List of herbs with known adverse effects

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This is a partial list of herbs and herbal treatments with known or suspected adverse effects, either alone or in interaction with other herbs or drugs. Non-inclusion of an herb in this list does not imply that it is free of adverse effects. In general, the safety and effectiveness of alternative medicines have not been scientifically proven [1] and remain largely unknown. [2] Beyond adverse effects from the herb itself, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal." [3]

Contents

Most of the adverse effects stated in this list are associated with only a small percentage of cases; they should be understood as potential risks rather than as certainties.

Herbs, treatments, and constituents with known or suspected adverse effects

NameOther common namesScientific nameAdverse effects
Aconite monkshood, wolfsbane, aconitum [4] Aconitum spp. Heart palpitations and arrhythmias, hypotension, nausea, vomiting, abdominal pain, respiratory system paralysis, death [4] [5]
Aloe vera juicemedicinal aloe Aloe vera "abdominal pain, diarrhea, potentially carcinogenic, with others can potentiate cardiac glycosides and antiarrhythmic agents" [3]
Anthranoid laxatives "abdominal pain, diarrhea, potentially carcinogenic, with others can potentiate cardiac glycosides and antiarrhythmic agents" [3]
Areca nut betel nut Areca catechu "deterioration of psychosis in patients with preexisting psychiatric disorders"; [5] known carcinogen contributing to cancer of the mouth, pharynx, esophagus and stomach when chewed. [6]
Aristolochic acid (contained in herbs in the genus Aristolochia e.g. Aristolochia serpentaria (Virginia snakeroot), Aristolochia reticulata (Texas snakeroot) and in Chinese herbs such as Aristolochia fangchi and Aristolochia manshuriensis [7] (banned in China and withdrawn from Chinese Pharmacopoea 2005; Stephania tetrandra and Magnolia officinalis do not contain aristolochic acid[ citation needed ]). Kidney toxicity [5] associated with kidney failure; associated with development of cancer, particularly of the urinary tract, known carcinogen [8] [9]
Atractylate Atractylis gummifera Liver damage, [3] nausea, vomiting, epigastric and abdominal pain, diarrhoea, anxiety, headache and convulsions, often followed by coma [10]
Ayurvedic Herbo-mineral (Rasashastra) Medicines Heavy metal contamination [11]
Bitter orange 'Fainting, arrhythmia, heart attack, stroke, death' [4]
Broom broom flower, dyer's broom, dyer's greenwood, dyer's weed, dyer's whin, furze, green broom, greenweed, wood waxen [12] Genista tinctoria [12] Uterotonic properties, [5] nausea vomiting, and diarrhea, [12] contraindicated for pregnancy and breast feeding [12]
Buckthorn bark and berryalder buckthorn Rhamnus frangula "abdominal pain, diarrhea, potentially carcinogenic, with others can potentiate cardiac glycosides and antiarrhythmic agents" [3]
Cascara sagrada barkbearberry Rhamnus purshiana "abdominal pain, diarrhea, potentially carcinogenic, with others can potentiate cardiac glycosides and antiarrhythmic agents" [3]
Chaparral creosote bush, gobernadora, larreastat [4] Larrea tridentata , Larrea divaricata [4] Liver damage, [3] [4] [5] kidney problems, [4] Hypotension in cancer patients [3]
Chinese herbal mixtures Heavy metal poisoning [5]
Coltsfoot coughwort, farfarae folium leaf, foalswort [4] Tussilago farfara Liver damage, cancer [4]
Comfrey comphrey, blackwort, common comfrey, slippery root [4] Symphytum officinale Liver damage, [4] [5] cancer [4]
Country mallow heartleaf, silky white mallow Sida cordifolia "Heart attack, heart arrhythmia, stroke, death" [4]
Dan Shenred sage, Chinese sage, tan shen Salvia miltiorrhiza Potentiates warfarin activity, leading to excessive anticoagulation and bleeding [3] [13]
Dong quaifemale ginseng Angelica sinensis May induce uterine contractions; contraindicated when pregnant or nursing [14]
European Mistletoe common mistletoe Viscum album Toxic to cardio and central nervous systems, gastrointestinal bleeding [3]
Ephedra ma huang Ephedra sinica Agitation and palpitations, [3] "hypertension, irregular heart rate, insomnia, nervousness, tremors and seizures, paranoid psychosis, heart attacks, strokes, and death", [1] [15] kidney stones [15]
