Safety review of popular herbal products
Dr. Darrell Hulisz from Case Western Reserve University School of Medicine in Cleveland, Ohio reviews popular herbals.
Let’s focus on safety issues.
Echinacea
- Common side effects include unpleasant taste and allergic reactions.
- Because the flower is related to ragweed, cross allergenicity may occur in people allergic to ragweed.
- Not recommended in patients with progressive or autoimmune disorders.
Garlic
- Might lower blood pressure in people with hypertension.
- Use cautiously in people with bleeding disorders or in those taking antiplatelet therapy.
- Monitor for deceased blood levels of warfarin (Coumadin).
- Malodorous breath and garlic-like body odor.
Ginkgo biloba
- Mild gastrointestinal side effects and headache.
- Avoid in patients using anticoagulants (eg, warfarin; Coumadin) or antiplatelet therapy (eg, aspirin or clopidogrel [Plavix]), or in those with active bleeding such as peptic ulcer disease.
- Not recommended in patients with seizure disorders.
St. John’s wort
- Should not be taken with serotonin uptake inhibitors (SSRIs), as symptoms of serotonin syndrome might occur (headache, sweating, dizziness, and agitation)
- Avoid during pregnancy.
- Associated with photosensitivity.
- Can reduce blood levels of digoxin (Lanoxin) and indinavir (Crixivan).
- Cases of heart transplant rejection were associated with a reduction in cyclosporine (Sandimmune) blood levels.
- Breakthrough bleeding and unwanted pregnancies reported in women who also took oral contraceptives.
Valerian
- Restlessness and palpitations.
- Additive effect with other central nervous system depressants.
- Caution if operating machinery when starting treatment.
- Headaches, excitability, and uneasiness.
Chamomile
- Allergic reaction.
- Sedative effects — use with caution when taking drugs with sedative side effects, or with alcohol.
Ginger
- Prolonged bleeding
- Caution in people taking anticoagulants.
- Mild gastrointestinal upset, including heartburn, diarrhea, and mouth irritation.
Ginseng
- Avoid in people with heart disease who take other stimulants.
- Rarely associated with reversible breast pain and tenderness, and postmenopausal bleeding.
- Overuse associated with diarrhea, hypertension, nervousness, dermatologic eruptions, and insomnia.
- Don’t use in people with active bleeding.
- Use cautiously with anticoagulants and/or antiplatelet medications.
Saw Palmetto
- Headache and intestinal upset.
Black cohosh
- Rash or intestinal upset.
- Don’t use in lactating or pregnant women.
- Avoid in women with a history of estrogen-dependent tumors or endometrial cancer.
The bottom line?
Many of the side effects listed here are supported by limited data. Check with the article for more details and guidelines.
11/25/08 22:22 JR