Seminars in Diagnostic Pathology
Volume 26, Issue 1 , Pages 28-37 , February 2009

Clinical approach to clinical herbal toxicity

  • Richard T. Tovar, MD, FACEP, FACMT

      Affiliations

    • Corresponding Author InformationAddress reprint requests and correspondence: Richard T. Tovar, MD, FACEP, FACMT, Medical College of Wisconsin, New Berlin Police and Fire Department, 3215 Golf Road #130, Delafield, WI 53018

References 

  1. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States: 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569–1575
  2. http://www.fda.govAccessed August 1, 2008
  3. Dietary Supplement Health and Education Act of 1994, Publ. No. 103-417, Stat. 4325 (1994)
  4. Bown D. The Herb Society of America New Encyclopedia of Herbs and Their Uses. In: New York, NY: Dorling Kindersley; 2001;p. 18
  5. Bent S, Ko R. Commonly used herbal medicines in the United States: a review. Am J Med. 2004;116:478–485
  6. Public Health Security and Bioterrorism Preparedness and Response Act of 2002, Publ. No. 107-188, 116, Stat. 594 (Jan. 23, 2002)
  7. Pal SK, Yogeshwer S. Herbal medicine: current status and the future. Asian Pac J Cancer Prev. 2003;4:281–288
  8. Winslow L, Kroll D. Herbs as medicines. Arch Intern Med. 1998;158:2192–2211
  9. Miller L. Herbal medicinals (Selected clinical considerations focusing on known or potential drug-herb interactions). Arch Intern Med. 1998;158:2200–2211
  10. Woodward K. The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products. Hum Exp Toxicol. 2005;24:219–233
  11. Watkins R. Herbal therapeutics: the top 12 remedies. Emerg Med. 2002;34:12–19
  12. Milton D. Using alternative and complementary therapies in the emergency setting. J Emerg Nurs. 1998;24:500–508
  13. Moss T. Herbal medicine in the Emergency Department: a primer for toxicities and treatment. J Emerg Nurs. 1998;24:509–513
  14. Palmer M. Dietary supplements: “natural” is not always safe. Emerg Med. 1998;30:52–74
  15. Boyer E. Issues in the management of dietary supplement use among hospitalized patients. J Med Toxicol. 2005;1:30–34
  16. Woolf AD, Watson WA, Smolinske S, et al. The severity of toxic reactions to ephedra: comparisons to other botanical products and national trends from 1993-2002. Clin Toxicol. 2003;43:347–355
  17. Williamson E. Drug interactions between herbal and prescription medicines. Drug Safety. 2003;26:1075–1092
  18. Ernst E. Harmless herbs? (A review of the recent literature). Am J Med. 1998;104:170–178
  19. http://www.FDA.govAccessed September 1, 2008
  20. Saad B, Azaizeh H, Abu-Hijleh G, Said O. Safety of traditional arab herbal medicine. Evid Based Complement Alternat Med. 2006;3:433–439
  21. Dasgupta A, Bernard DW. Herbal remedies (Effects on clinical laboratory tests). Arch Pathol Lab Med. 2006;130:521–528
  22. Dasgupta A, Biddle DA, Wells A, et al. Positive and negative interference of Chinese medicine Chan Su in serum digoxin measurement: elimination of interference by using a monoclonal chemilunimescent digoxin assay or monitoring free digoxin concentration. Am J Clin Pathol. 2000;114:174–179
  23. Ko RJ. Safety of ethnic and imported herbal and dietary supplements. Clin Toxicol. 2006;44:611–616
  24. Huang WF, Wen KC, Hsiao ML. Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan. J Clin Pharmacol. 1997;37:344–350
  25. Ko RJ. Adulterants in 260 Asian patent medicines. N Engl J Med. 1998;339:847
  26. Ko RJ. PC-SOES. Urology. 2003;61:1292
  27. Chan K. Some aspects of toxic contaminants in herbal medicines. Chemosphere. 2003;52:1361–1371
  28. Koh HL, Woo SO. Chinese proprietary medicine in Singapore: regulatory control of toxic heavy metals and undeclared drugs. Drug Safety. 2000;23:351–362
  29. Liang WL, et al. Metal element analysis of commercial Chinese herbal medicines. Taiwan Kuxue. 1998;51:37–56
  30. Ueng TH, et al. YaoShipin Fenxi. 1997;5:241–263
  31. Ernst E, Pittler MH. Risks associated with herbal medicine products. Wiener Medizinische Wochenschrift. 2002;183–189
