'eature Arf;,le

Herbal Medicines: Are they safe?Milind Parle1* and Nitin BansaP

1Phannacology Division, Department of Phannaceutical Sciences,

Guru Jambheshwar University, Post Box No. 38, Hisar-125 001, Haryana, India

2Lard Shiva College of Phannacy, Post Box No. 63, Sirsa-125 055, Haryana, India

, *Correspondent author, E-mail: mparle@rediffmail.com

Received 28 November 2004; Accepted 24 October 2005

Abstract

The herbal drug industry is growing at an astounding rate all over the world. Herbal

remedies are now available not only in drug stores, but also, in food stores and supermarkets.

Therefore, the efficacy and safety of herbal drugs is very crucial. One of the most serious hazards

associated with herbal medicines is that consumers lnistakenly assume that since herbs are obtained

from nature, they must be safe. However, herbal medicines need to be used with utmost caution.

.Strychnine, curare and morphine are a few examples of poisonous alkaloids obtained from plant

source. Ginkgo bi/oba Linn. has been shown to be beneficial in managing Alzheimer's disease,

but is recently reported to precipitate epileptic seizures. No doubt, many herbs are found to bemiraculous cures for several diseases such as vincristine for cancer treatment and codeine as an

l!llti-tussiveagent. The authors are of the view that before marketing, herbal remedies must undergoanimal studies and clinical trials so as to establish their therapeutic value. This has become

important, since Dietary Supplement Health and Education Act 1994 have included herbs along

with vitamins, as food supplements. Thus, FDAhas almost lost its control over herbal drugs. There

is a need to ponder over some basic issues such as unifonn nomenclature, authentication and

standardization of plants and plant parts, acceptable impurities, contaminants, pharmacokineticprofile and shelf life before advocating herbal remedies.

1 Keywords: Herbs, Cardiotoxic, Contaminants, Hepatotoxic.. IPC code; Int. cP - A61K 35n8

~ .-",,,- __ u~ ~_

Introduction

The use of plants for treating

various diseases predates human history

and forms the origin of much of the

modem medicine. Long before the advent

of modem medicine, herbs were the

mainstream remedies for nearly all

ailments. People commonly diagnosed

their own illnesses, prepared and

prescribed their own herbal medicines,

or bought them from the local

apothecaries (Tyler, 2000). Herbal

medicines are being used increasingly as

dietary supplements to fight or prevent

common maladies like cancer, heart

attacks and depression (Eisenberg et aI,1998). When added to foods as

supplements, herbs have also been termedas nutraceuticals. Herbal remedies are

unpurified plant extracts containing

several constituents, which often work

together synergistically. According to WHO,

herbal medicine is defined as plant derived

material or preparation, which contains

raw or processed ingredients from one or

more plants, with therapeutic values. Use

of plant products, as medicine is inherent

in Ayurveda, the ancient Indian system of

health care (Dev, 1999). Several Ayurvedic

preparations employ a combination of

several species of plants for prevention or

cure of diseases. In China, modern

medicine utilizes the experience of ancient

practice of herbal medicines and has

worked out helpful drug regulations (Lee,

2000).

Based on ancient and experiential

evidence, these culturally accepted herbal

practices and beliefs are becoming quitecommon. Sales of herbal medicines are

booming as a consequence (Brevort,

1998). According to WHO, approximately

80% of the world's population prefer

herbal drugs for their routine health care.

In USA,the sales of herbal medicines are

approaching $ 4 billions a year.

The reasons people use herbal

medicines are diverse. However, there are

a number of theories explaining the

relatively recent upswing in the use ofherbal medicines. The consumers'

attitudes toward the relationship between

health and diet have been improving. The

avoidance behaviours have grown,

discouraging foods that contain

preservatives and other carcinogenic

materials. This concern quickly moved to

ingredients such as salt, sugar and

cholesterol (Wood, 1997). The increased

longevity of humans has resulted in an

increased interest in the "quality of life."

