Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal of Emergency Medicine
Published in: International Journal of Emergency Medicine 2/2009

Open Access 01-06-2009 | Review Article

Dietary supplements and herbal medicine toxicities—when to anticipate them and how to manage them

Authors: D. H. Phua, A. Zosel, K. Heard

Published in: International Journal of Emergency Medicine | Issue 2/2009

Login to get access

Abstract

Background

Dietary supplements and herbal medicines are gaining popularity in many developed countries.

Aims

Although most can be used without any problem, serious toxicities do occur.

Methods

Problems can be anticipated when they are used for non-traditional indications, at excessive dose, for prolonged duration, or by patients who are also on multiple modern pharmaceuticals. Problems should also be anticipated when these products claim to be able to relieve symptoms rapidly or when herbs with pronounced pharmacological effects or toxic components are used.

Results

Resuscitation, symptomatic and supportive care are the most important aspects of management of toxicities from these products.

Conclusion

This article reviews when problems with these products can be anticipated and outlines a practical approach to management.
Literature
1.
Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE (2007) 2006 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS). Clin Toxicol (Phila) 45:815–917CrossRef
2.
Chan TY, Chan AY, Critchley JA (1992) Hospital admissions due to adverse reactions to Chinese herbal medicines. J Trop Med Hyg 95:296–298PubMed
3.
Perharic L, Shaw D, Colbridge M, House I, Leon C, Murray V (1994) Toxicological problems resulting from exposure to traditional remedies and food supplements. Drug Saf 11:284–294PubMedCrossRef
4.
WHO: National policy on traditional medicine and regulation of herbal medicines. In, 2005.
5.
Ko RJ (1999) Causes, epidemiology, and clinical evaluation of suspected herbal poisoning. J Toxicol Clin Toxicol 37:697–708PubMedCrossRef
6.
Mulholland CA, Benford DJ (2007) What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm. Am J Clin Nutr 85:318S–322SPubMed
7.
Jacobus CH, Holick MF, Shao Q, Chen TC, Holm IA, Kolodny JM, Fuleihan GE, Seely EW (1992) Hypervitaminosis D associated with drinking milk. N Engl J Med 326:1173–1177PubMedCrossRef
8.
Gabardi S, Munz K, Ulbricht C (2007) A review of dietary supplement-induced renal dysfunction. Clin J Am Soc Nephrol 2:757–765PubMedCrossRef
9.
10.
Chen JK CT: Chinese Medical Herbology and Pharmacology. 2001.
11.
Takeuchi S, Homma M, Inoue J, Kato H, Murata K, Ogasawara T (2007) Case of intractable ventricula fibrillation by a multicomponent dietary supplement containing ephedra and caffeine overdose. Chudoku Kenkyu 20:269–271PubMed
12.
Dwyer JT, Allison DB, Coates PM (2005) Dietary supplements in weight reduction. J Am Diet Assoc 105:S80–86PubMedCrossRef
13.
Boumba VA, Mitselou A, Vougiouklakis T (2004) Fatal poisoning from ingestion of Datura stramonium seeds. Vet Hum Toxicol 46:81–82PubMed
14.
Lord GM, Tagore R, Cook T, Gower P, Pusey CD (1999) Nephropathy caused by Chinese herbs in the UK. Lancet 354:481–482PubMedCrossRef
15.
Bent S, Ko R (2004) Commonly used herbal medicines in the United States: a review. Am J Med 116:478–485PubMedCrossRef
16.
Huang WF, Wen KC, Hsiao ML (1997) Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan. J Clin Pharmacol 37:344–350PubMedCrossRef
17.
Yee SK, Chu SS, Xu YM, Choo PL (2005) Regulatory control of Chinese Proprietary Medicines in Singapore. Health Policy 71:133–149PubMedCrossRef
18.
Tay CH, Seah CS (1975) Arsenic poisoning from anti-asthmatic herbal preparations. Med J Aust 2:424–428PubMed
19.
Ernst E (2002) Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review. J Intern Med 252:107–113PubMedCrossRef
20.
21.
Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA (2002) Recent patterns of medication use in the ambulatory adult population of the United States: the survey. JAMA 287(3):337–44PubMedCrossRef
22.
Haller CA (2006) Clinical approach to adverse events and interactions related to herbal and dietary supplements. Clin Toxicol (Phila) 44:605–610CrossRef
23.
24.
Izzo AA, Ernst E (2001) Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs 61:2163–2175PubMedCrossRef
25.
O’Sullivan HM, Lum K (2004) The poisoning of 'awa: the non-traditional use of an ancient remedy. Pac Health Dialog 11:211–215PubMed
26.
Cooper K, Noller B, Connell D, Yu J, Sadler R, Olszowy H, Golding G, Tinggi U, Moore MR, Myers S (2007) Public health risks from heavy metals and metalloids present in traditional Chinese medicines. J Toxicol Environ Health A 70:1694–1699PubMedCrossRef
27.
Ernst E (2002) Toxic heavy metals and undeclared drugs in Asian herbal medicines. Trends Pharmacol Sci 23:136–139PubMedCrossRef
28.
Saper RB, Kales SN, Paquin J, Burns MJ, Eisenberg DM, Davis RB, Phillips RS (2004) Heavy metal content of ayurvedic herbal medicine products. Jama 292:2868–2873PubMedCrossRef