  32. Russo S, Mastropasqua M, Mosetti MA, et al. Low dose of liquorice can induce hypertension encephalopathy. Am J Nephrol. 2000;20:145–148
  33. Ko RJ. Safety of ethnic and imported herbal and dietary supplements. Clin Toxicol. 2006;44:611–616
  34. Nambiar S, Schwartz RH, Constantino A, et al. Hypertension in mother and baby linked to ingestion of Chinese herbal medicine. West J Med. 1999;171:152
  35. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr. 1998;132:550–552
  36. Ko RJ. A U.S. perspective on the adverse reactions from traditional Chinese medicines. J Chin Med Assoc. 2004;67:109–116
  37. Lin CC, Chan TY, Deng JF. Clinical features and management of herbal induced Aconite poisoning. Ann Emerg Med. 2004;43:574–579
  38. Lin TJ, Lu CC, Chen KW, et al. Outbreak of obstructive ventilatory impairment associated with consumption of sauropus androgynus vegetable. Clin Toxicol. 1996;34:1
  39. Spyker D, Lore LA, Brooks SM. An outbreak of pulmonary poisoning. Clin Toxicol. 1996;34:15
  40. Vanherweghem JL, Depierreux M, Tielemans C, et al. Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs. Lancet. 1993;341:387–391
  41. Nortier JL, Martinez MC, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb (aristolochia fanchi). N Engl J Med. 2000;342:1686–1692
  42. Bent S, Goldberg H, Padula A, et al. Spontaneous bleeding associated with ginko biloba: a case report and systematic review of the literature. J Gen Intern Med. 2005;20:657–661
  43. Köhler S, Funk P, Kieser M. Influence of a 7 day treatment with Ginkgo biloba special extract EGb 761 on bleeding time and coagulation: a randomized, placebo controlled double-blind study in health volunteers. Blood Coagul Fibrinolysis. 2004;15:303–309
  44. Haller C. Clinical approach to adverse effects and interactions related to herbal and dietary supplements. Clin Toxicol. 2006;44:605–610
  45. Corrigan JJ, et al. Coagulopathy associated with vitamin E ingestion. JAMA. 1974;230:1300–1301
  46. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57:1221–1227
  47. Escher M, Desmeules J, Giostra E, et al. Hepatitis associated with kava, a herbal remedy. Br J Med. 2001;322:139
  48. Gordon DW, Rosenthal G, Hart J, et al. Chaparral ingestion: the broadening spectrum of liver injury caused by herbal medications. JAMA. 1995;273:489–490
  49. Laliberté L, Villeneuve JP. Hepatitis after use of Germander, a herbal remedy. CMAJ. 1996;154:1689-1682
  50. Harvey J, Collin-Jones DG. Mistletoe hepatitis. Br J Med (Clin Res Ed). 1981;282:186–187
  51. Segelman A, Segelman FP, Karliner J, et al. Sassafras and herb tea (Potential health hazards). J Am Med Assoc. 1976;236:477
  52. Kingston RL, Foley C. Herbal, traditional, and alternative medicines. In:  Shannon MW,  Borron SW,  Burns M editor. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. (ed 4). Elsevier Saunders; 2007;p. 1077–1088
  53. Roulet M, Laurini R, Rivier L, et al. Hepatic veno-occlusive disease in newborn infant of a women drinking herbal tea. J Pediatr. 1988;112:433
  54. Ridker P, Ohkuma S, McDermott WV, et al. Hepatic veno-occlusive disease associated with the consumption of pyrrolizidine containing dietary substances. Gastroenterology. 1985;88:1050
  55. Teas J, Pino S, Critchley A, et al. Variability of iodine content in common commercially available edible seaweeds. Thyroid. 2004;14:836–841
  56. Marcus D, Snodgrass WR. Do no harm: avoidance of herbal medicines during pregnancy. Obset Gynecol. 2005;105:1119–1122
  57. Shilo S, Hirsch HJ. Iodine induced hyperthyroidism in a patient with a normal thyroid gland. Postgrad Med J. 1986;62:661–662
  58. Shintani S, Marase H, Tsukagoshi H, et al. Glycyrrhizin (licorice) induced hypokalemic myopathy: report of 2 cases and review of the literature. Eur Neurol. 1992;32:44–51
  59. Maliakal PP, Wanwimolruk S. Effect of herbal teas on hepatic drug metabolizing enzymes in rats. J Pharm Pharmacol. 2001;53:1323–1329
  60. Friedman JM Teratology Society. presentation to the FDA public meeting on safety issues associated with the use of dietary supplements during pregnancy. Teratology. 2000;62:134–137
