Therapeutics Letter 25 highlights the importance of clinicians documenting use of herbal medicines as part of their patient’s drug profile. Conclusions: To establish the effectiveness of herbs as medicines, they must be tested in prospective, double blind, randomized, placebo-controlled clinical trials (RCTs). Relatively few herbs have been tested in this manner. Plants are rich sources of chemicals and potential sources of effective medicines. However, more research, regulation, and standardization are required before herbal medicines can be recommended as effective and safe therapies.
Keywords:
Plants, Medicinal
;
Reference Standards
The medical use of herbs is widespread. In a multiethnic group of patients attending an emergency department in New York 22% reported that they used herbal medicines; use was highest among Asians (37%).
1
It is important therefore for clinicians to document use of herbal medicines as part of the patient’s drug profile.
Plants synthesize complex (organic) molecules for their structure and function, and therefore are a rich source of chemicals. Active chemicals purified from plants are accepted effective medications e.g. digoxin, and morphine.
When parts of plants or crude extracts of plants are used for medicinal purposes they are called herbal medicines.
What problems are specific to herbal medicines?
What is the active ingredient?
Most herbal medicines contain hundreds of chemicals and there is often no agreement as to which are potentially active. An example is garlic, comprised of many sulfur compounds, several of which are candidates for possible therapeutic activity.
2
How can one be sure that herbal medicines contain what is on the label?
The only regulatory requirements in Canada are that all products intended for medicinal use, including natural health products, are issued a Drug Identification Number. These numbers are not required for raw materials such as bulk herbs. Herbal medicines are not required to pass any regulatory analysis to be sold as a health food supplement.
There are many examples of herbal medicines that have been adulterated with other (more toxic) herbs, potent drugs (e.g. phenylbutazone
3
,
synthetic corticosteroids and other prescription drugs), or heavy metals
4
.
How are herbal medicines standardized?
The chemical constituents of plants vary depending on the species, variety and part of the plant, with conditions of growth (soil, water and temperature), and with the age of the plant.
These complexities and variations of chemical content make standardization essential.
In some cases standardization is attempted, but it is difficult and seldom accomplished.
How can effectiveness be determined?
To establish the effectiveness of herbs as medicines, they must be tested in prospective, double blind, randomized, placebo-controlled clinical trials (RCTs).
Relatively few herbs have been tested in this manner.
Do herbal medicines cause adverse effects?
There is a general conception that, because herbs are “natural”, they are completely safe. This is not true.
Herbs and herbal preparations can cause toxic adverse effects
4
–
7
,
serious allergic reactions
8
and adverse drug interactions
6
,
9
,
and can interfere with laboratory tests.
10
What herbal medicines are most commonly used by patients?
The
Table
provides an alphabetical list of some common herbal medicines with their traditional indications, present RCT evidence of effectiveness, and some known adverse effects. At the present time none of the RCT evidence of effectiveness can be considered conclusive; trials where some benefit over placebo has been shown require confirmation with larger trials of longer duration. There is very little data available for long term safety.
Herbal Medicines - A brief summary of present evidence
.
Summary
Plants are rich sources of chemicals and potential sources of effective medicines.
However, more research, regulation, and standardization are required before herbal medicines can be recommended as effective and safe therapies.
References
- 1.
Hung
OL
,
Shih
RD
,
Chiang
WK
,
Nelson
LS
,
Hoffman
RS
,
Goldfrank
LR
.
Herbal preparation use among urban emergency department patients
.
Academic Emergency Medicine
.
1997
;
4
:
209
–
213
.
[
PubMed: 9063549]
- 2.
Dorant
E
,
van-den-Brandt
PA
,
Goldbohm
RA
.
A prospective cohort study on Allium vegetable consumption, garlic supplement use, and the risk of lung carcinoma in the Netherlands
.
Cancer-Res
.
1994
Dec
1
;
54
(
23
):
6148
–
53
.
[
PubMed: 7954460]
- 3.
Segasothy
M
,
Samad
S
.
Illicit herbal preparation containing phenylbutazone causing analgesic nephropathy
.
