chemoprophylaxis (low-dose I.V.), immunocompromised patients at risk of aspergillosis (intranasal/nebulized), refractory meningitis (intrathecal), coccidioidal arthritis (intra-articular/I.M.).

Low-dose amphotericin B has been administered after bone marrow transplantation to reduce the risk of invasive fungal disease.

ADVERSE REACTIONS SIGNIFICANT
Systemic:

>10%:
Cardiovascular: Hypotension, tachypnea
Central nervous system: Fever, chills, headache (less frequent with I.T.), malaise
Endocrine & metabolic: Hypokalemia, hypomagnesemia
Gastrointestinal: Anorexia, nausea (less frequent with I.T.), vomiting (less frequent with I.T.), diarrhea, heartburn, cramping epigastric pain
Hematologic: Normochromic-normocytic anemia
Local: Pain at injection site with or without phlebitis or thrombophlebitis (incidence may increase with peripheral infusion of admixtures)
Neuromuscular & skeletal: Generalized pain, including muscle and joint pains (less frequent with I.T.)
Renal: Decreased renal function and renal function abnormalities including azotemia, renal tubular acidosis, nephrocalcinosis (>0.1 mg/mL)

1% to 10%:
Cardiovascular: Hypertension, flushing
Central nervous system: Delirium, arachnoiditis, pain along lumbar nerves (especially I.T. therapy)
Genitourinary: Urinary retention
Hematologic: Leukocytosis
Neuromuscular & skeletal: Paresthesia (especially with I.T. therapy)

<1% (Limited to important or life-threatening): Acute liver failure, agranulocytosis, anuria, bone marrow suppression, cardiac arrest, coagulation defects, convulsions, dyspnea, hearing loss, leukopenia, maculopapular rash, renal failure, renal tubular acidosis, thrombocytopenia, vision changes

CONTRAINDICATIONS — Hypersensitivity to amphotericin or any component of the formulation

WARNINGS / PRECAUTIONS
Boxed warnings: Error prevention: See "Other warnings/precautions" below. Fungal infections: See "Disease-related concerns" below.

Concerns related to adverse effects: Anaphylaxis: Has been reported with amphotericin B-containing drugs; facilities for cardiopulmonary resuscitation should be available during administration due to the possibility of anaphylactic reaction. If severe respiratory distress occurs, the infusion should be immediately discontinued; during the initial dosing, the drug should be administered under close clinical observation. Infusion reactions: Acute reactions (including fever and chills) may occur 1-3 hours after starting an intravenous infusion. These reactions are usually more common with the first few doses and generally diminish with subsequent doses.

Disease-related concerns: Fungal infections: [U.S. Boxed Warning]: Should be used primarily for treatment of progressive, potentially life-threatening fungal infections, not noninvasive forms of infection. Renal impairment: Use with caution in patients with renal impairment.

Concurrent drug therapy issues: Nephrotoxic drugs: Avoid use with other nephrotoxic drugs; drug-induced renal toxicity usually improves with interrupting therapy, decreasing dosage, or increasing dosing interval.

Special populations: Neutropenic patients: Pulmonary reactions may occur in neutropenic patients receiving leukocyte transfusions; separation of the infusions as much as possible is advised.

Other warnings/precautions: Error prevention: [U.S. Boxed warning]: Verify the product name and dosage if dose exceeds 1.5 mg/kg.

DRUG INTERACTIONS
Aminoglycosides: Amphotericin B may enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy

Antifungal Agents (Azole Derivatives, Systemic): May diminish the therapeutic effect of Amphotericin B. Risk C: Monitor therapy

Colistimethate: Amphotericin B may enhance the nephrotoxic effect of Colistimethate. Risk D: Consider therapy modification

Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

CycloSPORINE: Amphotericin B may enhance the nephrotoxic effect of CycloSPORINE. Risk C: Monitor therapy

Flucytosine: Amphotericin B may enhance the adverse/toxic effect of Flucytosine. This may be related to the adverse effects of amphotericin B on renal function. Risk C: Monitor therapy

Gallium Nitrate: Amphotericin B may enhance the nephrotoxic effect of Gallium Nitrate. Risk X: Avoid combination

Saccharomyces boulardii: Antifungal Agents may diminish the therapeutic effect of Saccharomyces boulardii. Risk D: Consider therapy modification

PREGNANCY RISK FACTOR — B (show table)

LACTATION — Excretion in breast milk unknown/contraindicated

MONITORING PARAMETERS — Renal function (monitor frequently during therapy), electrolytes (especially potassium and magnesium), liver function tests, temperature, PT/PTT, CBC; monitor input and output; monitor for signs of hypokalemia (muscle weakness, cramping, drowsiness, ECG changes, etc)

REFERENCE RANGE — Therapeutic: 1-2 mcg/mL (SI: 1-2.2 µmol/L)

CANADIAN BRAND NAMES — Fungizone®

INTERNATIONAL BRAND NAMES — Amphocil (MX); Fungizone (PL); Terix (MX)

MECHANISM OF ACTION — Binds to ergosterol altering cell membrane permeability in susceptible fungi and causing leakage of cell components with subsequent cell death. Proposed mechanism suggests that amphotericin causes an oxidation-dependent stimulation of macrophages (Lyman, 1992).

