Table 1 When adverse effects and toxicities may arise
From: Dietary supplements and herbal medicine toxicities—when to anticipate them and how to manage them
Factors predisposing to adverse effects and toxicities | When to anticipate them |
|---|---|
Inappropriate usage and inherent toxicity of herbs | Inappropriate indications (non-traditional indications)—weight loss, athletic performance, recreational use |
Inappropriate duration—use for prolonged periods of time, usually several weeks to months | |
Inappropriate dosage—excessive dose in order to achieve some particular results | |
Inadequate processing—herbs that are usually consumed in a certain way in a particular herbal tradition being processed in other non-recommended ways | |
Herbs with pronounced pharmacological effects or toxic components | |
Adulteration with modern pharmaceuticals (NSAIDs, steroids, antihistamines, Sildenafil, sulfonylurea) | Finished products claiming fast relief of symptoms or sexual enhancement |
Drug interaction | Patients on multiple modern pharmaceuticals, especially drugs with a narrow therapeutic index, such as warfarin, and taking dietary supplements and herbal products |
Patients taking multiple dietary supplements or herbal medicines | |
Heavy metal toxicities | Finished products from TCM, Ayurvedic traditions, or Mexican folk remedies |