Promef

Indications

Mudir is a Unani preparation (mudir means something that brings on menstrual flow) containing aloe (sibr), saffron (zafran) and ferrous sulphate (an iron salt), often with other herbs. It is traditionally used by women for scanty, delayed or irregular periods and for painful periods, and the iron helps treat iron deficiency anaemia, which can be linked with menstrual problems. Evidence for the herbal part is limited. Delayed or missed periods have many causes, including pregnancy, which must be ruled out first.

How It Works

Aloe latex is a strong stimulant laxative that also increases blood flow in the pelvis, and saffron in large amounts can stimulate the muscle of the womb; these are the traditional reasons they are used to bring on periods. Ferrous sulphate supplies iron, which the body uses to make haemoglobin, the oxygen-carrying part of red blood cells.

Dosage and Administration

Take by mouth only as directed on the label or by a registered Unani practitioner, usually after meals to reduce stomach upset. Do not exceed the stated amount or take it for long periods without advice. Do not take other iron supplements at the same time unless a doctor advises it.

Interactions

Iron reduces the absorption of Levothyroxine, Tetracycline, Doxycycline, Ciprofloxacin, Levofloxacin and some other medicines; take them at least 2 hours apart. Antacids, calcium, tea and coffee reduce iron absorption. Aloe can lower potassium, which matters with Digoxin, diuretics such as Furosemide, and corticosteroids, and it may reduce the absorption of other medicines. Saffron may add to the effect of blood thinners and blood pressure medicines. Tell your doctor about all medicines you take.

Contraindications

• Pregnancy or possible pregnancy: it may cause miscarriage.
• Breastfeeding.
• Inflammatory bowel disease, bowel obstruction or unexplained tummy pain.
• Iron overload conditions (such as haemochromatosis or thalassaemia without iron deficiency), or anaemia not caused by iron deficiency.
• Children, and allergy to any ingredient.

Side Effects

Possible effects include tummy cramps, diarrhoea, nausea, constipation and dark or black stools (normal with iron). Heavier periods or bleeding between periods may occur. Long use of aloe can cause low potassium and dehydration.

Get urgent medical help for heavy vaginal bleeding, severe tummy pain, fainting, signs of a possible pregnancy with bleeding or pain, vomiting blood, severe diarrhoea with weakness, or signs of a severe allergic reaction.

Pregnancy and Lactation

Do not use if you are pregnant, may be pregnant or are trying to conceive, as aloe and saffron may cause miscarriage. Do a pregnancy test before using it for a missed period. Do not use while breastfeeding, as aloe can pass into milk and cause diarrhoea in the baby.

Precautions and Warnings

Irregular or absent periods can be caused by pregnancy, thyroid problems, polycystic ovary syndrome, weight change or stress, and need medical assessment. Keep out of the reach of children: iron tablets are a common cause of serious poisoning in young children.

Overdose

Overdose can cause severe diarrhoea, vomiting, tummy pain and dehydration, and the iron content can cause dangerous poisoning, especially in children. Seek emergency medical help immediately, even if the person seems well at first, and take the pack with you.

Therapeutic Class

Unani herbal preparation with iron (traditional emmenagogue)

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.