PHARMACODYNAMICS / KINETICS
Distribution: Minimal amounts enter the aqueous humor, bile, CSF (inflamed or noninflamed meninges), amniotic fluid, pericardial fluid, pleural fluid, and synovial fluid

Protein binding, plasma: 90%

Half-life elimination: Biphasic: Initial: 15-48 hours; Terminal: 15 days

Time to peak: Within 1 hour following a 4- to 6-hour dose

Excretion: Urine (2% to 5% as biologically active form); ~40% eliminated over a 7-day period and may be detected in urine for at least 7 weeks after discontinued उसे.

Amoxicillin and clavulanate potassium

2010-08-02T22:35:00.000-07:00

MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Augmentin® may be confused with Azulfidine®

U.S. BRAND NAMES — Amoclan; Augmentin ES-600®; Augmentin XR®; Augmentin®

PHARMACOLOGIC CATEGORY
Antibiotic, Penicillin

DOSING: ADULTS — Note: Dose is based on the amoxicillin component; see "Augmentin® Product-Specific Considerations" table.

Susceptible infections: Children >40 kg and Adults: Oral: 250-500 mg every 8 hours or 875 mg every 12 hours

Augmentin® Product-Specific Considerations

125 mg: Chewable tablet: q8h dosing Suspension:

" q8h dosing
" For adults having difficulty swallowing tablets, 125 mg/5 mL suspension may be substituted for 500 mg tablet.

200 mg: Chewable tablet:

" q12h dosing
" Contains phenylalanine Suspension:

" q12h dosing
" For adults having difficulty swallowing tablets, 200 mg/5 mL suspension may be substituted for 875 mg tablet.

250 mg: Chewable tablet:

" q8h dosing
" Contains phenylalanine
" Tablet and chewable tablet are not interchangeable due to differences in clavulanic acid. Suspension:

" q8h dosing
" For adults having difficulty swallowing tablets, 250 mg/5 mL suspension may be substituted for 500 mg tablet. Tablet:

" q8h dosing
" Not for use in patients <40 kg
" Tablet and chewable tablet are not interchangeable due to differences in clavulanic acid.

400 mg: Chewable tablet:

" q12h dosing
" Contains phenylalanine Suspension:

" q12h dosing
" For adults having difficulty swallowing tablets, 400 mg/5 mL suspension may be substituted for 875 mg tablet.

500 mg: Tablet: q8h or q12h dosing

600 mg: Suspension:

" q12h dosing
" Not for use in adults or children ≥ 40 kg
" 600 mg/5 mL suspension is not equivalent to or interchangeable with 200 mg/5 mL or 400 mg/5 mL due to differences in clavulanic acid.

875 mg: Tablet:

" q12h dosing
" Not for use in Clcr <30 mL/minute

1000 mg: Extended release tablet:

" q12h dosing
" Not for use in children <16 years of age
" Not interchangeable with two 500 mg tablets
" Not for use if Clcr <30 mL/minute or hemodialysis

Acute bacterial sinusitis: Oral: Extended release tablet: Two 1000 mg tablets every 12 hours for 10 days

Bite wounds (animal/human): Oral: 875 mg every 12 hours or 500 mg every 8 hours

Chronic obstructive pulmonary disease: Oral: 875 mg every 12 hours or 500 mg every 8 hours

Diabetic foot: Oral: Extended release tablet: Two 1000 mg tablets every 12 hours for 7-14 days

Diverticulitis, perirectal abscess: Oral: Extended release tablet: Two 1000 mg tablets every 12 hours for 7-10 days

Erysipelas: Oral: 875 mg every 12 hours or 500 mg every 8 hours

Febrile neutropenia: Oral: 875 mg every 12 hours

Pneumonia:
Aspiration: Oral: 875 mg every 12 hours
Community-acquired: Oral: Extended release tablet: Two 1000 mg tablets every 12 hours for 7-10 days

Pyelonephritis (acute, uncomplicated): Oral: 875 mg every 12 hours or 500 mg every 8 hours

Skin abscess: Oral: 875 mg every 12 hours

DOSING: PEDIATRIC — Note: Dose is based on the amoxicillin component; see "Augmentin® Product-Specific Considerations" table.

(For additional information see "Amoxicillin and clavulanate potassium: Pediatric drug information")

Susceptible infections: Infants <3 months: Oral: 30 mg/kg/day divided every 12 hours using the 125 mg/5 mL suspension

Lower respiratory tract infections, severe infections, sinusitis: Children ≥ 3 months and <40 kg: Oral: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours

Mild-to-moderate infections: Children ≥ 3 months and <40 kg: Oral: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours

Otitis media (Augmentin ES-600®): Children ≥ 3 months and <40 kg: Oral: 90 mg/kg/day divided every 12 hours for 10 days in children with severe illness and when coverage for ß-lactamase positive H. influenzae and M. catarrhalis is needed.

Children >40 kg: Refer to adult dosing.

DOSING: ELDERLY — Refer to adult dosing.

DOSING: RENAL IMPAIRMENT
Clcr <30 mL/minute: Do not use 875 mg tablet or extended release tablets.

Clcr 10-30 mL/minute: 250-500 mg every 12 hours

Clcr <10 mL/minute: 250-500 every 24 hours

Hemodialysis: Moderately dialyzable (20% to 50%)
250-500 mg every 24 hours; administer dose during and after dialysis. Do not use extended release tablets.