Nephron
1991
;
59
:
166
–
167
.
[
PubMed: 1944737]
- 4.
Chan
TY
,
Chan
JC
,
Tomlinson
B
,
Critchley
JA
.
Chinese herbal medicines revisited: a Hong Kong perspective
.
Lancet
.
1993
Dec
18–25
;
342
(
8886–8887
):
1532
–
4
.
[
PubMed: 7902907]
- 5.
D’Arcy
PF
.
Adverse reactions and interactions with herbal medicines. Part 1. Adverse reactions
.
Adverse Drug Reactions & Toxicological Reviews
.
1991
;
10
:
189
–
208
.
[
PubMed: 1793770]
- 6.
D’Arcy
PF
.
Adverse reactions and interactions with herbal medicines. Part 2. Drug interactions
.
Adverse Drug Reactions & Toxicological Reviews
.
1993
;
12
:
147
–
62
.
[
PubMed: 8218717]
- 7.
Pillans
PI
.
Toxicity of herbal products
.
New Zealand Medical Journal
.
1995
Nov
24
;
108
(
1012
):
469
–
471
.
[
PubMed: 8538972]
- 8.
Florido-Lopez
JF
.
Gonzalez-delgado
P
.
Desanpedro
BS
.
Perez-Miranda
C
.
De Saavedra
JMA
.
Marinpozo
JF
.
Allergy to natural honeys and camomile tea
.
International Archives of Allergy & Immunology
.
1995
Oct
;
108
(
2
):
170
–
174
.
[
PubMed: 7549505]
- 9.
Rosenblatt
M
,
Mindei
,
J
.
Spontaneous hyphema associated with ingestion of Ginkgo biloba extract
.
N Engl J Med
.
1997
;
336
(
15
):
1108
.
[
PubMed: 9091822]
- 10.
- 11.
Fidler
P
.
Loprinzi
CL
.
Ofallon
JR
.
Leitch
JM
.
Lee
JK
.
Hayes
DL
.
Novotny
P
.
Clemensschutjer
D
.
Bartel
J
.
Michalak
JC
.
Prospective evaluation of a chamomile mouthwash for prevention of 5-fu-induced oral mucositis
.
Cancer
.
77
(
3
):
522
–
525
,
1996
Feb
1
.
[
PubMed: 8630960]
- 12.
Chrubasik
S
.
Zimpfer
C
.
Schutt
U
.
Ziegler
R
.
Effectiveness of harpagophytum procumbens in treatment of acute low back pain
.
Phytomedicine
.
3
(
1
):
1
–
10
,
1996
.
[
PubMed: 23194854]
- 13.
Scaglione
F
.
Lund
B
.
Efficacy in the treatment of the common cold of a preparation containing an echinacea extract
.
International Journal of Immunotherapy
.
11
(
4
):
163
–
166
,
1995
.
- 14.
Dorn
M
.
Knick
E
.
Lewith
G
.
Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections
.
Complementary Therapies in Medicine
. Vol
5
(
1
) (pp
40
–
42
),
1997
.
- 15.
Wright
-S
;
Burton
-JL
Oral evening-primrose-seed oil improves atopic eczema
.
Lancet
.
1982
Nov
20
;
2
(
8308
):
1120
–
2
.
[
PubMed: 6128449]
- 16.
Bamford
-
JT
;
Gibson
-
RW
;
Renier
-
CM
.
Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids)
.
J-Am-Acad-Dermatol
.
1985
Dec;
13
(
6
):
959
–
65
.
[
PubMed: 3908514]
- 17.
Schalin-Karrila
-
M
;
Mattila
-
L
;
Jansen
-
CT
;
Uotila
-
P
.
Evening primrose oil in the treatment of atopic eczema: effect on clinical status, plasma phospholipid fatty acids and circulating blood prostaglandins
.
Br-J-Dermatol.
1987
Jul
;
117
(
1
):
11
–
9
.
[
PubMed: 3307886]
- 18.
Berth
-
Jones-J
;
Graham
-
Brown-RA
.
Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis
[published erratum appears in Lancet 1993 Aug 28;342(8870):564] [see comments]
Lancet
.
1993
Jun
19
;
341
(
8860
):
1557
–
60
.
[
PubMed: 8099640]
- 19.
Biagi
-
PL
;
Bordoni
-
A
;
Hrelia
-
S
;
Celadon
-
M
;
Ricci
-
GP
;
Cannella
-
V
;
Patrizi
-
A
;
Specchia
-
F
;
Masi
-
M
.
The effect of gamma-linolenic acid on clinical status, red cell fatty acid composition and membrane microviscosity in infants with atopic dermatitis
.
Drugs-Exp-Clin-Res.
1994
;
20
(
2
):
77
–
84
[
PubMed: 7924900]
- 20.
Brzeski
-
M
;
Madhok
-
R
;
Capell
-
HA
.
Evening primrose oil in patients with rheumatoid arthritis and side-effects of non-steroidal anti-inflammatory drugs
.
Br-J-Rheumatol.
1991
Oct
;
30
(
5
):
370
–
2
.
[
PubMed: 1913008]
- 21.
Leventhal
-
LJ
;
Boyce
-
EG
;
Zurier
-
RB
.
Treatment of rheumatoid arthritis with gammalinolenic acid
[see comments]
Ann-Intern-Med.
1993
Nov
1
;
119
(
9
):
867
–
73
.
[
PubMed: 8214997]
- 22.
Zurier
RB
.
Rossetti
RG
.
Jacobson
EW
.
Demarco
DM
.
Liu
NY
.
Temming
JE
.
White
BM
.
Laposata
M
.
Gamma-linolenic acid treatment of rheumatoid arthritis – a randomized, placebo-controlled trial
.
Arthritis & Rheumatism.
39
(
11
):
1808
–
1817
,
1996
Nov.
[
PubMed: 8912502]
- 23.
Veale
-
DJ
;
Torley
-
HI
;
Richards
-
IM
;
O’Dowd
-
A
;
Fitzsimons
-
C
;
Belch
-
JJ
;
Sturrock
-
RD
.
A double-blind placebo controlled trial of Efamol Marine on skin and joint symptoms of psoriatic arthritis
.
Br-J-Rheumatol.
1994
Oct
;
33
(
10
):
954
–
8
.
[
PubMed: 7921757]
- 24.
Khoo
-
SK
;
Munro
-
C
;
Battistutta
-
D
.
Evening primrose oil and treatment of premenstrual syndrome
[see comments]
Med-J-Aust.
1990
Aug
20
;
153
(
4
):
189
–
92
.
[
PubMed: 2201888]
- 25.
Budeiri
D
.
Po
ALW
.
Dornan
JC
.
Is evening primrose oil of value in the treatment of premenstrual syndrome
.
Controlled Clinical Trials
.
17
(
1
):
60
–
68
,
1996
Feb.
[
PubMed: 8721802]
- 26.
Chenoy
-
R
;
Hussain
-
S
;
Tayob
-
Y
;
O’Brien
-
PM
;
Moss
-
MY
;
Morse
-
PF
.
Effect of oral gamolenic acid from evening primrose oil on menopausal flushing
.
BMJ
.
1994
Feb
19
;
308
(
6927
):
501
–
3
.
[
PMC free article: PMC2542782] [
PubMed: 8136666]
- 27.
Haslett
-
C
;
Douglas
-
JG
;
Chalmers
-
SR
;
Weighhill
-
A
;
Munro
-
JF
.
A double-blind evaluation of evening primrose oil as an antiobesity agent
.
Int-J-Obes.
1983
;
7
(
6
):
549
–
53
[
PubMed: 6360923]
- 28.
Greenfield
-
SM
;
Green
-
AT
;
Teare
-
JP
;
Jenkins
-
AP
;
Punchard
-
NA
;
Ainley
-
CC
;
Thompson
-
RP
.
A randomized controlled study of evening primrose oil and fish oil in ulcerative colitis
.
Aliment-Pharmacol-Ther.
1993
Apr
;
7
(
2
):
159
–
66
.
