Herbal Remedy

Aka: Herbal Remedy, Alternative Medicine, Natural Product, Chinese Herbal Medicine

1. See Also
   1. Dietary Supplement Resources
   2. Dietary Supplements in Obesity
2. Epidemiology: United States
   1. Adults on herbals and prescribed medication: 15 Million
      1. Adults alerting doctor of concurrent herbal use: 50%
   2. Americans spent $4 billion on herbals in 1998
   3. Worldwide use: 4 billion people
   4. Most commonly used herbal products in the United States
      1. Echinacea
      2. St. John's Wort
      3. Ginkgo Biloba
      4. Garlic
      5. Saw Palmetto
      6. Ginseng
      7. Goldenseal
      8. Aloe
      9. Siberian Ginseng
      10. Valerian
3. Background
   1. Traditional medicine is basis for 80% world healthcare
   2. Most medications are synthesized from plant sources
      1. Plant Derivatives: 75% of modern medications
      2. Direct Extracts: 25% of modern medications
   3. Little efficacy data exists for herbals
      1. Only 30-40 of 1200 herbs have evidence of benefit
      2. Prescribed medications by contrast must show benefit
   4. Modern drugs directly derived from plant sources
      1. Acetylsalicylic acid (Aspirin) from willow bark
      2. Atropine from deadly nightshade plant
      3. Cantharidin from Blister beetle (for Wart Treatment)
      4. Colchicine from meadow saffron plant
      5. Cortisone from Mexican Discorea species
      6. Digitalis (Digoxin) from the foxglove plant
      7. Morphine and other Narcotics from the opium poppy
      8. Pilocarpine from the South American Jaborandi Tree
      9. Podophyllin or Podophyllum from mayapple plant
      10. Pyrethrins from chrysanthemums (for lice treatment)
      11. Quinine from yellow cinchona
      12. Reserpine from the snakeroot plant
      13. Scopolamine from Colombian Datura arborea tree
      14. SennaLaxatives from the senna plant
      15. Taxol from the yew tree
      16. Vincristine, Vinblastine from rosy periwinkle plant
      17. Yohimbine from black currant trees (Rubiaceae)
4. Disadvantages: Related to herbal medication use
   1. No enforced labeling of efficacy
   2. No quality control regulation
   3. Adverse effects are not routinely labeled
      1. See below as well as specific herbal medications
      2. Serious drug interactions may exist (e.g. St. John's Wort)
   4. No standardization of concentration and potency
      1. Many herbal preparations are mislabeled
      2. Some contain little if any active ingredient
   5. Preparations may contain contaminants
      1. Pesticides
      2. Heavy metals (often found in folk remedies)
         1. Arsenic
         2. Mercury
         3. Lead (see Lead-Containing Herbal Remedies)
         4. Cadmium
      3. Prescription drugs illicitly placed in product
         1. Phenylbutazone
         2. Aminopyrine
         3. Prednisone
         4. Testosterone
         5. Diazepam
         6. Indomethacin
5. Adverse Effects
   1. General
      1. Patient should report adverse effects to physician
      2. Notify FDA of adverse effects
         1. FDA MedWatch
            1. http://www.fda.gov/medwatch/
            2. Phone: 1-800-332-1088
   2. CyanidePoisoning risk with seeds, bark, or leaves
      1. Apricot
      2. Cassava beans
      3. Cherries
      4. Choke cherries
      5. Peaches
      6. Plums
   3. Hepatotoxicity
      1. See Hepatotoxin
   4. Allergic Reaction Risk for those with ragweed allergy
      1. Goldenrod
      2. Marigold
      3. Yarrow
      4. St. John's Wort
      5. Chamomile (or Mayweed or dog fennel)
   5. Anticholinergic and Hallucinogenic Risks
      1. Catnip
      2. Juniper
      3. Lobelia
      4. Jimsonweed
      5. Wormwood
      6. Nutmeg
   6. Laxative abuse risk
      1. Buckthorn bark
      2. Senna
      3. Dock roots
      4. Aloe vera
   7. Abortion risk in pregnancy
      1. Devil's claw root
      2. Barberry
      3. Dong Quai
      4. High concentrations of Ruta, Hydrastis or Oregano
   8. Blood Pressure alteration
      1. See Herbals Affecting Blood Pressure
   9. Bleeding risk (anticoagulant activity)
      1. Ginkgo Biloba
      2. Feverfew
      3. Garlic
      4. Ginseng
      5. Dong Quai
      6. Red Clover
6. History
   1. Do you use Alternative Medicines?
      1. Herbal Product?
      2. Herbal Supplement?
      3. Natural Remedy?
   2. What other prescribed or OTC medications do you use?
   3. For how long have you used this herbal product?
   4. Do you have any allergies to plant products?
   5. Are you currently pregnant or Breast Feeding?
7. Precautions: Pointers for patients purchasing herbal products
   1. Purchased products should be labeled appropriately
      1. Botanical name of herb
      2. Strength or concentration of active ingredient
      3. Batch or lot number
      4. Expiration date
      5. Name of manufacturer and contact information
   2. Avoid herbal products in pregnancy and Lactation
      1. Be particularly cautious in first trimester
      2. See adverse effects above or see specific herb
   3. Use herbal therapies with caution if immunocompromised
      1. Herbal therapies may be contaminated with microbes
   4. Use the lowest effective dose of a product
   5. Avoid prolonged use of any product
   6. Stop herbal therapies 2 weeks before elective surgery
   7. Avoid mixing herbal products
   8. Discuss herbal use with your physician
      1. Discuss potential drug interactions with physician
      2. Discuss adverse effects (see above)
      3. Reevaluate efficacy and safety on regular basis
   9. Check manufacturer quality
      1. ConsumerLab.com
         1. http://www.consumerlab.com
8. References
   1. Borins (1998) Postgrad Med 104(1):91-100
   2. Cupp (1999) Am Fam Physician 59(5):1239-44
   3. Dipaola (1998) N Engl J Med 339(12):785-91
   4. Eliason (1997) J Am Board Fam Prac 10:265-71
   5. Ernst (1998) Am J Med 104:170
   6. Ko (1998) N Engl J Med 339(12):847
   7. Laliberte (1996) Can Med Assoc J 154(11):1689-92
   8. Litovitz (1994) Am J Emerg Med 12:46-85
   9. Mar (1999) West J Med 171:168-71
   10. Rand (November, 1998) Modern Medicine 66:38-9