A large segment of population demand a

multipurpose herbal medicine, which

would relieve their arthritis, improvecardiovascular health and enhance mental

'R Natural Product Radiance

sharpness all at the same time. Marketing

efforts by herbal companies have

pr~j ected herbs into the limelight.Advertisements in the mass media

including television programs have

increased consumer awareness and given

the herbal products undue respectability

and credibility (Brevort, 1998). These

advertisements attract the people of all

ages. Children use herbs for their

nutritional values, young persons for their

euphoric effects, older persons for theiranti-ageing effects and women for

slimming and beautifying effects.Patient's utilization of herbs for

self-medication has a number of other

reasons. Manypatients are uncomfortable

about discussing their medical problems

and fear lack of confidentialityin handlingtheir health information. Often, patients

with non-specific symptoms or general

malaise may fear possible misdiagnosis

and wrong treatment. The lack of time to

see a physician is commonly indicated as

a reason particularly where prior visit did

not result in a positive experience(Studdert et al, 1998). The patient's

freedom to "choose" a practitioner,encourage people to utilize alternative

treatments and herbal medicines. Many

patients select herbal medicines because

of a deductive approach based on

anecdotal information, that is, "it worked

for my friend or relative". Additionally,

people are increasingly disposed to

accepting therapeutic value of a treatmentbased on faith or intuition rather than

scientific reasoning (Astin, 1998; Zeil,1999). Herbal medicine approach is

particularly alluring when it emphasizes

the body's natural capacity for self-repair,

given appropriate conditions. Researchhas found that users of the herbal

medicines are frequently those who strive

to keep control of their lives in their ownhands and need to trust effectiveness of

the treatment (Astin, 1998). People also

tend to believe that natural products are

inherently better than syntheticdrugs. The

natural drugs somehow contain the "vital

force" that is going to improve their

health. In addition, the herbal

preparations are far less expensive than

prescription drugs. Herbal medicine use

presents both promise and risks. The

promise is of alternative and effectivetreatment for chronic disorders. The risk

is borne out of the great-unknown effects

of herbs on the human body.People who

use herbal medicines for self-diagnosed

ailments run potential health risks. The

risks involve people of all ages (Cupp,

1999). Now,we would like to highlight

some issues on which regulatory

guidelines need to be laid down.

Regulatory control

A manufacturer must gain

approval of FDA before marketing asubstance as a medicine. Traditional

herbal medicines cannot be patented

because of stringent and inadequate patent

laws and costlyapproval processes. Since,

Food and Drug Administration (FDA)do

not regulate herbal products, they cannot

be labeled as useful therapeutic remedies(Glisson et al, 1999). Most herbal

products are considered as dietary

~upplements and are not required to meet

the standards specified in Federal, Food,

Drugs and Cosmetics Act. For example,

Ginsengwasclearlycharacterized as a drug

till recently and could be labeled and

prescribed to patients as such. Today,FDA

calls, Ginseng, legallya food for beverage

Feature Article

use. Now, it is common to find Ginseng

recommended for many differentmedical

conditions. With regard to using herbs as

food additives, the FDAhas maintained a

list of substances "Generally recognizedas safe" (the GRASlist). The list contains

about 250 herbs, primarily limiting their

use in beverages and as food additives.The list, of course, contains no reference

to herbs as drugs. In 1990, the Nutrition

Labeling and Education Act required

consistent, scientificallybased labeling of

all processed foods. Herbal medicines

were still left in limbo. Finally, in 1994,

DietarySupplement and Health EducationAct (DSHEA)included herbal remedies in

the definition of dietary supplements.

According to DSHEA,the manufacturer is

responsible for controlling quality, but if

a concern about safetyarises, the burden

of proof lies not with the manufacturerbut with the FDA,which has to prove that

the product is unsafe or ineffective (Ang­Lee et al, 2001). Due to lack of proper

regulations and guidelines, thesesubstances enter the market legallywithout ethical human trials. Herbal

medicines often shield themselves behind

the terms such as "natural", "food

supplement", "herbal" and "healthy". The

consumer then becomes a guinea pigwith

no one monitoring the situation. In themeantime, numerous people suffer

"unknown" kidney and liver failures and

await transplants, while sales continue.