[
PubMed: 8485269]
- 29.
Aman
-
MG
;
Mitchell
-
EA
;
Turbott
-
SH
.
The effects of essential fatty acid supplementation by Efamol in hyperactive children
.
J-Abnorm-Child-Psychol.
1987
Mar
;
15
(
1
):
75
–
90
.
[
PubMed: 3553274]
- 30.
Arnold
-
LE
;
Kleykamp
-
D
;
Votolato
-
NA
;
Taylor
-
WA
;
Kontras
-
SB
;
Tobin
-
K
.
Gamma-linolenic acid for attention-deficit hyperactivity disorder: placebo-controlled comparison to D-amphetamine
.
Biol-Psychiatry.
1989
Jan
15
;
25
(
2
):
222
–
8
.
[
PubMed: 2539203]
- 31.
Belch
-
JJ
;
Shaw
-
B
;
O’Dowd
-
A
;
Saniabadi
-
A
;
Leiberman
-
P
;
Sturrock
-
RD
;
Forbes
-
CD
.
Evening primrose oil (Efamol) in the treatment of Raynaud’s phenomenon: a double blind study
.
Thromb-Haemost.
1985
Aug
30
;
54
(
2
):
490
–
4
.
[
PubMed: 4082084]
- 32.
Oxholm
-
P
;
Manthorpe
-
R
;
Prause
-
JU
;
Horrobin
-
D
.
Patients with primary Sjogren’s syndrome treated for two months with evening primrose oil
.
Scand-J-Rheumatol.
1986
;
15
(
2
):
103
–
8
.
[
PubMed: 3529370]
- 33.
Oliwiecki
-
S
;
Burton
-
JL
.
Evening primrose oil and marine oil in the treatment of psoriasis
.
Clin-Exp-Dermatol.
1994
Mar
;
19
(
2
):
127
–
9
.
[
PubMed: 8050140]
- 34.
Palevitch
D
.
Earon
G
.
Carasso
R
.
Feverfew (tanacetum parthenium) as a prophylactic treatment for migraine – a double-blind placebo-controlled study
.
Phytotherapy Research
.
11
(
7
):
508
–
511
,
1997
Nov.
- 35.
Murphy
-
JJ
;
Heptinstall
-
S
;
Mitchell
-
JR
.
Randomised double-blind placebo-controlled trial of feverfew in migraine prevention
.
Lancet
.
1988
Jul
23
;
2
(
8604
):
189
–
92
.
[
PubMed: 2899663]
- 36.
Pattrick
-
M
;
Heptinstall
-
S
;
Doherty
-
M
.
Feverfew in rheumatoid arthritis: a double blind, placebo controlled study
.
Ann-Rheum-Dis.
1989
Jul
;
48
(
7
):
547
–
9
.
[
PMC free article: PMC1003814] [
PubMed: 2673080]
- 37.
Silagy
-
CA
;
Neil
-
HA
.
A meta-analysis of the effect of garlic on blood pressure
.
J-Hypertens.
1994
Apr;
12
(
4
):
463
–
8
.
[
PubMed: 8064171]
- 38.
Warshafsky
-
S
;
Kamer
-
RS
;
Sivak
-
SL
.
Effect of garlic on total serum cholesterol. A meta-analysis
[see comments]
Ann-Intern-Med.
1993
Oct
1
;
119
(
7 Pt 1
):
599
–
605
.
[
PubMed: 8363171]
- 39.
- 40.
Neil
HAW
.
Silagy
CA
.
Lancaster
T
.
Hodgeman
J
.
Vos
K
.
Moore
JW
.
Jones
L
.
Cahill
J
.
Fowler
GH
.
Garlic powder in the treatment of moderate hyperlipidaemia – a controlled trial and meta-analysis
.
Journal of the Royal College of Physicians of London
.
30
(
4
):
329
–
334
,
1996
Jul–Aug.
[
PMC free article: PMC5401602] [
PubMed: 8875379]
- 41.
Grontved
A
.
Brask
T
.
Kambskard
J
.
Hentzer
E
.
Ginger root against seasickness
.