Flavonoids (contained in many medicinal plants) [5] Vitamin P, citrinFlavonoids, bioflavonoids Hemolytic anemia, kidney damage [5]
Germander Teucrium Liver damage [3] [5]
Ginger Zingiber officinale May increase the risk of bleeding [16]
Ginkgo gingko Ginkgo biloba Bleeding [15] [16]
American Ginseng American Ginseng, Canadian Ginseng, Ginseng, Ginseng Root, North American Ginseng, Occidental Ginseng, Ontario Ginseng, Panax quinquefolium, Panax quinquefolius, Red Berry, Ren Shen, Sang, Shang, Shi Yang Seng, Wisconsin Ginseng [17] Panax quinquefolius "Hypertensive and chronotropic activities, may increase digoxin levels", [3] diarrhea, itching, insomnia, headaches, nervousness, rapid heartbeat, hypertension or hypotension, breast tenderness, vaginal bleeding. Very rarely Stevens–Johnson syndrome, liver damage, severe allergy has been reported [17] May lower blood sugar excessively in combination with diabetes medication. [17] Contains a chemical linked to possible birth defects. [17] May worsen hormone sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, and uterine fibroids. [17] Insomnia. [17]
Goldenseal orangeroot, yellow puccoon Hydrastis canadensis Uterotonic [3]
Greater celandine celandine Chelidonium majus Liver damage [4]
Guarana Paullinia cupana Agitation and insomnia [3]
Guar gum guaran Obstruction of gastrointestinal tract [5]
Gugulipid guggal, guggul, Mukul myrrh tree Commiphora mukul "Headache, nausea, hiccups, diminished efficacy of other cardiovascular drugs including diltiazem and propranolol" [3]
Hawthorn common hawthorn, may, mayblossom, maythorn, quickthorn, whitethorn, motherdie, haw Crataegus monogyna "Potentiates digitalis activity, increases coronary dilation effects of theophylline, caffeine, papaverine, sodium nitrate, adenosine and epinephrine, increase barbiturate-induced sleeping times" [3]
Horse chestnut conker tree, conker Aesculus hippocastanum Liver toxicity, allergic reaction, anaphylaxis [3]
Kava awa, kava-kava [4] Piper methysticum Potentiates CNS sedatives, [3] chronic use might cause a reversible dry skin condition. [18]
Khat qat Catha edulis Chronic liver dysfunction [3] [19]
Kratom Mitragyna speciosa Hepatotoxicity [20] [19]
Liquorice root Glycyrrhiza glabra Hypokalemia, hypertension, arrhythmias, edema [5]
Lobelia asthma weed, pukeweed, vomit wort Lobelia inflata Toxicity, rapid heartbeat, hypotension, coma, death [4]
Milk thistle Marian thistle Silybum marianum Mild laxative, allergy [5]
Pennyroyal Mentha pulegium Liver damage [3] [5]
Peony Bai Shao, Chi Shao, Chinese peony, common peony, coral peony, Cortex Moutan, European peony, Jiu Chao Bai Shao, Moutan, Mu Dan PI, peony flower, peony root, piney, radix peony, red peony, Shakuyaku, Shao Yao, tree peony, Ud Saleeb, Udsalam, Udsalap, White Peony [21] Radix Paeoniae, Radix Paeoniae Alba, Radix Paeoniae Rubra, Paeonia, Paeonia alba, Paeonia lactiflora, Paeonia mascula; Paeonia obovata; Paeonia officinalis; Paeonia suffruticosa, Paeonia veitchii, Paeoniae Flos, Paeoniae Radix [21] May slow clotting; contraindicated for people with bleeding disorders and before and after surgery. May induce uterine contractions; contraindicated when pregnant or nursing. [21]
Pyrrolizidine alkaloids (contained in comfrey, borage, senecio, coltsfoot, and others)Liver damage [5]
Reserpine Rauvolfia serpentina "Sedation, inability to complete tasks, mental depression, nasal congestion, increased gastric secretion and mild diarrhea" [3]
Safrole Sassafras albidum Liver damage [3]
Saw palmetto Serenoa repens "rare and mild gastrointestinal upset, headaches, diarrhea, gynecomastia, paroxysmal atrial fibrillation, ventricular rupture and death in one patient" [3]
Senna Egyptian senna Senna alexandrina (Cassia senna)"abdominal pain, diarrhea, potentially carcinogenic, with others can potentiate cardiac glycosides and antiarrhythmic agents", [3] liver damage [3]
St John's wort Tipton's weed, Klamath weed Hypericum perforatum Photosensitization, [3] [15] GI disturbances, "allergic reactions, fatigue, dizziness, confusion, dry mouth" [15]
Valerian garden valerian, garden heliotrope, all-heal Valeriana officinalis "drowsiness, GI upset, headache, palpitations, insomnia", [3] oversedation, overstimulation [16]
Vasambusweet flag Acorus calamus Vomiting and nausea [22]
Yohimbe yohimbine Pausinystalia johimbe rapid heart rate, hypertension, hypotension, heart problems, death [4]