Peritoneal dialysis: Moderately dialyzable (20% to 50%)
Amoxicillin: Administer 250 mg every 12 hours
Clavulanic acid: Dose for Clcr <10 mL/minute

Continuous arteriovenous or venovenous hemofiltration effects:
Amoxicillin: ~50 mg of amoxicillin/L of filtrate is removed
Clavulanic acid: Dose for Clcr <10 mL/minute

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Powder for oral suspension: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 mL, 75 mL, 100 mL) [contains phenylalanine]; 400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, 75 mL, 100 mL) [contains phenylalanine]; 600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 mL, 125 mL, 200 mL)
Amoclan:
200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 mL, 75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.14 mEq/5 mL; fruit flavor]
400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, 75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.29 mEq/5 mL; fruit flavor]
600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 mL, 125 mL) [contains phenylalanine 7 mg/5 mL, potassium 0.248 mEq/5 mL; orange flavor]
Augmentin®:
125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per 5 mL (75 mL, 100 mL, 150 mL) [contains potassium 0.16 mEq/5 mL; banana flavor]
200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL (50 mL, 75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.14 mEq/5 mL; orange flavor] [DSC]
250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL (75 mL, 100 mL, 150 mL) [contains potassium 0.32 mEq/5 mL; orange flavor]
400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL (50 mL, 75 mL, 100 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.29 mEq/5 mL; orange flavor] [DSC]
Augmentin ES-600®: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL (75 mL, 125 mL, 200 mL) [contains phenylalanine 7 mg/5 mL and potassium 0.23 mEq/5 mL; strawberry cream flavor]

Tablet: 250: Amoxicillin 250 mg and clavulanate potassium 125 mg; 500: Amoxicillin 500 mg and clavulanate potassium 125 mg; 875: Amoxicillin 875 mg and clavulanate potassium 125 mg
Augmentin®:
250: Amoxicillin 250 mg and clavulanate potassium 125 mg [contains potassium 0.63 mEq/tablet]
500: Amoxicillin 500 mg and clavulanate potassium 125 mg [contains potassium 0.63 mEq/tablet]
875: Amoxicillin 875 mg and clavulanate potassium 125 mg [contains potassium 0.63 mEq/tablet]

Tablet, chewable: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg [contains phenylalanine]; 400: Amoxicillin 400 mg and clavulanate potassium 57 mg [contains phenylalanine]

Tablet, extended release:
Augmentin XR®: 1000: Amoxicillin 1000 mg and clavulanate acid 62.5 mg [contains potassium 12.6 mg (0.32 mEq) and sodium 29.3 mg (1.27 mEq) per tablet; packaged in either a 7-day or 10-day package]

DOSAGE FORMS: CONCISE
Powder for oral suspension: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL; 400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL; 600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL
Amoclan:
200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg per 5 mL
400: Amoxicillin 400 mg and clavulanate potassium 57 mg per 5 mL
600: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL
Augmentin®:
125: Amoxicillin 125 mg and clavulanate potassium 31.25 mg per 5 mL
250: Amoxicillin 250 mg and clavulanate potassium 62.5 mg per 5 mL
Augmentin ES-600®: Amoxicillin 600 mg and clavulanate potassium 42.9 mg per 5 mL

Tablet: 500: Amoxicillin 500 mg and clavulanate potassium 125 mg; 875: Amoxicillin 875 mg and clavulanate potassium 125 mg
Augmentin®:
250: Amoxicillin 250 mg and clavulanate potassium 125 mg
500: Amoxicillin 500 mg and clavulanate potassium 125 mg
875: Amoxicillin 875 mg and clavulanate potassium 125 mg

Tablet, chewable: 200: Amoxicillin 200 mg and clavulanate potassium 28.5 mg; 400: Amoxicillin 400 mg and clavulanate potassium 57 mg

Tablet, extended release:
Augmentin XR®: 1000: Amoxicillin 1000 mg and clavulanate acid 62.5 mg

GENERIC EQUIVALENT AVAILABLE — Yes: Excludes extended release

ADMINISTRATION — Administer around-the-clock to promote less variation in peak and trough serum levels. Administer with food to decrease stomach upset; shake suspension well before use. Extended release tablets should be administered with food.

Some penicillins (eg, carbenicillin, ticarcillin, and piperacillin) have been shown to inactivate aminoglycosides in vitro. This has been observed to a greater extent with tobramycin and gentamicin, while amikacin has shown greater stability against inactivation. Concurrent use of these agents may pose a risk of reduced antibacterial efficacy in vivo, particularly in the setting of profound renal impairment. However, definitive clinical evidence is lacking. If combination penicillin/aminoglycoside therapy is desired in a patient with renal dysfunction, separation of doses (if feasible), and routine monitoring of aminoglycoside levels, CBC, and clinical response should be considered.

USE — Treatment of otitis media, sinusitis, and infections caused by susceptible organisms involving the lower respiratory tract, skin and skin structure, and urinary tract; spectrum same as amoxicillin with additional coverage of beta-lactamase producing B. catarrhalis, H. influenzae, N. gonorrhoeae, and S. aureus (not MRSA). The expanded coverage of this combination makes it a useful alternative when amoxicillin resistance is present and patients cannot tolerate alternative treatments.