Acta Oto-Laryngologica.
Vol
105
(
1–2
) (pp
45
–
49
),
1988
.
[
PubMed: 3277342]
- 42.
Fischer-Rasmussen
W
.
Kjaer
SK
.
Dahl
C
.
Asping
U
.
Ginger treatment of hyperemesis gravidarum
.
European Journal of Obstetrics, Gynecology, & Reproductive Biology
. Vol
38
(
1
) (pp
19
–
24
),
1990
.
[
PubMed: 1988321]
- 43.
Bone
ME
.
Wilkinson
DJ
.
Young
JR
.
McNeil
J
.
Carlton
S
.
Ginger root – a new antiemetic. The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery
.
Anaesthesia
. Vol
45
(
8
) (pp
669
–
671
),
1990
.
[
PubMed: 2205121]
- 44.
Phillips
S
.
Ruggier
R
.
Hutchinson
SE
.
Forum. Zingiber officinale (Ginger) –
An antiemetic for day case surgery
.
Anaesthesia
. Vol
48
(
8
) (pp
715
–
717
),
1993
.
[
PubMed: 8214465]
- 45.
Arfeen
Z
.
Owen
H
.
Plummer
JL
.
Ilsley
AH
.
Sorby-Adams
RAC
.
Doecke
CJ
.
A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea and vomiting
.
Anaesthesia & Intensive Care
. Vol
23
(
4
) (pp
449
–
452
),
1995
.
[
PubMed: 7485935]
- 46.
- 47.
Kleijnen
-
J
;
Knipschild-P Ginkgo biloba
.
Lancet
.
1992
Nov
7
;
340
(
8828
):
1136
–
9
.
[
PubMed: 1359218]
- 48.
Lebars
PL
.
Katz
MM
.
Berman
N
.
Itil
TM
.
Freedman
AM
.
Schatzberg
AF
.
A placebo-controlled, double-blind, randomized trial of an extract of ginkgo biloba for dementia
.
JAMA
.
278
(
16
):
1327
–
1332
,
1997
Oct
22
.
[
PubMed: 9343463]
- 49.
Rowin
J
.
Lewis
SL
.
Spontaneous bilateral subdural hematomas associated with chronic ginkgo biloba ingestion
.
Neurology
.
46
(
6
):
1775
–
1776
,
1996
Jun.
[
PubMed: 8649594]
- 50.
Rosenblatt
M
.
Mindel
J
.
Spontaneous hyphema associated with ingestion of ginkgo biloba extract
.
New England Journal of Medicine
.
336
(
15
):
1108
,
1997
Apr
10
.
[
PubMed: 9091822]
- 51.
Holgers
-
KM
;
Axelsson
-
A
;
Pringle
-
I
.
Ginkgo biloba extract for the treatment of tinnitus
.
Audiology
.
1994
Mar–Apr
;
33
(
2
):
85
–
92
.
[
PubMed: 8179518]
- 52.
Engels
HJ
.
Said
JM
.
Wirth
JC
.
Failure of chronic ginseng supplementation to affect work performance and energy metabolism in healthy adult females
.
Nutrition Research
.
16
(
8
):
1295
–
1305
,
1996
Aug.
- 53.
Engels
HJ
.
Wirth
JC
.
No ergogenic effects of ginseng (panax ginseng meyer, c.a.) during graded maximal aerobic exercise
.
Journal of the American Dietetic Association
.
97
(
10
):
1110
–
1115
,
1997
Oct.
[
PubMed: 9336557]
- 54.
Morris
AC
.
Jacobs
I
.
Mclellan
TM
.
Klugerman
A
.
Wang
LCH
.
Zamecnik
J
.
No ergogenic effect of ginseng ingestion
.
International Journal of Sport Nutrition
.
6
(
3
):
263
–
271
,
1996
Sep.
[
PubMed: 8876346]
- 55.
Dowling
EA
.
Redondo
DR
.
Branch
JD
.
Jones
S
.
Mcnabb
G
.
Williams
MH
.
Effect of eleutherococcus senticosus on submaximal and maximal exercise performance
.