  61. Wilkinson JM. Effect of Ginger tea on the fetal development of Sprague-Swaley rats. Reprod Toxicol. 2000;14:507–512
  62. Banerjee S, Sharma R, Kale RK, et al. Influence of certain essential oils on carcinogen metabolizing enzymes and acid soluble sulfhydryls in mouse liver. Nutr Cancer. 1994;21:263–269
  63. Miyoshi N, Nakamura Y, Ueda Y, et al. Dietary ginger constituents, galanals A and B, are potent apoptosis in human T lymphoma Jurkat cells. Cancer Lett. 2003;199:113–119
  64. Backgon J. Ginger in preventing nausea and vomiting of pregnancy: a caveat due to its thromboxane synthetase activity and effect on testosterone binding. Eur J Obstet Gynecol Reprod Biol. 1991;42:163–164
  65. Kiuchi F, Iwakami S, Shibuya M, et al. Inhibition of prostaglandin and leukotriene synthesis by ginerols and diarylheptanoids. Chem Pharm Bull. 1992;40:387–391
  66. Heinrich M. Ethnobotony and natural products: the search for new molecules, new treatments of old diseases or a better understanding of indigenous cultures. Curr Top Med Chem. 2003;3:141–154
  67. Ernst E. Serious psychiatric and neurological adverse effects of herbal medicines: a systematic review. Acta Psychiatr Scand. 2003;108:83–91
  68. Saxe T. Toxicity of medicinal herbal preparations. Am Fam Phys. 1987;35:135
  69. Huang K. The Pharmacology of Chinese Herbs. Boca Raton, FL: CRC Press; 1993;
  70. Centers for Disease Control and Prevention. Unexplained severe illness possibly associated with consumption with Kombucha tea—Iowa. MMWR. 1995;44:892
  71. Perron A, Patterson JA, Yanofsky NN. Kombucha “mushroom” hepatotoxicity. Ann Emerg Med. 1995;26:660
  72. Mueller SC, Majcher-Peszynska J, Uehleke B, et al. The extent of induction of CYP3A by St. John's Wort varies among products and is linked to hyperforin dose. Eur J Clin Pharmacol. 2006;62:29–36
  73. Mathews JM, Etheridge AJ, Black SR, et al. Inhibition of human cytochrome P450 activities by Kava extract and kavalactones. Drug Metab Dispos. 2002;30:1153–1157
  74. Huang WF, Wen KC, Hsaio ML, et al. Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan. J Clin Pharmacol. 1997;37:344–350
  75. Haller C, Anderson IB, Kim SY, et al. An evaluation of selected herbal reference texts and comparison to published reports of adverse herbal events. Adv Drug React Toxicol Rev. 2002;21:143–150
  76. Rodriguez-Fragoso L, Reyes-Esparza J, Burchiel SW, et al. Risks and benefits of commonly used herbal medicines in Mexico. Toxicol Appl Pharmacol. 2008;227:125–135
  77. Ernst E. Adulteration of Chinese herbal medicines with synthetic drugs: a review. J Intern Med. 2002;252:107–113
  78. Delgoda R, Westlake AC. Herbal interactions involving cytochrome P450 enzymes. Toxicol Rev. 2004;23:239–249
  79. Lazarou J. Incidence of adverse drug reactions in hospitalized patients: a meta analysis of prospective studies. J Am Med Asssoc. 1998;279:1200–1205
  80. World Health Organization. Traditional Medicine. [fact sheet no. 134] Geneva: WHO; 2003;
  81. Harnack L, Rydell SA, Stang J. Prevalence of use of herbal products by adults in the Minneapolis/St Paul, Minn., metropolitan area. Mayo Clin Proc. 2001;76:688–694
  82. Eisenberg D. Unconventional medicine in the United States: prevalence, costs, and the patterns of use. N Engl J Med. 1993;328:246–252
  83. Bent S, Ko R. Commonly used herbal medicines in the United States: a review. Am J Med. 2004;116:478–485
  84. Ruck B, Shih RD, Marcus SM. Hypertensive crisis from herbal treatment of impotence. Am J Emerg Med. 1999;17:317–318
  85. Linden C, Vellman WP, Rumack B. Yohimbine: a new street drug. Ann Emerg Med. 1985;14:1002–1004
  86. Theoharides TD. Sudden death of a healthy college student related to ephedrine toxicity from a Ma Huang containing drink. J Clin Psychopharmacol. 1997;17:437–439

PII: S0740-2570(08)00115-9

doi: 10.1053/j.semdp.2008.12.004

Seminars in Diagnostic Pathology
Volume 26, Issue 1 , Pages 28-37 , February 2009

Article Tools