ADVERSE REACTIONS SIGNIFICANT
>10%: Gastrointestinal: Diarrhea (3% to 34%; incidence varies upon dose and regimen used)

1% to 10%:
Dermatologic: Diaper rash, skin rash, urticaria
Gastrointestinal: Abdominal discomfort, loose stools, nausea, vomiting
Genitourinary: Vaginitis, vaginal mycosis
Miscellaneous: Moniliasis

<1% (Limited to important or life-threatening): Alkaline phosphatase increased, cholestatic jaundice, flatulence, headache, hepatic dysfunction, hepatitis, liver function tests increased, prothrombin time increased, thrombocytosis, vasculitis (hypersensitivity)

Additional adverse reactions seen with ampicillin-class antibiotics: Agitation, agranulocytosis, alkaline phosphatase increased, anaphylaxis, anemia, angioedema, anxiety, behavioral changes, bilirubin increased, black "hairy" tongue, confusion, convulsions, crystalluria, dizziness, enterocolitis, eosinophilia, erythema multiforme, exanthematous pustulosis, exfoliative dermatitis, gastritis, glossitis, hematuria, hemolytic anemia, hemorrhagic colitis, indigestion, insomnia, hyperactivity, interstitial nephritis, leukopenia, mucocutaneous candidiasis, pruritus, pseudomembranous colitis, serum sickness-like reaction, Stevens-Johnson syndrome, stomatitis, transaminases increased, thrombocytopenia, thrombocytopenic purpura, tooth discoloration, toxic epidermal necrolysis

CONTRAINDICATIONS — Hypersensitivity to amoxicillin, clavulanic acid, penicillin, or any component of the formulation; history of cholestatic jaundice or hepatic dysfunction with amoxicillin/clavulanate potassium therapy; Augmentin XR™ : severe renal impairment (Clcr <30 mL/minute) and hemodialysis patients

WARNINGS / PRECAUTIONS
Concerns related to adverse effects: Anaphylactoid/hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity, history of sensitivity to multiple allergens, or previous IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria). Use with caution in asthmatic patients. Low incidence of cross-allergy with cephalosporins exists. Diarrhea: Incidence of diarrhea is higher than with amoxicillin alone. Hepatic effects: Although rare, hepatic dysfunction is more common in elderly and/or males, and occurs more frequently with prolonged treatment, and may occur after therapy is complete. Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns: Hepatic impairment: Use with caution in patients with hepatic impairment. Infectious mononucleosis: A high percentage of patients with infectious mononucleosis have developed rash during therapy; ampicillin-class antibiotics not recommended in these patients. Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.

Dosage form specific issues: Clavulanic acid content: Due to differing content of clavulanic acid, not all formulations are interchangeable. Phenylalanine: Some products contain phenylalanine.

DRUG INTERACTIONS
Allopurinol: May enhance the potential for allergic or hypersensitivity reactions to Amoxicillin. Risk C: Monitor therapy

Fusidic Acid: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Methotrexate: Penicillins may decrease the excretion of Methotrexate. Risk C: Monitor therapy

Mycophenolate: Penicillins may decrease serum concentrations of the active metabolite(s) of Mycophenolate. This effect appears to be the result of impaired enterohepatic recirculation. Risk C: Monitor therapy

Tetracycline Derivatives: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification

Uricosuric Agents: May decrease the excretion of Penicillins. Risk C: Monitor therapy

PREGNANCY RISK FACTOR — B (show table)

PREGNANCY IMPLICATIONS — Adverse events have not been observed in animal studies; therefore, amoxicillin/clavulanate is classified as pregnancy category B. Both amoxicillin and clavulanic acid cross the placenta. There is no documented increased risk of teratogenic effects caused by amoxicillin/clavulanate. A potential increased risk of necrotizing enterocolitis in the newborn has been noted after maternal use of amoxicillin/clavulanate for preterm labor or premature prolonged rupture of membranes. When used during pregnancy, pharmacokinetic changes have been observed with amoxicillin alone (refer to the Amoxicillin monograph for details).

LACTATION — Enters breast milk/use caution

BREAST-FEEDING CONSIDERATIONS — Amoxicillin is found in breast milk. The manufacturer recommends that caution be used if administered to breast-feeding women. The use of amoxicillin/clavulanate may be safe while breast-feeding; however, the risk of adverse events in the infant may be increased when compared to the use of amoxicillin alone. The risk of adverse events may be related to maternal dose. Nondose-related effects could include modification of bowel flora and allergic sensitization of the infant.

DIETARY CONSIDERATIONS — May be taken with meals or on an empty stomach; take with meals to increase absorption and decrease GI intolerance; may mix with milk, formula, or juice. Extended release tablets should be taken with food. Some products contain phenylalanine. If you have phenylketonuria or PKU, avoid use. All dosage forms contain potassium.

PRICING — (data from drugstore.com)
Chewable (Amoxicillin-Pot Clavulanate)
400-57 mg (20): $63.79

Suspension (reconstituted) (Amoxicillin-Pot Clavulanate)
600-42.9 mg/5 mL (75): $35.99

Tablet, 12-hour (Augmentin XR)
1000-62.5 mg (28): $116.70

Tablets (Amoxicillin-Pot Clavulanate)
250-125 mg (30): $116.54
500-125 mg (20): $45.99
875-125 mg (20): $31.99

Tablets (Augmentin)
250-125 mg (30): $118.99
500-125 mg (30): $166.71
875-125 mg (20): $145.99

MONITORING PARAMETERS — Assess patient at beginning and throughout therapy for infection; with prolonged therapy, monitor renal, hepatic, and hematologic function periodically; monitor for signs of anaphylaxis during first dose

CANADIAN BRAND NAMES — Alti-Amoxi-Clav; Apo-Amoxi-Clav®; Augmentin®; Clavulin®; Novo-Clavamoxin; ratio-Aclavulanate

