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ANTLER VELVET

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Antler velvet is the fast-growing cartilage-type tissue that regrows naturally on elk and red deer each year. It is the epidermis that covers the inner structure of the growing bone and cartilage. The velvet is removed either by a veterinarian or a producer (accredited by a veterinarian). Antler velvet is dried and processed and marketed as a remedy for a wide range of disorders.

Specific Substances

    A) DEER ANTLER VELVET
    1) Cervi
    2) Cervus nippon antler
    3) Cornu cervi parvum
    4) Deer antler
    5) Deer antler velvet
    6) Deer velvet
    7) Deer velvet antler
    8) Elk velvet antler
    9) Horns of gold
    10) Lu rong
    11) Nokyong
    12) Pilosa antler
    13) Rokujo
    14) Velvet
    15) Velvet antler
    16) Velvet of young deer horn
    ELK ANTLER VELVET
    1) Cervus elaphus antler
    2) Velvet antler
    3) Wapiti antler

Available Forms Sources

    A) FORMS
    1) Antler velvet is available as capsule, extract, powder, tablet or tea. Natraflex(TM), an antler velvet supplement, is available as 250 mg capsules (Anon, 2003).
    B) SOURCES
    1) Antler velvet is the fast-growing cartilage-type tissue that regrows naturally on elk and red deer each year. It is the epidermis that covers the inner structure of the growing bone and cartilage. The velvet is removed either by a veterinarian or a producer (accredited by a veterinarian). Antler velvet is dried and processed and marketed as a remedy for a wide range of disorders(Suttie et al, 2003; Jellin et al, 2002; Fennessy, 1991; Goldsmith, 1988).
    C) USES
    1) Deer antler velvet has been used in traditional medicine for the treatment of arthritis, osteomyelitis, calcium deficiency, anemia, menopausal disorders, impotence, spermatorrhea, and as an aid in childbirth. It has also been used as a tonic and preventative medicine (Fennessy, 1991).
    2) Deer velvet has recently gained popularity as being marketed for a wide range of disorders including sciatica, shoulder pain, neck stiffness, infertility in women, liver disease, high cholesterol, varicose veins, dysmenorrhea, hypertension, gout, rheumatoid arthritis (Dalefield & Oehme, 1999).
    3) Animal studies have suggested that antler velvet may inhibit the development of tolerance to repeated doses of morphine (Kim & Lim, 1999; Kim et al, 1999).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: Antler velvet is the fast-growing cartilage-type tissue that regrows naturally on elk and red deer each year. It is the epidermis that covers the inner structure of the growing bone and cartilage. The velvet is removed either by a veterinarian or a producer (accredited by a veterinarian). Antler velvet is dried and processed and marketed as a remedy for a wide range of disorders. It has been used in traditional medicine for the treatment of arthritis, osteomyelitis, calcium deficiency, anemia, menopausal disorders, impotence, spermatorrhea, and as an aid in childbirth. It has also been used as a tonic and preventative medicine. Deer velvet has recently gained popularity as being marketed for a wide range of disorders including sciatica, shoulder pain, neck stiffness, infertility in women, liver disease, high cholesterol, varicose veins, dysmenorrhea, hypertension, gout, rheumatoid arthritis. Antler velvet is available as capsule, extract, powder, tablet or tea.
    B) PHARMACOLOGY: HEPATOPROTECTIVE EFFECT: Investigators postulate that antler velvet extract administration might result in a reduction of lipid peroxidation and malondialdehyde formation via stimulation of hepatic superoxide dismutase, which scavenge oxygen radicals. ANTI-NARCOTIC TOLERANCE EFFECT: The reduction in the development of morphine-induced analgesic tolerance and physical dependence may be due to an increase in glutathione levels following the administration of antler products. Keratin may represent the active component for this action.
    C) EPIDEMIOLOGY: Exposure is rare.
    D) WITH POISONING/EXPOSURE
    1) Occupational asthma, allergic rhinitis, and pruritus have been reported in persons handling deer or deer velvet.
    0.2.20) REPRODUCTIVE
    A) The potential androgenic effects of antler velvet may adversely affect the developing fetus if taken during pregnancy. Drugs used to anesthetize animals during harvesting of antler velvet are transported into the antlers, may potentially cause toxicity, and have a mutagenic action.