Herbs with adverse drug interactions

NameOther common namesScientific nameDrugAdverse effects
Cinchona bark Cinchona pubescens WarfarinPossible additive effect [3]
Chamomile Blood thinners [23]
Devil's Claw grapple plant, wood spider Harpagophytum WarfarinAdditive effect [3]
Ephedra Ephedra Caffeine, decongestants, stimulants [15] Increases sympathomimetic effect of ephedra [3]
Feverfew featherfew Tanacetum parthenium AspirinAdditive effect [3]
Garlic Allium sativum WarfarinAdditive effect
Ginger Zingiber officinale WarfarinAdditive effect, causes iris bleeding [3]
Ginkgogingko Ginkgo biloba Aspirin, warfarin, ticlopidine, clopidogrel, dipyridamole, garlic, vitamin E [15] With aspirin – retards aspirin absorption [3]
Ginseng Panax ginseng Warfarin [15]
Papaya extract Carica papaya WarfarinDamage to GI tract mucous membranes [3]
Kava kava-kava Piper methysticum Sedatives, sleeping pills, antipsychotics, alcohol [15]
Milkvetch Astragalus Astragalus may interact with medications that suppress the immune system, such as cyclophosphamide. [24] It may also affect blood sugar levels and blood pressure.
Pineapple enzyme Ananas comosus Bromelain"Diarrhea, increased tendency for bleeding if used simultaneously with anticoagulants and inhibitors of thrombocytic aggregation due to modulation of the arachidonate cascade" [3]
Psyllium seed Plantago sppCoumarin derivatesRetards absorption of drug [3]
St John's wortTipton's weed, Klamath weed Hypericum perforatum Antidepressants, [15] [16] warfarin, protease inhibitors for HIV, birth control, some asthma drugs, and many other medications [16]

