The precise mechanism through which fluticasone propionate affects rhinitis symptoms is not known. Corticosteroids have been shown to have a wide range of effects on multiple cell types (., mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (., histamine, eicosanoids, leukotrienes, cytokines) involved in inflammation. In 7 trials in adults, Flonase Nasal Spray has decreased nasal mucosal eosinophils in 66% of patients (35% for placebo) and basophils in 39% of patients (28% for placebo). The direct relationship of these findings to long-term symptom relief is not known.
A number of well-designed clinical trials have been conducted evaluating the efficacy of saffron 30 mg daily over 6 to 8 weeks in mild to moderate depression. 33 , 34 , 35 , 36 , 37 The studies found saffron to be more effective than placebo and at least equivalent to therapeutic doses of imipramine and fluoxetine using the Hamilton Depression Rating Scale. No significant differences were found in adverse events in any of the studies. However, the studies involved small sample sizes (40 patients) and were conducted by the same group of researchers, within a non–Western population. 38 , 39 The cost of stigma-based saffron capsules is significant, and 2 of the trials evaluated petal-derived saffron with satisfactory results. 33 , 36 The same researchers favorably evaluated saffron for the relief of premenstrual syndrome. 40
Some confusion exists regarding the nomenclature of the products derived from L. virosa and related plants. Flowering lettuce plants contain large amounts of a milky-white sap, which has a bitter taste and strong opiate-like odor. When the juice is collected and is exposed to air, it turns a brownish color. This substance is called lactucarium, a mixture of compounds to which the touted narcotic properties of the product have been ascribed. Lactucarium has been reported to contain approximately % lactucin, a sesquiterpinoid lactone. Additionally, the mixture contains a volatile oil, caoutchouc, mannitol, and lactucerol (taraxasterol) (approximately 50%). Lactucerin, also found in the latex, is the acetyl derivative of taraxasterol, a widely distributed triterpene. 4 , 6