Laboratory Monitoring

    A) Plasma concentrations are not readily available or clinically useful in the management of overdose.
    B) Monitor pulse oximetry and/or arterial blood gases in patients with respiratory signs or symptoms.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF TOXICITY
    1) Treatment is symptomatic and supportive. Significant toxicity is not expected.
    B) DECONTAMINATION
    1) PREHOSPITAL; Acute toxicity has not been reported after antler velvet overdose. Prehospital gastrointestinal decontamination is generally not indicated.
    2) HOSPITAL: Acute toxicity has not been reported after antler velvet overdose. Gastrointestinal decontamination is generally not indicated. It should be considered after very large ingestions or exposures where more toxic coingestants are involved.
    C) AIRWAY MANAGEMENT
    1) Airway management is very unlikely to be necessary unless other toxic agents have been administered concurrently. Ensure adequate ventilation and perform endotracheal intubation early in patients with severe respiratory distress.
    D) ANTIDOTE
    1) None.
    E) ENHANCED ELIMINATION
    1) There is no information regarding the effectiveness of hemodialysis or hemoperfusion for the removal of antler velvet from plasma.
    F) PATIENT DISPOSITION
    1) HOME CRITERIA: A patient with an inadvertent exposure, that remains asymptomatic can be managed at home.
    2) OBSERVATION CRITERIA: Patients with a deliberate overdose, and those who are symptomatic should be observed with frequent monitoring of vital signs. Patients that remain asymptomatic can be discharged.
    3) ADMISSION CRITERIA: Patients who remain symptomatic despite treatment should be admitted.
    4) CONSULT CRITERIA: Consult a local poison center or medical toxicologist for assistance in managing patients with severe toxicity or in whom the diagnosis is not clear.
    G) PITFALLS
    1) When managing a suspected overdose, the possibility of multiagent involvement should be considered.
    H) DIFFERENTIAL DIAGNOSIS
    1) Any pulmonary disease including bronchitis, pneumonia and reactive airway disease.

Range Of Toxicity

    A) TOXICITY: A minimum toxic dose has not been established.

Clinical Effects

Summary Of Exposure

    A) USES: Antler velvet is the fast-growing cartilage-type tissue that regrows naturally on elk and red deer each year. It is the epidermis that covers the inner structure of the growing bone and cartilage. The velvet is removed either by a veterinarian or a producer (accredited by a veterinarian). Antler velvet is dried and processed and marketed as a remedy for a wide range of disorders. It has been used in traditional medicine for the treatment of arthritis, osteomyelitis, calcium deficiency, anemia, menopausal disorders, impotence, spermatorrhea, and as an aid in childbirth. It has also been used as a tonic and preventative medicine. Deer velvet has recently gained popularity as being marketed for a wide range of disorders including sciatica, shoulder pain, neck stiffness, infertility in women, liver disease, high cholesterol, varicose veins, dysmenorrhea, hypertension, gout, rheumatoid arthritis. Antler velvet is available as capsule, extract, powder, tablet or tea.
    B) PHARMACOLOGY: HEPATOPROTECTIVE EFFECT: Investigators postulate that antler velvet extract administration might result in a reduction of lipid peroxidation and malondialdehyde formation via stimulation of hepatic superoxide dismutase, which scavenge oxygen radicals. ANTI-NARCOTIC TOLERANCE EFFECT: The reduction in the development of morphine-induced analgesic tolerance and physical dependence may be due to an increase in glutathione levels following the administration of antler products. Keratin may represent the active component for this action.
    C) EPIDEMIOLOGY: Exposure is rare.
    D) WITH POISONING/EXPOSURE
    1) Occupational asthma, allergic rhinitis, and pruritus have been reported in persons handling deer or deer velvet.

Respiratory

    3.6.2) CLINICAL EFFECTS
    A) OCCUPATIONAL ASTHMA
    1) WITH POISONING/EXPOSURE
    a) Occupational asthma due to deer dander has been reported in a deer farmer. Dyspnea, chest discomfort, and allergic rhinitis occurred in a 44-year-old farmer 2 years after he started deer farming. The patient had strong skin reactions to sheep, goats, and camels without prior exposure to them(Dalefield & Oehme, 1999).