INTERNATIONAL BRAND NAMES — Acarbixin (MX); Aclam (ID); Ambilan (PE); AMK (TH); Amobay Cl (MX); Amocla (KP); Amocla Duo (KP); Amoclan (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Amoclav (DE); Amoksiclav (TH); Amoksiklav (CL, PL); Amolanic (KP); Amolanic Duo (KP); Amoxa (KP); Amoxi Plus (PY); Amoxiclav (MX); Amoxiclav-BID (MX); Amoxiclav-Teva (IL); Amoxsiklav Forte (TH); Amoxxlin (KP); Amoxyclav (IL); Augamox (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); AugMaxcil (ZA); Augmentan (DE); Augmentin (AE, AT, AU, BB, BE, BF, BG, BH, BJ, BM, BS, BZ, CH, CI, CR, CY, CZ, DE, DK, DO, EG, ES, ET, FI, FR, GB, GH, GM, GN, GR, GT, GY, HK, HN, IE, IL, IN, IQ, IR, IT, JM, JO, JP, KE, KP, KW, LB, LR, LY, MA, ML, MR, MU, MW, MX, MY, NE, NG, NI, NL, NO, OM, PA, PE, PK, PL, PT, QA, RU, SA, SC, SD, SE, SL, SN, SR, SV, SY, TH, TN, TR, TT, TZ, UG, UY, VE, YE, ZA, ZM, ZW); Augmentine (ES); Augmex (PH); Augpen (TH); Augurcin (PH); Bactiv (PH); Bactoclav (PH); Bioclavid (AE, BH, CY, DE, DK, EG, IL, IQ, IR, JO, KW, LB, LY, OM, PH, QA, SA, SE, SY, YE); Bioclavid Forte (PH); Cavumox (MY, TH); Cax (PH); Clacillin Duo Dry Syrup (KP); Clamax (KP); Clamentin (ZA); Clamohexal (AU); Clamohexal Duo (AU); Clamovid (HK, MY, SG); Clamoxin (MX); Clamoxyl (AU); Clamoxyl Duo 400 (AU); Clamoxyl DuoForte (AU); Clavamox (DE, ID, IN); Clavant (MX); Clavar (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Claventin (IL); Clavinex (CN, EC); Clavipen (MX); Clavmex (PH); Clavodar (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Clavoxil (BR); Clavoxine (EC); Clavucyd (MX); Clavulin (BF, BJ, CI, CO, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, MX, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZA, ZM, ZW); Clavulin Duo Forte (AU); Clavulox Duo (AR, PY); Clavumox (DE, PE, ZA); Clavuser (MX); Cramon Duo (KP); Curam (AU, CO, CR, DO, GT, HK, MY, NI, PA, PE, PL, SG, SV, TH, TW); Danoclav (ID); Darzitil Plus (AR); E-Moxclav (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Enhancin (SG); Exten (PH); Fleming (HK); Forcid (PL); Fugentin (SG); Fullicilina Plus (AR); Gimaclav (MX); Hibiotic (AE, BH, CY, EG, IL, IQ, IR, JO, KW, LB, LY, OM, QA, SA, SY, YE); Klamonex (KP); Klavic (PH); Klavocin (PL); Kmoxilin (KP); Lansiclav (ID); Moxiclav (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IL, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, QA, SA, SC, SD, SG, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Moxicle (KP, TH); Moxlin (MX); Natravox (PH); Novamox (BR); Nufaclav (ID); Penhance (PH); Quali-Mentin (HK); Ramoclav (PL); Ranclav (TH, ZA); Riclasip (MX); Servamox (MX); Sinufin (MX); Spektramox (SE); Sullivan (PH); Suplentin (PH); Synermox (NZ); Taromentin (PL); Velamox CL (PE); Vestaclav (MY); Viaclav (ID); Vulamox (CO, ID)

MECHANISM OF ACTION — Clavulanic acid binds and inhibits beta-lactamases that inactivate amoxicillin resulting in amoxicillin having an expanded spectrum of activity. Amoxicillin inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

PHARMACODYNAMICS / KINETICS — Amoxicillin pharmacokinetics are not affected by clavulanic acid.

Amoxicillin: See Amoxicillin monograph.

Clavulanic acid:
Protein binding: ~25%
Metabolism: Hepatic
Half-life elimination: 1 hour
Time to peak: 1 hour
Excretion: Urine (30% to 40% as unchanged drug)

PATIENT INFORMATION — Take entire course of medication. Take extended release tablets with food. Report diarrhea promptly. Females should report onset of symptoms of candidal vaginitis

Amoxapine

2010-08-02T22:34:00.001-07:00

MEDICATION SAFETY ISSUES
Sound-alike/look-alike issues:
Amoxapine may be confused with amoxicillin, Amoxil®
Asendin may be confused with aspirin

MEDICATION GUIDE — An FDA-approved patient medication guide, which is available with the product information and at http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088622.pdf, must be dispensed with this medication for each new outpatient prescription and refill.

PHARMACOLOGIC CATEGORY
Antidepressant, Tricyclic (Secondary Amine)

DOSING: ADULTS — Once symptoms are controlled, decrease gradually to lowest effective dose. Maintenance dose is usually given at bedtime to reduce daytime sedation.