Quality assurance

If an herbal remedy is effective,

quality assurance is needed to ensure that

the product has the expected effects.

Quality assurance is also important ifsufficient data is not available about its

Vol 5(1) January-February 2006 0

feature Artitle

efficacy. Quality implies certification in

respect of authentication, standardization,

composition, stability and safety. It also

ensures that the herbal product is freefrom adulterants and contaminants.

Authentication of some plants is difficult,

because there is a need to adopt uniform

binomial names for medicinal plants' to

eliminate confusion created by the

common names. Artemisip absinthiumLinn. for example, contains an activenarcotic derivative, which can cause

central nervous system disorders and

generalizedmental deterioration. Thisherbhas at least 11 different common names

(wormwood, absintium, absinth,

absinthe, madderwort, wermuth,

mugwort, magenkraut and herbal

absinthii), 7 of which bear noresemblance with its botanical name

(patvardhan, 2004).

The potency of the active

ingredients in herbal remedies is

dependent on how and where herbs are

grown, when they are harvested, how theyare stored, what parts of the plants are

used, and how these parts are extracted

from the plant. Thus, there may bevariation even within the same herbal

remedy in terms of the amount and

Artemisia absinthiwn

strength of the ~ctive ingredients(Maudlin, 1999). Standardization implies

that the active ingredient must beidentified to ensure that all brands and

batches have the same amounts of

working agent. This is impossible with the

herbal medicines, because the

constituents responsible for the claimedeffects are often not identified. For

example, Ma-haung (Ephedra) is a

sympathomimetic agent that contains 5-6different alkaloids. The alkaloid content

varies (lot-to-lot variation) widely in

commercial Ephedra containing

preparations. In many other cases, we mayhave no idea about the constituents

responsible for pharmacological activity.

The constituents may seem to work

synergistically and cannot be separated

without loss of activityof the preparation.

Because herbal preparations are used ascrude mixtures, these are very difficult to

standardize as allopathic medicines. In theabsence of standardization, however, a

number of herbs have become popular.

For examples, St. John's Wort is used

extensively for mild to moderate

depression and some preliminary test hasindicated no ill effects or interactions.

Likewise, Saw palmetto has shown

promising results when used for prostateproblems. Garlic has been shown to havesome beneficial effects on cholesterol

levels; Echinacea for treatment and

prevention of common cold; and Valerian

for its calming and sleep-inducing effects

(Youngkin & Israel, 1996).

Moreover,purity and adulteration

of commercially produced herbal

products have raised major questions.

Varying concentrations of activeingredients in samples from same lot and

same region can be encountered because

of presence of contaminants and

adulterants. For example, Echinacea,which is used as an immuno-stimulant is

available in 3 species, Echinaceaangustifolia DC., E. paUida (Nutt)Nutt and E.purpurea (Linn.) Moench.

E. purpurea is adulterated with

similar looking plant Partheniumintegrifolium Linn. (Wild Quinine).

These conditions also complicate the

standardization process. Various

adulterants and contaminants are givenin

Table 1. In addition, there are no specific

standardization guidelines followed to

ensure acceptable levelsof impurities such

as bacterial counts, pesticides, residual

solvents and heavy metals. Moreover,

quality assurance of herbal preparations

should be mandatory because of

intentional incorporation of drug

substances. Arecent studyof herbal creams

prescribed for dermatological conditions

in the United Kingdom revealed that 8 of

11 preparations contained undeclaredDexamethasone at a mean concentration

of456 mg/g (Keane et aI, 1999).