Hematologic

    3.13.2) CLINICAL EFFECTS
    A) LEUKOCYTOSIS
    1) WITH THERAPEUTIC USE
    a) CASE REPORT: A 48-year-old woman who intentionally ingested an unknown amount of antler velvet to improve her health presented to the emergency department 3 days after the acute onset of a dermal eruption consistent with acute generalized exanthematous pustulosis (AGEP). At presentation her temperature was slightly elevated (37.8 degrees C) and laboratory analysis showed leukocytosis (WBC, 19 x 10(9)/L), neutrophilia, (neutrophils, 16.8 x 10(9)/L), eosinophilia (eosinophils, 1.4 x 10(9)/L), and elevated liver enzymes. She was treated with methylprednisolone 0.5 mg/kg/day, antihistamines, and topical corticosteroids. She recovered completely within 7 days (Yoon et al, 2011).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) ITCHING OF SKIN
    1) WITH POISONING/EXPOSURE
    a) After 9 years of farming red deer, severe allergic rhinitis and dermal pruritus developed in response to handling deer or deer velvet (Dalefield & Oehme, 1999).
    B) ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS
    1) WITH THERAPEUTIC USE
    a) CASE REPORT: A 48-year-old woman who intentionally ingested an unknown amount of antler velvet to improve her health presented to the emergency department 3 days after the acute onset of a dermal eruption consistent with acute generalized exanthematous pustulosis (AGEP). The eruptions to her neck, trunk, and extremities were symmetrical, erythematous to purpuric, and appeared in scattered clusters of nonfollicular, tiny pustules that did not affect mucous membranes. At presentation her temperature was slightly elevated and laboratory analysis showed leukocytosis, neutrophilia, eosinophilia, and elevated liver enzymes. Blood and urine cultures were negative. She was treated with methylprednisolone 0.5 mg/kg/day, antihistamines, and topical corticosteroids. She recovered completely within 7 days (Yoon et al, 2011).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ACUTE ALLERGIC REACTION
    1) WITH POISONING/EXPOSURE
    a) After 9 years of farming Red deer, severe allergic rhinitis and dermal pruritus developed in response to handling deer or deer velvet (Dalefield & Oehme, 1999).

Reproductive

    3.20.1) SUMMARY
    A) The potential androgenic effects of antler velvet may adversely affect the developing fetus if taken during pregnancy. Drugs used to anesthetize animals during harvesting of antler velvet are transported into the antlers, may potentially cause toxicity, and have a mutagenic action.
    3.20.3) EFFECTS IN PREGNANCY
    A) PREGNANCY EFFECTS
    1) The potential androgenic effects of antler velvet may adversely affect the developing fetus if taken during pregnancy. Drugs used to anesthetize animals during harvesting of antler velvet are transported into the antlers, may potentially cause toxicity, and have a mutagenic action (Dalefield & Oehme, 1999).

Carcinogenicity

    3.21.3) HUMAN STUDIES
    A) CARCINOMA
    1) In the process of removing antlers, the animals are often restrained chemically with parenteral administration of such drugs as xylazine, fentanyl, azaperone, carfentanil, and ketamine. A controlled study found xylazine in antler velvet ranged from 70 to 220 nanograms per gram of antler following administration of this drug to the deer at a dose of 0.25 to 0.52 milligrams/kilogram intramuscularly. The effect of xylazine residues in antler velvet on consumers of the product is undetermined. The Joint FAO/WHO evaluated the residues of xylazine and several other veterinary drugs in animals and food in 1996 and were unable to establish Acceptable Daily Intakes because a metabolite of xylazine, 2,6-xylidine, is genotoxic and carcinogenic. Maximum Residue Limits for xylazine were also not established because of lack of information on the metabolism of xylazine. Antler velvet is usually harvested 10 to 30 minutes after administration of the chemical restraint which is within the withholding times for human consumption as specified by the manufacturer of the drugs. In New Zealand, the withholding time for human consumption for xylazine is 2 days(Dalefield & Oehme, 1999).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Plasma concentrations are not readily available or clinically useful in the management of overdose.
    B) Monitor pulse oximetry and/or arterial blood gases in patients with respiratory signs or symptoms.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Patients who remain symptomatic despite treatment should be admitted.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Patient with an inadvertent exposure, that remains asymptomatic can be managed at home.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Consult a local poison center or medical toxicologist for assistance in managing patients with severe toxicity or in whom the diagnosis is not clear.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients with a deliberate overdose, and those who are symptomatic should be observed with frequent monitoring of vital signs. Patients that remain asymptomatic can be discharged.