Depression: Oral: Initial: 25 mg 2-3 times/day. If tolerated, dosage may be increased to 100 mg 2-3 times/day. May be given in a single bedtime dose when dosage <300 mg/day.
Maximum daily dose: 600 mg (inpatients); 400 mg (outpatients)

DOSING: PEDIATRIC
Depression: Oral:
Children: Not established in children <16 years of age.
Adolescents: Initial: 25-50 mg/day; increase gradually to 100 mg/day. May administer as divided doses or as a single dose at bedtime.

Note: Once symptoms are controlled, decrease gradually to lowest effective dose. Maintenance dose is usually given at bedtime to reduce daytime sedation.

DOSING: ELDERLY — Oral: Initial: 25 mg at bedtime increased by 25 mg weekly for outpatients and every 3 days for inpatients if tolerated; usual dose: 50-150 mg/day, but doses up to 300 mg may be necessary. Note: Once symptoms are controlled, decrease gradually to lowest effective dose. See Geriatric Considerations.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet: 25 mg, 50 mg, 100 mg, 150 mg

DOSAGE FORMS: CONCISE
Tablet: 25 mg, 50 mg, 100 mg, 150 mg

GENERIC EQUIVALENT AVAILABLE — Yes

ADMINISTRATION — May be administered with food to decrease GI distress.

USE — Treatment of depression, psychotic depression, depression accompanied by anxiety or agitation

ADVERSE REACTIONS SIGNIFICANT
>10%:
Central nervous system: Drowsiness
Gastrointestinal: Xerostomia, constipation

1% to 10%:
Central nervous system: Anxiety, ataxia, confusion, dizziness, excitement, headache, insomnia, nervousness, restlessness
Dermatologic: Edema, skin rash
Endocrine: Prolactin levels increased
Gastrointestinal: Nausea
Neuromuscular & skeletal: Tremor, weakness
Ocular: Blurred vision
Miscellaneous: Diaphoresis

<1% (Limited to important or life-threatening): Agranulocytosis, allergic reactions, diarrhea, extrapyramidal symptoms, galactorrhea, hypertension, impotence, incoordination, intraocular pressure increased, leukopenia, menstrual irregularity, mydriasis, neuroleptic malignant syndrome, numbness, painful ejaculation, paresthesia, photosensitivity, seizure, SIADH, syncope, tardive dyskinesia, testicular edema, tinnitus, urinary retention, vomiting

CONTRAINDICATIONS — Hypersensitivity to amoxapine or any component of the formulation; use of MAO inhibitors within past 14 days; acute recovery phase following myocardial infarction

WARNINGS / PRECAUTIONS
Boxed warnings: Suicidal thinking/behavior: See "Major psychiatric warnings" below.

Major psychiatric warnings:
• [U.S. Boxed Warning]: Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive disorder (MDD) and other psychiatric disorders; consider risk prior to prescribing. Short-term studies did not show an increased risk in patients >24 years of age and showed a decreased risk in patients ≥ 65 years. Closely monitor patients for clinical worsening, suicidality, or unusual changes in behavior, particularly during the initial 1-2 months of therapy or during periods of dosage adjustments (increases or decreases); the patient's family or caregiver should be instructed to closely observe the patient and communicate condition with healthcare provider. A medication guide concerning the use of antidepressants should be dispensed with each prescription. Amoxapine is not FDA approved for use in patients <16 years of age. The possibility of a suicide attempt is inherent in major depression and may persist until remission occurs. Patients treated with antidepressants should be observed for clinical worsening and suicidality, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Worsening depression and severe abrupt suicidality that are not part of the presenting symptoms may require discontinuation or modification of drug therapy. Use caution in high-risk patients during initiation of therapy. Prescriptions should be written for the smallest quantity consistent with good patient care. The patient's family or caregiver should be alerted to monitor patients for the emergence of suicidality and associated behaviors such as anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, and mania; patients should be instructed to notify their healthcare provider if any of these symptoms or worsening depression or psychosis occur. May worsen psychosis in some patients or precipitate a shift to mania or hypomania in patients with bipolar disorder. Monotherapy in patients with bipolar disorder should be avoided. Patients presenting with depressive symptoms should be screened for bipolar disorder. Amoxapine is not FDA approved for the treatment of bipolar depression.

Concerns related to adverse effects: Anticholinergic effects: May cause anticholinergic effects (constipation, xerostomia, blurred vision, urinary retention); use with caution in patients with decreased gastrointestinal motility, paralytic ileus, urinary retention, BPH, xerostomia, or visual problems. The degree of anticholinergic blockade produced by this agent is moderate relative to other antidepressants. Extrapyramidal symptoms: May cause extrapyramidal symptoms, including pseudoparkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesia (risk of these reactions is low). Neuroleptic malignant syndrome (NMS): Use may be associated with NMS; monitor for mental status changes, fever, muscle rigidity, and/or autonomic instability (risk may be increased in patients with Parkinson's disease or Lewy body dementia). Orthostatic hypotension: May cause orthostatic hypotension (risk is moderate relative to other antidepressants); use with caution in patients at risk of this effect or in those who would not tolerate transient hypotensive episodes (cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia). Sedation: May cause sedation, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). The degree of sedation is moderate relative to other antidepressants.

Disease-related concerns: Cardiovascular disease: Use with caution in patients with a history of cardiovascular disease (including previous MI, stroke, tachycardia, or conduction abnormalities); the risk conduction abnormalities with this agent is moderate relative to other antidepressants. Hepatic impairment: Use with caution in patients with hepatic impairment. Renal impairment: Use with caution in patients with renal impairment. Seizure disorder: Use with caution in patients at risk of seizures, including those with a history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold. Thyroid dysfunction: Use with caution in patients with hyperthyroidism or those receiving thyroid supplementation.