Safety

Potential risks in consumption of

herbal medicines are generally

unrecognized. The words "herb" and"safe" both contain four letters. One of

the most serious risks associated with

herbal medicines is the factthat consumers

mistakenly assume that because herbs are

natural, they are safe. Natural does not

imply free from harm. Many herbal

medicines are known to produce toxic

reactions, possible mutagenic effects or

allergic reactions (Ernst, 1998; Senior,1998). In this context, a case report from

Brussels (Belgium) narrates a story of

II.... Natural Product Radiance

Echinacea angustifolia

30 women treated with a Chinese herbal

slimming preparation. These ladies died

from renal failure in 1991-92. This

happened with Aristolochia spp. oneof the considered non-toxic herbs

(Marwick, 1995). Potentialadverse effects

associated with some of the herbal drugsare summarized below (De Smet, 2002).

Cardiotoxic herbs -Aconite

root tuber, cardioactive glycosides(digoxin, digitoxin, lanatoside,

strophanthine), Liquoriceroot, Ma-haung(Ephedra) and Pokeweed leaf or root.

Hepatotoxic herbs - Green

tea leaf, impila root, Ma-haung(Ephedra), kava rhizome, herbs rich in

anthranoids, proto berberine alkaloids,

coumarin, podophyllotoxin and toxic

pyrrolizidine alkaloids.

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Neurotoxic herbs - Aconite

root tuber, Alocasia macrorrhizaSchott (Giant Taro) root tuber, Gingko

seed or leaf, Indian tobacco, Ma-haung

(Ephedra), Nux-vomica, yellow Jasmine

rhizome, Artemisia species rich insantonin, essential oils rich in ascaridole

and thujole, herbs rich in colchicine and

podophyllotoxin.

Renal toxic herbs - Impila

root, Jerring root and Pennyroyal oil.

It is difficult to determine which

botanicals contain toxic substances that

have acute adverse effects in a largefraction of users. It is more difficult;however, to recognize adverse effects that

develop over long periods of time (e.g.hypokalemia from anthranoid laxatives),

Botanicals

(as adulterants)

Microorganisms(as contaminants)

Microbial toxins

(as contaminants)

Pesticides

(as contaminants)

Fumigation agents(as contaminants)

Toxic metals·

(as contaminants)

Drugs (as adulterants)

(De Smet, 2002)

Table 1: Some adulterants and contaminants

Ailanthus, Phytolacca and Scopolia leaves substituted for belladonna;

Xanthium leaves for stramonium and Dandelion for henbane, etc.

Staphylococcus aureus, Escherichia coli, Salmonella, Shigella,Pseudomonas aeruginosa

Aflatoxin, bacterial endotoxins

Chlorinated pesticides, Organic phosphates, Carbamate insecticides and

herbicides, Dithiocarbamate fungicide, Triazin herbicides

. Ethylene oxide, Methyl bromide, Phosphine

Lead, Cadmium, Mercury, Arsenic.

Analgesics and Anti-inflammatorydrugs (e.g. amino-phenazone, phenylbutazone,

indomethacine), Corticosteroids, Benzodiazepines, Warfarin, Fenfluramine, Sildenafil

Vol 5(1) January-February 2006 -- ---00

feature Art;cle

occur idiosyncratically, or are readily

ascribed to an underlying disease (e.g.

hepatitis from the bile-duct remedy

Celandine) .

Pharmacokinetic profile

Establishing optimum dosage

regimen in clinical situations is essential.

It is veryimportant to know the behaviour

of a drug molecule once it is administered

to a patient by various routes in various

dosage forms. Determination of

pharmacokinetic parameters helps to

understand all the factors including

inter-relationship between absorption, viz. herb-drug interactions, herb-herb

distribution, metabolism and excretion of interactions, herb-food interactions and

drug and consequently the blood levels herb-disease interactions (Table 2)

achieved. For a given dose of any herbal (Barnes et al, 2003; Fugh-Berman, 2000;

medicine, its physiological effect (or that Horowitz, 2000; Hussin, 2001).