Monitoring

    A) Plasma concentrations are not readily available or clinically useful in the management of overdose.
    B) Monitor pulse oximetry and/or arterial blood gases in patients with respiratory signs or symptoms.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) Acute toxicity has not been reported after antler velvet overdose. Prehospital gastrointestinal decontamination is generally not indicated.
    6.5.2) PREVENTION OF ABSORPTION
    A) SUMMARY
    1) Acute toxicity has not been reported after antler velvet overdose. Gastrointestinal decontamination is generally not indicated. It should be considered after very large ingestions or exposures where more toxic coingestants are involved.
    B) ACTIVATED CHARCOAL
    1) CHARCOAL ADMINISTRATION
    a) Consider administration of activated charcoal after a potentially toxic ingestion (Chyka et al, 2005). Administer charcoal as an aqueous slurry; most effective when administered within one hour of ingestion.
    2) CHARCOAL DOSE
    a) Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).
    1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).
    b) ADVERSE EFFECTS/CONTRAINDICATIONS
    1) Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
    2) Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).
    6.5.3) TREATMENT
    A) SUPPORT
    1) MANAGEMENT OF TOXICITY: Treatment is symptomatic and supportive. Significant toxicity is not expected. Airway management is very unlikely to be necessary unless other toxic agents have been administered concurrently. Ensure adequate ventilation and perform endotracheal intubation early in patients with severe respiratory distress.
    B) MONITORING OF PATIENT
    1) Plasma concentrations are not readily available or clinically useful in the management of overdose.
    2) Monitor pulse oximetry and/or arterial blood gases in patients with respiratory signs or symptoms.

Enhanced Elimination

    A) LACK OF INFORMATION
    1) There is no information regarding the effectiveness of hemodialysis or hemoperfusion for the removal of antler velvet from plasma.

Range Of Toxicity

Summary

    A) TOXICITY: A minimum toxic dose has not been established.

Therapeutic Dose

    7.2.1) ADULT
    A) GENERAL
    B) The dosing of dietary supplements is highly dependent on a variety of factors such as quality of raw materials, manufacturing process, and packaging. Since no official standards have been established to date to regulate the production of dietary supplements in the United States, dosage ranges must be employed as guidelines only.
    C) ORAL
    1) GENERAL USE, powder: 1 to 3 grams divided into two or three doses daily(Bensky et al, 1993).
    2) GENERAL USE, tea: 3 to 4.5 grams daily, double-boiled by itself, may be soaked in wine (Bensky et al, 1993).
    7.2.2) PEDIATRIC
    A) GENERAL
    1) Pediatric dosing is not available.

Pharmacology Toxicology

Pharmacologic Mechanism

    A) ANTIAGING EFFECT - The antiaging effects are thought to result in part from the activation of hepatic protein synthesis. Antler velvet may increase protein synthesis in the liver due to a net increase in RNA transcription from gene deoxyribonucleic acid (DNA) and increasing levels of anabolic steroid hormones (Wang et al, 1988).
    B) GROWTH PROMOTING EFFECT - In vitro, elk antler velvet significantly promoted fibroblast growth (p less than 0.05) (Sunwoo et al, 1997).
    C) HEPATOPROTECTIVE EFFECT - Investigators postulate that antler velvet extract administration might result in a reduction of lipid peroxidation and malondialdehyde formation via stimulation of hepatic superoxide dismutase, which scavenge oxygen radicals(Wang et al, 1988a).
    D) ANTI-NARCOTIC TOLERANCE EFFECT - The reduction in the development of morphine-induced analgesic tolerance and physical dependence may be due to an increase in glutathione levels following the administration of antler products. Keratin may represent the active component for this action(Kim et al, 1999).