Concurrent drug therapy issues: Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.

Special populations: Elderly: Use with caution in the elderly.

Other warnings/precautions: Discontinuation of therapy: Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods. Electroconvulsive therapy: May increase the risks associated with electroconvulsive therapy; consider discontinuing, when possible, prior to ECT treatment.

METABOLISM / TRANSPORT EFFECTS — Substrate of CYP2D6 (major)

DRUG INTERACTIONS
Acetylcholinesterase Inhibitors (Central): Anticholinergics may diminish the therapeutic effect of Acetylcholinesterase Inhibitors (Central). Acetylcholinesterase Inhibitors (Central) may diminish the therapeutic effect of Anticholinergics. If the anticholinergic action is a side effect of the agent, the result may be beneficial. Risk C: Monitor therapy

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy

Alfuzosin: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk C: Monitor therapy

Alpha-/Beta-Agonists (Direct-Acting): Tricyclic Antidepressants may enhance the vasopressor effect of Alpha-/Beta-Agonists (Direct-Acting). Exceptions: Dipivefrin. Risk D: Consider therapy modification

Alpha1-Agonists: Tricyclic Antidepressants may enhance the vasopressor effect of Alpha1-Agonists. Risk D: Consider therapy modification

Alpha2-Agonists: Tricyclic Antidepressants may diminish the antihypertensive effect of Alpha2-Agonists. Exceptions: Apraclonidine; Brimonidine. Risk D: Consider therapy modification

Altretamine: May enhance the orthostatic effect of Tricyclic Antidepressants. Risk C: Monitor therapy

Amphetamines: Tricyclic Antidepressants may enhance the stimulatory effect of Amphetamines. Tricyclic Antidepressants may also potentiate the cardiovascular effects of Amphetamines. Risk C: Monitor therapy

Anticholinergics: May enhance the adverse/toxic effect of other Anticholinergics. Exceptions: Paliperidone. Risk C: Monitor therapy

Artemether: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination

Barbiturates: May increase the metabolism of Tricyclic Antidepressants. Risk D: Consider therapy modification

Beta2-Agonists: Tricyclic Antidepressants may enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy

CarBAMazepine: May increase the metabolism of Tricyclic Antidepressants. Risk C: Monitor therapy

Chloroquine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk C: Monitor therapy

Cimetidine: May decrease the metabolism of Tricyclic Antidepressants. Risk C: Monitor therapy

Cinacalcet: May increase the serum concentration of Tricyclic Antidepressants. Risk C: Monitor therapy

Ciprofloxacin: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk C: Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy

CYP2D6 Inhibitors (Moderate): May decrease the metabolism of CYP2D6 Substrates. Risk C: Monitor therapy

CYP2D6 Inhibitors (Strong): May decrease the metabolism of CYP2D6 Substrates. Risk D: Consider therapy modification

Desmopressin: Tricyclic Antidepressants may enhance the adverse/toxic effect of Desmopressin. Risk C: Monitor therapy

Dexmethylphenidate: May decrease the metabolism of Tricyclic Antidepressants. Risk C: Monitor therapy

Dronedarone: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Dronedarone. Risk X: Avoid combination

DULoxetine: May decrease the metabolism of Tricyclic Antidepressants. Risk C: Monitor therapy

Gadobutrol: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk D: Consider therapy modification

Iobenguane I 123: Tricyclic Antidepressants may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination

Lithium: May enhance the neurotoxic effect of Tricyclic Antidepressants. Risk C: Monitor therapy

Lumefantrine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination

MAO Inhibitors: May enhance the serotonergic effect of Tricyclic Antidepressants. This may cause serotonin syndrome. Risk X: Avoid combination

MAO Inhibitors: May enhance the orthostatic effect of Orthostasis Producing Agents. Risk C: Monitor therapy

Methylphenidate: May decrease the metabolism of Tricyclic Antidepressants. Risk C: Monitor therapy

Nilotinib: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination

Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy

Pimozide: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Pimozide. Risk X: Avoid combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergics. These effects are specific to the GI tract. Risk D: Consider therapy modification

Propoxyphene: May enhance the CNS depressant effect of Tricyclic Antidepressants. Risk C: Monitor therapy

Protease Inhibitors: May increase the serum concentration of Tricyclic Antidepressants. Risk C: Monitor therapy

QTc-Prolonging Agents: May enhance the adverse/toxic effect of other QTc-Prolonging Agents. Their effects can be additive, causing life-threatening ventricular arrhythmias. Risk D: Consider therapy modification

QuiNIDine: Tricyclic Antidepressants may enhance the QTc-prolonging effect of QuiNIDine. QuiNIDine may decrease the metabolism of Tricyclic Antidepressants. Risk D: Consider therapy modification

QuiNINE: QTc-Prolonging Agents may enhance the QTc-prolonging effect of QuiNINE. QuiNINE may enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination

Selective Serotonin Reuptake Inhibitors: May decrease the metabolism of Tricyclic Antidepressants. Risk D: Consider therapy modification

Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Risk D: Consider therapy modification

Sibutramine: May enhance the serotonergic effect of Serotonin Modulators. This may cause serotonin syndrome. Risk X: Avoid combination