of its constituents) will be governed by Pharmacokinetic information about

its bioavailability. Herbal medicines are herbal medicines is not readily available

complex mixtures. Therefore, oral or due to lack of scientific studies,

topical routes of administration are inadequate reporting and improper

preferred. Knowledge of herbal documentation (Samanta et al, 2004).

pharmacokinetics can provide valuable People do suffer complications due to the

information to aid practitioners in adverse effects of herbs or due to

prescribing herbs safely and effectively. interactions. The extent of knowledge

Pharmacokinetic data is important for regarding the ~nteractions,antagonistic or

understanding all possible interactions, additive effects,within and between herbs

Table 2: Various interactions using herbal remedies

Type of interaction IngredientsConsequences! risks

Herb-herb interactions!

Caffeinewith Ginseng Overstimulation and GITupsetGinseng with Coumarins

Bleeding episodes

---·-----·-----1----·----------Herbs with hypertensive properties

Herbs with hypo-or hyperglycaemic

activity

Herb-drug interactions

Herb-disease interactions

~!~ Garlic with Coumarins I Bleeding episodes

Hawthorn with Digoxin I Heart failure

, Echiruu:eawithcorticosteroids Gmmunosuppression-------·----I Ginseng with antidiabetics I Potentiation

I Rosemerry with antidiabetics I' AntagonismI Valerian with hypnotics I Potentiation

II Dandelion with diuretics i Increased risk of hypokalemia

I Aloes, Cascara, Rhubarb and Senna, i Antagonism

I etc. with antidiarrhoeals +- -Her~-food interactions--i Ginsengwith tea, coffee " GIT-up~et and overstimulation1 Digoxin and black liquorice Irregular heart rhythms and cardiac arrest

, St.John'S wort with aged cheese ,Fatal rise in blood pressure!II Problem to patients with hypertension

I Sudden fallJrise in blood glucose levelsII

(Barnes et aI, 2003; Fugh-Berman, 2000; Horowitz, 2000; Hussin, 2001)

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, ..

Digitalis purpurea

with this drug, it's use is now confined to

laboratory as a depletor of monoamines

(Schuldiner, 1994). Codeine (COREX),

isolated from Papaver somniferumLinn., is used as an anti-tussive agent

(Caraco et aI, 1999). Neurobiologistsand

phytochemists are now exploring the

possibilityofisolatingsome hormones like

estrogens, testosterone, etc. from plant

Catharanthus roseus

(LANOXIN) isolated from Digitalispurpurea Linn. is clinicallyprescribed

for the treatment of congestive heart

failure (Uretsky et aI, 1993). Vincristine

(ONCOVIN)and vinblastine (VELBAN),thealkaloids obtained from Catharanthus

roseus G. Don syn. Vinca rosea Linn.

are popular for their anticancer activity

(Noble et aI, 1958). Emetine, isolated

from ipecac is therapeutically used to

produce emesis particularlyin case ofover

dosage or accidental poisoning. Atropine

(BELLPINOATRIN)is a favourite drug ofgastroenterologists for relieving spastic

pain and glaucoma (Tryba& Cock, 1997).Colchicine (GOUTNIL) obtained from

Colchicum autumnale Linn., is a

popular antigout agent among the elderly

patients (Zemer et aI, 1991). Reserpine

(SERPASIL)obtained from Rauwolfiaserpentina Benth. ex Kurz was·

enthusiastically introduced into Indian

market as an antipsychotic and

antihypertensive agent. However, due toincreased suicidal tendencies observed

Efficacy of herbals

and conventional drugs is largelyunknown. Besides the direct risks of

adverse effectsand drug interactions, there

is an indirect risk that an herbal remedy

may compromise/delay an effectiveformof conventional treatment.

The interactions are of greatest

concern when patients are taking drugs

with a narrow therapeutic window. In

general, the most important drug-nutrient

interactions to guard against include

bleeding disorders (including bleeding in

the brain), upsetting brain chemistry

(serotonin syndrome, cholinergic

syndrome, triggering bipolar disease,

etc.), cardiac toxicity and hepatotoxicity(Mcneill, 1999).