Medicine & Science in Sports & Exercise
.
28
(
4
):
482
–
489
,
1996
Apr.
[
PubMed: 8778554]
- 56.
Scaglione
F
.
Cattaneo
G
.
Alessandria
M
.
Cogo
R
.
Efficacy and safety of the standardized ginseng extract g 115 for potentiating vaccination against common cold and/or influenza syndrome
.
Drugs Under Experimental & Clinical Research
.
22
(
2
):
65
–
72
,
1996
.
[
PubMed: 8879982]
- 57.
D’Angelo
-
L
;
Grimaldi
-
R
;
Caravaggi
-
M
;
Marcoli
-
M
;
Perucca
-
E
;
Lecchini
-
S
;
Frigo
-
GM
;
Crema
-
A
.
A double-blind, placebo-controlled clinical study on the effect of a standardized ginseng extract on psychomotor performance in healthy volunteers
.
J-Ethnopharmacol.
1986
Apr–May
;
16
(
1
):
15
–
22
.
[
PubMed: 3528672]
- 58.
Linde
K
.
Ramirez
G
.
Mulrow
CD
.
Pauls
A
.
Weidenhammer
W
.
Melchart
D
.
St-John wort for depression – an overview and meta-analysis of randomised clinical trials
.
British Medical Journal
.
313
(
7052
):
253
–
258
,
1996
Aug
3
.
[
PMC free article: PMC2351679] [
PubMed: 8704532]
- 59.
Golsch
S
.
Vocks
E
.
Rakoski
J
.
Brockow
K
.
Ring
J
.
Reversible increase of photosensitivity by St.-Johns-wort-extract
[German]
Hautarzt.
48
(
4
):
249
–
252
,
1997
Apr.
[
PubMed: 9206713]
- 60.
Lowe
FC
.
Ku
JC
.
Phytotherapy in treatment of benign prostatic hyperplasia – a critical review
[Review]
Urology
.
48
(
1
):
12
–
20
,
1996
Jul.
[
PubMed: 8693632]
- 61.
Carraro
JC
.
Raynaud
JP
.
Koch
G
.
Chisholm
GD
.
Disilverio
F
.
Teillac
P
.
Dasilva
FC
.
Cauquil
J
.
Chopin
DK
.
Hamdy
FC
.
Hanus
M
.
Hauri
D
.
Kalinteris
A
.
Marencak
J
.
Perier
A
.
Perrin
P
.
Comparison of phytotherapy (permixon(r)) with finasteride in the treatment of benign prostate hyperplasia – a randomized international study of 1,098 patients
.
Prostate
.
29
(
4
):
231
–
240
,
1996
Oct.
[
PubMed: 8876706]
- 62.
Perharic
L
.
Shaw
D
.
Leon
C
.
Desmet
PAGM
.
Murray
VSG
.
Possible association of liver damage with the use of chinese herbal medicine for skin disease
.
Veterinary & Human Toxicology
.
37
(
6
):
562
–
566
,
1995
Dec.
[
PubMed: 8588298]
- 63.
Sheehan
-
MP
;
Rustin
-
MH
;
Atherton
-
DJ
;
Buckley
-
C
;
Harris
-
DW
;
Brostoff
-
J
;
Ostlere
-
L
;
Dawson
-
A
;
Harris
-
DJ
[corrected to Harris-DW]
Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis
[published erratum appears in Lancet 1992 Jul 18;340(8812):188] [see comments]
Lancet
.
1992
Jul
4
;
340
(
8810
):
13
–
7
.
[
PubMed: 1351600]
- 64.
Court
WA
.
Reynolds
LB
.
Hendel
JG
.
Influence Of Root Age On The Concentration Of Ginsenosides Of American Ginseng (Panax Quinquefolium)
.
Canadian Journal of Plant Science
.
76
(
4
):
853
–
855
,
1996
Oct.
- 65.
Smith
RG
.
Caswell
D
.
Carriere
A
.
Zielke
B
.
Variation In The Ginsenoside Content Of American Ginseng, Panax Quinquefolius L, Roots
.