St Johns Wort: May increase the metabolism of Tricyclic Antidepressants. The risk of serotonin syndrome may theoretically be increased. Risk D: Consider therapy modification

Sulfonylureas: Cyclic Antidepressants may enhance the hypoglycemic effect of Sulfonylureas. Risk C: Monitor therapy

Terbinafine: May decrease the metabolism of Tricyclic Antidepressants. Risk D: Consider therapy modification

Tetrabenazine: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Tetrabenazine. Risk X: Avoid combination

Thioridazine: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Thioridazine. Risk X: Avoid combination

TraMADol: Tricyclic Antidepressants may enhance the neuroexcitatory and/or seizure-potentiating effect of TraMADol. Risk C: Monitor therapy

Valproic Acid: May increase the serum concentration of Tricyclic Antidepressants. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Tricyclic Antidepressants may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Yohimbine: Tricyclic Antidepressants may increase the serum concentration of Yohimbine. Risk C: Monitor therapy

Ziprasidone: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Ziprasidone. The risk of a severe arrhythmia may be increased. Risk X: Avoid combination

ETHANOL / NUTRITION / HERB INTERACTIONS
Ethanol: Avoid ethanol (may increase CNS depression).

Food: Grapefruit juice may inhibit the metabolism of some TCAs and clinical toxicity may result.

Herb/Nutraceutical: Avoid valerian, St John's wort, SAMe, kava kava.

PREGNANCY RISK FACTOR — C (show table)

LACTATION — Enters breast milk/contraindicated (AAP rates "of concern")

PRICING — (data from drugstore.com)
Tablets (Amoxapine)
25 mg (60): $25.99
50 mg (60): $28.99
100 mg (30): $35.99
150 mg (30): $38.99

MONITORING PARAMETERS — Monitor blood pressure and pulse rate prior to and during initial therapy evaluate mental status, suicidal ideation (especially at the beginning of therapy or when doses are increased or decreased); monitor weight; ECG in older adults

REFERENCE RANGE — Therapeutic: Amoxapine: 20-100 ng/mL (SI: 64-319 nmol/L); 8-OH amoxapine: 150-400 ng/mL (SI: 478-1275 nmol/L); both: 200-500 ng/mL (SI: 637-1594 nmol/L)

INTERNATIONAL BRAND NAMES — Asendin (ID); Defanyl (FR); Demolox (DK, IN)

MECHANISM OF ACTION — Reduces the reuptake of serotonin and norepinephrine. The metabolite, 7-OH-amoxapine has significant dopamine receptor blocking activity similar to haloperidol.

PHARMACODYNAMICS / KINETICS
Onset of antidepressant effect: Usually occurs after 1-2 weeks, but may require 4-6 weeks

Absorption: Rapid and well absorbed

Distribution: Vd: 0.9-1.2 L/kg; enters breast milk

Protein binding: 80%

Metabolism: Primarily hepatic

Half-life elimination: Parent drug: 11-16 hours; Active metabolite (8-hydroxy): Adults: 30 hours

Time to peak, serum: 1-2 hours

Excretion: Urine (as unchanged drug and metabolites)

PATIENT INFORMATION — Dry mouth may be helped by sips of water, sugarless gum, or hard candy; avoid alcohol; very important to maintain established dosage regimen; photosensitivity to sunlight can occur, do not discontinue abruptly; full effect may not occur for 3-4 weeks; full dosage may be taken at bedtime to avoid daytime sedation

Drug Information Directory

Patient information: Anaphylaxis symptoms and diagnosis

Patient information: Allergy to penicillin and related antibiotics

Barbados Cherry

Black sugar maple

Cucurbit Resources in Namibia

ACANTHOSICYOS HORRIDA

CITRULLUS ECIRRHOSUS

CITRULLUS LANATUS

REFERENCES

Acacia seyal Del.

Acacia tortilis (Forsk.) Hayne

Acacia saligna (Labill.) H.Wendl

Acacia senegal (L.) Willd.

New Arid Land Ornamentals

Acacia redolens Maslin, Desert CarpetTM

Baccharis hybrid 'Starn' (P.P.A.F.) ThompsonTM

Cercidium species 'Desert Museum'

Chilopsis linearis (Cav.) Sweet, Lucretia HamiltonTM

Chrysactinia mexicana Gray (Damianita)

Dalea capitata Sierra GoldTM

Dasylirion longissimum

Euphorbia biglandulosa Desf. (Gopher Plant)

Hesperaloe parviflora (Torr.) J. Coult., 'Yellow' (Yellow yucca)

Hymenoxys acaulis (Pursh) K. Parker (Angelita Daisy)

Leucophyllum candidum I.M. Johnst. Thunder CloudTM

Leucophyllum langmaniae Rio BravoTM

Muhlenbergia capillaris (Lam.) Trin. Regal MistTM

Penstemon species

Acacia nilotica (L.) Del

Acacia mearnsii de Wild

Acacia mearnsii de Wild

Acacia mearnsii de Wild

Acacia mangium Willd

Acacia redolens Maslin, Desert Carpet^TM

Baccharis hybrid 'Starn' (P.P.A.F.) Thompson^TM

Chilopsis linearis (Cav.) Sweet, Lucretia Hamilton^TM

Dalea capitata Sierra Gold^TM

Leucophyllum candidum I.M. Johnst. Thunder Cloud^TM

Leucophyllum langmaniae Rio Bravo^TM

Muhlenbergia capillaris (Lam.) Trin. Regal Mist^TM