References

General Bibliography

    1) Anon: NATRAflex's Premium velvet antler. NATRAflex Brands. Castle Rock, CO. 2003. Available from URL: www.natraflex.com/velvetantler.htm. As accessed 8/18/03.
    2) Barling PM & Shirley J: Diaphorase activity in sebaceous glands and related structures of the male red deer.. Comp Biochem Physiol Biochem Mol Biol 1999; 123(1):17-21..
    3) Bensky D, Gamble A, & Kaptchuk T (Eds): Chinese Herbal Medicine: Materia Medica, revised edition., Eastland Press Inc, Seattle, WA, 1993, pp 336-338..
    4) Chyka PA, Seger D, Krenzelok EP, et al: Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43(2):61-87.
    5) Dalefield RR & Oehme FW: Controversies in toxicology; Deer velvet antler: some unanswered questions on toxicology.. Vet Human Toxicol 1999; 41(1):39-41..
    6) Elliot CG, Colby TV, & Kelly TM: Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest 1989; 96:672-674.
    7) FDA: Poison treatment drug product for over-the-counter human use; tentative final monograph. FDA: Fed Register 1985; 50:2244-2262.
    8) Fennessy PF: Velvet antler: The product and pharmacology. In Proceedings of a Deer Course for Veterinarians, Deer Branch Course (No. 8) , Deer Branch of the New Zealand Veterinary Association, Sydney, New South Wales, Australia, 1991, pp 169-180.
    9) Goldsmith LA: The velvet case.. Arch Dermatol 1988; 124(5):768..
    10) Golej J, Boigner H, Burda G, et al: Severe respiratory failure following charcoal application in a toddler. Resuscitation 2001; 49:315-318.
    11) Graff GR, Stark J, & Berkenbosch JW: Chronic lung disease after activated charcoal aspiration. Pediatrics 2002; 109:959-961.
    12) Harris CR & Filandrinos D: Accidental administration of activated charcoal into the lung: aspiration by proxy. Ann Emerg Med 1993; 22:1470-1473.
    13) Hattori M, Yang X-W, Kaneko S, et al: Constituents of the pilose antler of Cervus nippon var. mantchuricus.. Shoyakugaku Zasshi 1989; 43(2):173-176..
    14) Jellin JM, Gregory PJ, & Batz F: Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. 4th ed, Therapeutic Research Faculty, Stockton, CA, 2002, pp 89-90.
    15) Jhon G-J, Park S-Y, Han S-Y, et al: Studies of the chemical structure of gangliosides in deer antler, Cervus nippon.. Chem Pharm Bull 1999; 47(1):123-127..
    16) Kim H-S & Lim H-K: Inhibitory effects of velvet antler water extract on morphine-induced conditioned place preference and DA receptor supersensitivity in mice.. J Ethnopharmacol 1999; 66(1):25-31..
    17) Kim H-S, Lim H-K, & Park W-K: Antinarcotic effect of the velvet antler extract on morphine in mice.. J Ethnopharmacol 1999; 66(1):41-49..
    18) Ko KM, Yip TT, Tsao SW, et al: Epidermal growth factor from deer (Cervus elaphus) submaxillary gland and velvet antler.. Gen Comp Endocrinol 1986; 63(3):431-440..
    19) None Listed: Position paper: cathartics. J Toxicol Clin Toxicol 2004; 42(3):243-253.
    20) Pollack MM, Dunbar BS, & Holbrook PR: Aspiration of activated charcoal and gastric contents. Ann Emerg Med 1981; 10:528-529.
    21) Rau NR, Nagaraj MV, Prakash PS, et al: Fatal pulmonary aspiration of oral activated charcoal. Br Med J 1988; 297:918-919.
    22) Sunwoo HH, Nakano T, & Sim JS: Effect of water-soluble extract from the antler of wapiti (Cervus elaphus) on the growth of fibroblasts.. Can J Anim Sci 1997; 77(2):343-345..
    23) Sunwoo HH, Nakano T, & Sim JS: Isolation and characterization of proteoglycans from growing antlers of wapiti (Cervus elaphus).. Comp Biochem & Physiol Part B 1998a; 121(4):437-442..
    24) Sunwoo HH, Nakano T, Hudson RJ, et al: Chemical composition of antlers from Wapiti (Cervus elaphus).. J Agric Food Chem 1995; 43(11):2846-2849..
    25) Sunwoo HH, Nakano T, Hudson RJ, et al: Isolation, characterization and localization of glycosaminoglycans in the growing antlers of wapiti (Cervus elaphus).. Comp Biochem & Physiol Part B 1998; 120(2):273-283..
    26) Sunwoo HH, Sim LYM, Nakano T, et al: Glycosaminoglycans from the growing antlers of wapiti (Cervus elaphus).. Can J Anim Sci 1997a; 77:715-721..
    27) Suttie JM, Fennessy PF, Haines SR et al: The velvet antler industry: Background research and findings. Health World Online. Los Angeles, CA. 2003. Available from URL: http://www.healthy.net/library/articles/abdo/antler.asp.
    28) Wang B-X, Zhao X-H, Qi S-B, et al: Stimulating effect of deer antler extract on protein synthesis in senescence-accelerated mice in vivo.. Chem Pharm Bull 1988; 36(7):2593-2598..
    29) Wang B-X, Zhao X-H, Yang X-W, et al: Inhibition of lipid peroxidation by deer antler (Rokujo) extract in vivo and in vitro.. J Med & Pharm Soc 1988a; 5:123-128..
    30) Yoon TY, Lee DY, Kim YJ, et al: Acute generalized exanthematous pustulosis induced by velvet antler. Br J Dermatol 2011; 165(2):447-448.