Canadian Journal of Botany-Revue Canadienne de Botanique
.
74
(
10
):
1616
–
1620
,
1996
Oct.
- 66.
Tai
-
YT
;
But
-
PP
;
Young
-
K
;
Lau
-
CP
Cardiotoxicity after accidental herb-induced aconite poisoning
[see comments]
Lancet
.
1992
Nov
21
;
340
(
8830
):
1254
–
6
.
[
PubMed: 1359321]
- 67.
Espinoza
EO
.
Mann
MJ
.
Bleasdell
B
.
Dekorte
S
.
Cox
M
.
Toxic Metals In Selected Traditional Chinese Medicinals
.
Journal of Forensic Sciences
.
41
(
3
):
453
–
456
,
1996
May
.
- 68.
Prpicmajic
D
.
Pizent
A
.
Jurasovic
J
.
Pongracic
J
.
Resteksamarzija
N
.
Lead poisoning associated with the use of ayurvedic metal-mineral tonics
.
Journal of Toxicology – Clinical Toxicology
.
34
(
4
):
417
–
423
,
1996
.
[
PubMed: 8699556]
- 69.
Winship
-
KA
Toxicity of comfrey
.
Adverse-Drug-React-Toxicol-Rev.
1991
Spring
;
10
(
1
):
47
–
59
.
[
PubMed: 1878443]
- 70.
Sheikh
NM
.
Philen
RM
.
Love
LA
.
Chaparral-associated Hepatotoxicity
.
Archives of Internal Medicine
.
157
(
8
):
913
–
919
,
1997
Apr
28
.
[
PubMed: 9129552]
- 71.
- 72.
Anderson
IB
.
Mullen
WH
.
Meeker
JE
.
Khojastehbakht
SC
.
Oishi
S
.
Nelson
SD
.
Blanc
PD
.
Pennyroyal Toxicity – Measurement Of Toxic Metabolite Levels In Two Cases And Review Of The Literature
.
Annals of Internal Medicine
.
124
(
8
):
726
ff.,
1996
Apr
15
.
[
PubMed: 8633832]
- 73.
Depierreux
-
M
;
Van
-
Damme-B
;
Vanden
-
Houte-K
;
Vanherweghem
-
JL
.
Pathologic aspects of a newly described nephropathy related to the prolonged use of Chinese herbs
.
Am-J-Kidney-Dis.
1994
Aug
;
24
(
2
):
172
–
80
.
[
PubMed: 8048421]
- 74.
Chan
TYK
.
Critchley
JAJH
.
Usage And Adverse Effects Of Chinese Herbal Medicines
.
Human & Experimental Toxicology
.
15
(
1
):
5
–
12
,
1996
Jan.
[
PubMed: 8845209]
- 75.
Scaglione
F
.
Lund
B
.
Efficacy in the treatment of the common cold of a preparation containing an echinacea extract
.
International Journal of Immunotherapy
.
11
(
4
):
163
–
166
,
1995
.
- 76.
Dorn
M
.
Knick
E
.
Lewith
G
.
Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections
.
Complementary Therapies in Medicine
. Vol
5
(
1
) (pp
40
–
42
),
1997
.
- 77.
Janssen
PLTMK
.
Meyboom
S
.
Van Staveren
WA
.
De Vegt
F
.
Katan
MB
.
Consumption of ginger (Zingiber Officinale Roscoe) does not affect ex vivo platelet thromboxane production in humans
.
European Journal of Clinical Nutrition
. Vol
50
(
11
) (pp
772
–
774
),
1996
.
[
PubMed: 8933126]
- 78.
Roncin
JP
.
Schwartz
F
.
Darbigny
P
.
EGB 761 in control of acute mountain sickness and vascular reactivity to cold exposure
.
Aviation Space & Environmental Medicine
.
67
(
5
):
445
–
452
,
1996
May
.
[
PubMed: 8725471]
- 79.
Mouren
-
X
;
Caillard
-
P
;
Schwartz
-
F
.
Study of the antiischemic action of EGb 761 in the treatment of peripheral arterial occlusive disease by TcPo2 determination
.