Morphine is known to possess

excellent analgesic activities with

significant diarrhoea and cough relievingproperties. This alkaloid, however, is no

more prescribed because of its narcotic

nature (Gutstein& Akil,2001). Strychnine

is the principle alkaloid present in Nux­vomica (Strychnos nux-vomicaLinn.) seeds. Strychnine produces

excitation of all portions of CNS. It is

mainly used as an experimental tool to

produce tonic-clonic seizures in mice

(Klassen, 2001). Ginkgo biloba Linn.

is another example, which is found to be

beneficial in the management ofAlzheimer

disease. However, it is recently reported

to precipitate epileptic seizures (Granger, "2001). d-lUbocurarine, obtained from

curare plant is widely employed as an

experimental tool to block nicotinic

receptors competitively in laboratory

preparations like frog rectus abdominis

muscle (Bevan, 1994). Digoxin

Vol 5(1) January-February 2006 m

Feature Art;c/e

Herbs are generally safe if used with

proper knowledge, but they can beharmful and even fatal if misused

(Studdert et aI, 1998; Senior,1998). ~

Bleeding disorders can be caused by

any herb that contains a significantconcentration of ingredients

possessing anticoagulant property

(such as Red clover and Dong quaicontaining coumarins) when taken

concurrently with anticoagulant

medications (such as Warfarin,

Coumadin, Clopidogrel, etc.).Ginkgo biloba and Devil's claw

One of the most serious risks

associated with herbal medicines is

the fact that consumers mistakenlyassume that because herbs are

natural, they are safe.

The potency of the active ingredients

in herbal remedies is dependent on

how and where herbs are grown,when

they are harvested, how they are

stored, what parts of the plants are

used, and how these parts are

extracted from the plant. Thus, there

may be variation even within the

same herbal remedy in terms of the

amount and strength of the active

ingredients.

Some of the herbs have different

common names and different herbs

have similar appearance so

authentication becomes a necessity.

The possibility of presence ofadulterants and contaminants can notbe ruled out.

Tips/Warnings for healthy useof herbal remedies

The therapeutic applications oftraditional medicines are based on

empirical observations by ancient

man and lack preclinical and clinicalinvestigations.

yielded several lead compounds such as •

opioid analgesics, isolated from poppy

(Papaver somniferum). Synthetic

manipulations with these lead compounds

have resulted in many useful medicines

such as Pethidine, Methadone and •Pentazocine, etc. (Gutstein &Akil, 2001).

Coumarins derived from sweet clover are

clinically used as oral anticoagulants.

Extensive research using these lead

compounds has resulted in therapeutically

effective derivatives like Warfarin,

Dicoumarol, Acenocoumarol, etc.

(Majerus & Tollefsen, 2001). There are

several diseases like cancer, AIDS,

psoriasis, cataract, Alzeihmer's disease

and bronchial asthma, for which a

satisfactory allopathic medicine is not •

available even today. Therefore, novel

effectivemedicines can be developed using

phytoconstituents (lead compounds)

present in numerous untapped plant •material. The potential of medicinal

plants as a useful source for earning

foreign exchange can also be exploited in

near future, keeping in view hugereservoir of plants available in Himalayan

flora (Wakdikar, 2004). India can serve

as a medicinal plant paradise of the •world.

Colchicum autumnale

source. Herbals serve as useful sources of

vitamins. For example, vitamin C is

present in citrus fruits, lemons, oranges,tomatoes, strawberries, etc. Tomatoes andcarrots are the rich sources of vitamin A.

VitaminB complex can be obtained fromgreen vegetables, soyabeans, cereals and

whole grain breads. In the absence of

these vitamin rich nutrients, we would

suffer from vitamin deficiency disorders

like night blindness, beriberi, scurvy andosteoporosis.