Herbal plants associated with allergic reactions

See also

Related Research Articles

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References

  1. 1 2 Talalay, P. (2001). "The importance of using scientific principles in the development of medicinal agents from plants". Academic Medicine. 76 (3): 238–247. doi: 10.1097/00001888-200103000-00010 . PMID   11242573.
  2. ↑ Eisenberg, D. M. (1997). "Advising patients who seek alternative medical therapies". Annals of Internal Medicine. 127 (1): 61–69. doi:10.7326/0003-4819-127-1-199707010-00010. PMID   9214254. S2CID   23351104.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Elvin-Lewis, M. (2001). "Should we be concerned about herbal remedies". Journal of Ethnopharmacology. 75 (2–3): 141–164. doi:10.1016/S0378-8741(00)00394-9. PMID   11297844.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 "Dangerous Supplements: Twelve Supplements You Should Avoid". Consumer Reports Magazine. September 2010.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Ernst, E. (1998). "Harmless herbs? A review of the recent literature". The American Journal of Medicine. 104 (2): 170–178. doi:10.1016/S0002-9343(97)00397-5. PMID   9528737.
  6. ↑ "Betel chewing causes cancer". SciDev.
  7. ↑ "Aristolochia manshuriensis – Plant Finder". www.missouribotanicalgarden.org. Retrieved 6 March 2019.
  8. ↑ "Natural Does Not Mean Safe". Slate Magazine. 2012.
  9. ↑ "Aristolochic Acid: FDA Concerned About Botanical Products, Including Dietary Supplements, Containing Aristolochic Acid". FDA. 2001.
  10. ↑ Daniele, C.; Dahamna, S.; Firuzi, O.; Sekfali, N.; Saso, L.; Mazzanti, G. (2005). "Atractylis gummifera L. Poisoning: An ethnopharmacological review". Journal of Ethnopharmacology. 97 (2): 175–181. doi:10.1016/j.jep.2004.11.025. PMID   15707749.
  11. ↑ Saper, RB; Phillips, RS; Sehgal, A; Khouri, N; Davis, RB; Paquin, J; Thuppil, V; Kales, SN (27 August 2008). "Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet". JAMA: The Journal of the American Medical Association. 300 (8): 915–23. doi:10.1001/jama.300.8.915. PMC   2755247 . PMID   18728265.
  12. 1 2 3 4 "Broom". WebMD.
  13. ↑ Chan, T. Y. (2001). "Interaction between warfarin and danshen (Salvia miltiorrhiza)". The Annals of Pharmacotherapy. 35 (4): 501–504. doi:10.1345/aph.19029. PMID   11302416. S2CID   20809476.
  14. ↑ HH, Tsai (2013). "A review of potential harmful interactions between anticoagulant/antiplatelet agents and Chinese herbal medicines". PLOS ONE. 8 (5): e64255. Bibcode:2013PLoSO...864255T. doi: 10.1371/journal.pone.0064255 . PMC   3650066 . PMID   23671711.
  15. 1 2 3 4 5 6 7 8 9 10 Cupp, M. J. (1999). "Herbal remedies: Adverse effects and drug interactions". American Family Physician. 59 (5): 1239–1245. PMID   10088878.
  16. 1 2 3 4 5 "Herbal Medicine". University of Maryland Medical Center. Archived from the original on 20 December 2017. Retrieved 1 September 2018.
  17. 1 2 3 4 5 6 "American Ginseng". WebMD.
  18. ↑ Norton, Scott A.; Ruze, Patricia (1 July 1994). "Kava dermopathy". Journal of the American Academy of Dermatology. 31 (1): 89–97. doi:10.1016/S0190-9622(94)70142-3. PMID   8021378.
  19. 1 2 Pantano, Flaminia; Tittarelli, Roberta; Mannocchi, Giulio; Zaami, Simona; Ricci, Serafino; Giorgetti, Raffaele; Terranova, Daniela; Busardò, Francesco; Marinelli, Enrico (16 April 2016). "Hepatotoxicity Induced by 'the 3Ks': Kava, Kratom and Khat". International Journal of Molecular Sciences. 17 (4): 580. doi: 10.3390/ijms17040580 . PMC   4849036 . PMID   27092496.
  20. ↑ LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases. 2012. PMID   31643176.
  21. 1 2 3 "Peony". WebMD. Retrieved 31 December 2011.
  22. ↑ "Vasambu". Tamilnadu.com. 1 April 2013. Archived from the original on 22 May 2016.
  23. ↑ "Chamomile".
  24. ↑ Astragalus, NCCAM
  25. ↑ Heydari, Mojtaba; Mayer, Johannes Gottfried; Hashempur, Mohammad Hashem; Raee, Mohammad Javad; Ostovar, Mohadeseh; Hajimonfarednejad, Mahdie (5 April 2018). "Cinnamon: A systematic review of adverse events". Clinical Nutrition. 38 (2): 594–602. doi:10.1016/j.clnu.2018.03.013. PMID   29661513. S2CID   4942968.
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