Angiology
.
1994
Jun
;
45
(
6
):
413
–
7
.
[
PubMed: 8203766]
- 80.
Sotaniemi
EA
.
Haapakoski
E
.
Rautio
A
.
Ginseng therapy in non-insulin-dependent diabetic patients – effects on psychophysical performance, glucose homeostasis, serum lipids, serum aminoterminalpropeptide concentration, and body weight
.
Diabetes Care
.
18
(
10
):
1373
–
1375
,
1995
Oct.
[
PubMed: 8721940]
- 81.
Cui
-
J
;
Garle
-
M
;
Eneroth
-
P
;
Bjorkhem
-
I
.
What do commercial ginseng preparations contain?
[letter]
Lancet
.
1994
Jul
9
;
344
(
8915
):
134
.
[
PubMed: 7912373]
- 82.
Chosidow
O
.
Dega
H
.
Peytavin
G
.
Ginseng as cause of stevens-johnson syndrome
.
Lancet
.
348
(
9022
):
267
,
1996
Jul
27
.
[
PubMed: 8684215]
- 83.
Janetzky
K
.
Morreale
AP
.
Probable interaction between warfarin and ginseng
.
American Journal of Health-System Pharmacy
.
54
(
6
):
692
–
693
,
1997
Mar
15
.
[
PubMed: 9075501]
- 84.
Ginseng
.
Med-Lett-Drugs-Ther
.
1980
Aug
22
;
22
(
17
):
72
.
[
PubMed: 7402178]
- 85.
Grasso
-
M
;
Montesano
-
A
;
Buonaguidi
-
A
;
Castelli
-
M
;
Lania
-
C
;
Rigatti
-
P
;
Rocco
-
F
;
Cesana
-
BM
;
Borghi
-
C
.
Comparative effects of alfuzosin versus Serenoa repens in the treatment of symptomatic benign prostatic hyperplasia
.
Arch-Esp-Urol.
1995
Jan–Feb
;
48
(
1
):
97
–
103
.
[
PubMed: 7537488]
- 86.
Sheehan
MP
.
Stevens
H
.
Ostlere
LS
.
Atherton
DJ
.
Brostoff
J
.
Rustin
MHA
.
Follow-up of adult patients with atopic eczema treated with Chinese herbal therapy for 1 year
.
Clinical & Experimental Dermatology
. Vol
20
(
2
) (pp
136
–
140
),
1995
.
[
PubMed: 8565248]
- 87.
Ferguson
JE
.
Chalmers
RJG
.
Rowlands
DJ
.
Reversible dilated cardiomyopathy following treatment of atopic eczema with chinese herbal medicine
.
British Journal of Dermatology
.
136
(
4
):
592
–
593
,
1997
Apr.
[
PubMed: 9155965]
Please visit our web site for the complete list of 87 references on this topic.
Please note the following
correction
to Therapeutics Letter 24 (April/May 1998) in Table 2: the daily dose range for pravastatin (Pravachol
®
) should be 10 – 40 mg and the average daily cost $0.93 – $2.23.
This Therapeutics Letter contains an assessment and synthesis of published (and whenever possible peer-reviewed) publications up to Aug 1, 1998. We attempt to maintain the accuracy of the information contained in the Therapeutics Letter by extensive literature searches and verification by both the authors and the editorial board. In addition this Therapeutics Letter was submitted for review to 55 experts and primary care physicians in order to correct any identified shortcomings or inaccuracies and to ensure that the information is concise and relevant to clinicians.
The Therapeutics Initiative’s objectives are unbiased review and dissemination of therapeutic evidence. Our recommendations are intended to apply to most patients; exceptional patients require exceptional approaches. We are committed to evaluate the effectiveness of our educational activities using the Pharmacare/Pharmanet database without identifying individual physicians, pharmacists or patients. Please notify us if you do not wish to be part of this evaluation. The Therapeutics Initiative is funded through a 5-year grant to the University of British Columbia from the Government of British Columbia, Ministry of Health and Ministry Responsible for Seniors.