Lacunae and limitations ofDue to lack of research initiatives traditional medicines

and accelerated stability studies, some of • Most of the marketed Ayurvedic •

the marketed herbal remedies are being preparations comprise of multiplesold without mentioning expiry date. herbs, e.g. Mentat, Chyawanprash,

Herbal drug research should be directed Brahmi Rasayana, Triphala, etc.towards establishing the safetyand qualityof herbal remedies in addition to their •.

efficacy using modern analytical

techniques that allow reproducible

fingerprinting of herbal products(Dawson, 2005). No doubt, herbs have

Challenges and scope ofherbal drug research

m--------------- Natural Product Radiance

'eature Art;c'e

References

Acknowledgements

The authors are grateful to Dr.R.P.Bajpai,Hon'ble ViceChancellor,Guru

Jambheshwar University, Hisar and Shri

Desh KamalBishnoi, Director, Lord Shiva

College of Pharmacy, Sirsa for their

inspiration and encouragement.

misidentified plants or contaminants such

as bacteria, heavy metals or even

prescription drugs. The authors are of the

view that before marketing, herbal

remedies must undergo well-plannedanimal studies and ethical clinical trials

so as to establish their therapeutic value.

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33-48.

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2.

3.

1.

Another subtle but real risk involves

pregnantwomen and nursing motherswho take herbal medicines and pass

it on to the child through breast milk.

There are hardly any studies on the

teratogenic effects of herbalremedies. There is little knowledgeof the effects of herbal medicines on

the developing fetuses (Delaney,1997).

CombiningValerianwithprescription

and non-prescription sleep aids and!

or alcohol can create a dangerousstate of oversedation.

Echinacea, which fires up the

immune system, does not mix wellwith corticosteroids or anyother drug

that suppresses the immune response(Mcneill, 1999).

In India, we have several systems

of medicine, viz. Nature cure, Ayurveda,

Homeopathy, Siddha and Unani being

activelypracticed in different parts of our

country. When a patient gets seriously ill, 4.

he desperately desires relief fromdiscomfort at the earliest irrespective of

the system of medicine. In other words, 5.he is open to accept any medication, if

relief is guaranteed. In such a situation,we as Indians are best placed to work out

an integrated system of medicine taking 6.advantageof both, modern technologyandtraditional therapies. Moreover, clinicians

shou1dnever recommend herbal remedies 7.without sufficient evidence of their safety

backed by rigorous study.Toxic effectsofherbs are often not the fau1tof herbs, but

are caused by products containing

Conclusion

The herbal agent hawthorn works in

the body in a similar fashion as other

cardiac glycoside drugs, such as

Digoxin.

Herbal supplements that elevate

acetylcholine concentrations in thebrain (huperzine A, Bacopamonnieri (Linn.) Penn.,phosphatidylserine, acetyl- L

carnitine, DMAE-dimethylamino

ethanol) have the potential to cause

cholinergic syndrome, if taken

concurrently with anti-Alzheimer's

drugs (such as acetylcholinesterase

inhibitors - Donepezil, Tacrine)

(Janetzky & Morreale, 1997; Bladt

& Wagner, 1994).

Popu1ar herb St.Johns Wort helps in

relieving mild to moderate

depression, but do not mix it with

prescription antidepressants,

especially the serotonin reuptakeinhibitors such as Prozac, Serzone,

Luvox,Paxiland Zoloft.This is a case

of getting too much of a good thing,which can be harmful.

have also been shown to cause •

bleeding disorders in humans,sometimes in the absence of

concurrent anticoagulant medicationuse. Feverfew (a herb used to treat

migraine headaches), ginger,turmeric and white willow extract •

may also induce a mild anticoagulant

effect, but till date, bleedingdisorders have not been shown to

occur to an appreciable degree inhumans (Mcneill, 1999; Rosenblatt •

& Mindel, 1997; McRae, 1996;

Matthews, 1998).

•

•

•

Vol 5(1) January-February 2006 m

feature Article

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An extract of this article was presented during 8th National Conference on Biomechanics held at lIT, New Delhi on November 19-21, 2004

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