29.
Bose A, Vashistha K, O’Loughlin BJ (1983) Azarcon por empacho−another cause of lead toxicity. Pediatrics 72:106–108PubMed
30.
Baer RD, Ackerman A (1988) Toxic Mexican folk remedies for the treatment of empacho: the case of azarcon, greta, and albayalde. J Ethnopharmacol 24:31–39PubMedCrossRef
31.
Childhood lead poisoning associated with tamarind candy and folk remedies−California, 1999–2000. MMWR Morb Mortal Wkly Rep 2002;51:684–686.
32.
Crosby WH (1977) Lead-contaminated health food. Association with lead poisoning and leukemia. Jama 237:2627–2629PubMedCrossRef
33.
Geraldine M, Herman DS, Venkatesh T (2007) Lead poisoning as a result of infertility treatment using herbal remedies. Arch Gynecol Obstet 275:279–281PubMedCrossRef
34.
Markowitz SB, Nunez CM, Klitzman S, Munshi AA, Kim WS, Eisinger J, Landrigan PJ (1994) Lead poisoning due to hai ge fen. The porphyrin content of individual erythrocytes. Jama 271:932–934PubMedCrossRef
35.
Schaumburg HH, Berger A (1992) Alopecia and sensory polyneuropathy from thallium in a Chinese herbal medication. Jama 268:3430–3431PubMedCrossRef
36.
37.
Momcilovic B (1999) A case report of acute human molybdenum toxicity from a dietary molybdenum supplement–a new member of the "Lucor metallicum" family. Arh Hig Rada Toksikol 50:289–297PubMed
38.
Khan IA, Allgood J, Walker LA, Abourashed EA, Schlenk D, Benson WH (2001) Determination of heavy metals and pesticides in ginseng products. J AOAC Int 84:936–939PubMed
39.
Milburn DS, Myers CW (1991) Tryptophan toxicity: a pharmacoepidemiologic review of eosinophilia-myalgia syndrome. Dicp 25:1259–1262PubMed
40.
Williamson BL, Tomlinson AJ, Hurth KM (1998) Posada de la Paz M, Gleich GJ, Naylor S: Rapid HPLC screening method for contaminants found in implicated L-tryptophan associated with eosinophilia myalgia syndrome and adulterated rapeseed oil associated with toxic oil syndrome. Biomed Chromatogr 12:255–261PubMedCrossRef
41.
But PP (1994) Herbal poisoning caused by adulterants or erroneous substitutes. J Trop Med Hyg 97:371–374PubMed
42.
Bensoussan A, Myers SP, Carlton AL (2000) Risks associated with the practice of traditional Chinese medicine: an Australian study. Arch Fam Med 9:1071–1078PubMedCrossRef
43.
Haller CA, Meier KH, Olson KR (2005) Seizures reported in association with use of dietary supplements. Clin Toxicol (Phila) 43:23–30CrossRef
44.
Haller CA, Kearney T., Bent, S., Ko R., Benowitz, N.L., Olson, K. : Dietary Supplement Adverse Events: Report of a One Year Prospective Poison Center Study. In NACCT 2007. New Orleans, USA, 2007.
45.
Ciganda C, Laborde A (2003) Herbal infusions used for induced abortion. J Toxicol Clin Toxicol 41:235–239PubMedCrossRef
46.
Kockler DR, McCarthy MW, Lawson CL (2001) Seizure activity and unresponsiveness after hydroxycut ingestion. Pharmacotherapy 21:647–651PubMedCrossRef
47.
Gurley BJ, Gardner SF, Hubbard MA (2000) Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 57:963–969PubMed
48.
Liberti LE, Der Marderosian A (1978) Evaluation of commercial ginseng products. J Pharm Sci 67:1487–1489PubMedCrossRef
49.
Farah MH, Edwards R, Lindquist M, Leon C, Shaw D (2000) International Monitoring of Adverse Health Effects Associated with Herbal Medicines. Pharmacoepidemiology and Drug Safety 9:105–112PubMedCrossRef
50.
Palmer ME, Haller C, McKinney PE, Klein-Schwartz W, Tschirgi A, Smolinske SC, Woolf A, Sprague BM, Ko R, Everson G, Nelson LS, Dodd-Butera T, Bartlett WD, Landzberg BR (2003) Adverse events associated with dietary supplements: an observational study. Lancet 361:101–106PubMedCrossRef
51.
52.
Eisenberg DM, Kessler RC, Foster C, Norlook FE, Calkins DR, Delbano TL (1993) Unconventional Medicine in the United States−Prevalence, Costs, and Patterns of Use. NEJM 328:246–252PubMedCrossRef
53.
Stewart MJ, Steenkamp V, Zuckerman M (1998) The toxicology of African herbal remedies. Ther Drug Monit 20:510–516PubMedCrossRef
54.
Ko R (2006) Safety of ethnic & imported herbal and dietary supplements. Clin Toxicol (Phila) 44:611–616CrossRef
Metadata
Title
Dietary supplements and herbal medicine toxicities—when to anticipate them and how to manage them
Authors
D. H. Phua
A. Zosel
K. Heard
Publication date
01-06-2009
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 2/2009
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1007/s12245-009-0105-z

Other articles of this Issue 2/2009

International Journal of Emergency Medicine 2/2009 Go to the issue

Brief Research Report

Improved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departments

Clinical Images

Listening to syncope

Original Article

Correlations between capnographic waveforms and peak flow meter measurement in emergency department management of asthma

Clinical Images

Portomesenteric air from acute necrotizing appendicitis

Case Report

Case of carbon monoxide poisoning after smoking shisha

Original Article

Resident productivity: trends over consecutive shifts