Herbal and Alternative Products
The use of herbal medicines, dietary supplements, and other alternative products has risen sharply since passage of the Dietary Supplement Health and Education Act (DSHEA) in 1994. In contrast to prescription or nonprescription drugs, these products do not require FDA approval before marketing. Premarketing evaluation of safety and efficacy is not mandated, and adherence to good manufacturing practices and quality control standards is not enforced. Consumers often mistakenly believe that these “natural” products are free of harm and may unknowingly be at risk for illness from the products and herb-drug and herb-disease interactions, particularly with “polysupplement” use. Table II–30 lists common selected products that are available as herbal remedies or dietary supplements or that have alternative uses, along with their potential toxicities.
Product | Source or Active Ingredient | Common or Purported Use(s) | Clinical Effects and Potential Toxicity |
|---|---|---|---|
Aconite (monkshood) | Aconitine, mesaconitine, and hypaconitine | Rheumatism, pain | Nausea, vomiting, paresthesia, numbness; hypotension, palpitations, ventricular tachycardia, ventricular arrhythmias. |
Androstenedione | Sex steroid precursor | Increase muscle size and strength | Virilization in women, increased estrogen in men. |
Anabolic steroids | Methandrostenolone, oxandrolone, testolactone, many other steroid derivatives | Body building | Virilization; feminization; cholestatic hepatitis; aggressiveness, mania, or psychosis; hypertension; acne; hyperlipidemia; immune suppression. |
Azarcon (Greta) | Lead salts | Hispanic folk remedy for abdominal pain, colic | Lead poisoning (See Lead). |
Bitter orange | Citrus aurantium (source of synephrine) | Weight loss, athletic enhancement | Synephrine: alpha-adrenergic agonist (See Pseudoephedrine, Phenylephrine, and Other Decongestants); may cause vasoconstriction, hypertension. |
Bufotoxin | Bufotenine (toad venom); “love stone”; Chan su | Purported aphrodisiac, hallucinogen | Cardiac glycosides (See Digoxin and Other Cardiac Glycosides). |
Cascara sagrada | Rhamnus purshiana | Cathartic in some diet aids | Abdominal cramps, diarrhea; fluid and electrolyte loss. |
Chitosan | Derived from marine exoskeletons | Weight loss | Dyspepsia, oily stools, shellfish hypersensitivity reaction. |
Chondroitin sulfate | Shark or bovine cartilage or synthetic | Osteoarthritis | Possible anticoagulant activity. |
Chromium | Chromium picolinate | Glucose and cholesterol lowering, athletic performance enhancement | Renal insufficiency, possibly mutagenic in high doses, niacin-like flushing reaction with picolinate salt (See Chromium). |
Comfrey | Symphytum officinale | Anti-inflammatory, gastritis, diarrhea | Hepatic veno-occlusive disease, possible teratogen/carcinogen. (Note: Many other plants also contain hepatotoxic pyrrolizidine alkaloids; see Table II–48) |
Creatine | Creatine monohydrate, creatine monophosphate | Athletic performance enhancement | Nausea, diarrhea, muscle cramping, rhabdomyolysis, renal dysfunction. |
DHEA | Dihydroepiandrosterone (an adrenal steroid) | Anticancer, antiaging | Possible androgenic effects. |
Echinacea | Echinacea angustifolia Echinacea pallida Echinacea purpurea | Immune stimulation, prevention of colds | Allergic reactions, possible exacerbation of autoimmune diseases. |
Fenugreek |
