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      Dietary supplements and herbal medicine toxicities—when to anticipate them and how to manage them

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          Abstract

          Background

          Dietary supplements and herbal medicines are gaining popularity in many developed countries.

          Aims

          Although most can be used without any problem, serious toxicities do occur.

          Methods

          Problems can be anticipated when they are used for non-traditional indications, at excessive dose, for prolonged duration, or by patients who are also on multiple modern pharmaceuticals. Problems should also be anticipated when these products claim to be able to relieve symptoms rapidly or when herbs with pronounced pharmacological effects or toxic components are used.

          Results

          Resuscitation, symptomatic and supportive care are the most important aspects of management of toxicities from these products.

          Conclusion

          This article reviews when problems with these products can be anticipated and outlines a practical approach to management.

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          Most cited references50

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          Unconventional medicine in the United States. Prevalence, costs, and patterns of use.

          D M Eisenberg, R C Kessler, C. Foster … (1993)
          Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic. We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy. One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among socio-demographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States. The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.
          Article 0 comments Cited 437 times – based on 0 reviews     Review now
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            Recent Patterns of Medication Use in the Ambulatory Adult Population of the United States

            David Kaufman, Judith P. Kelly, Lynn Rosenberg … (2002)
            Article 0 comments Cited 143 times – based on 0 reviews     Review now
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              Heavy metal content of ayurvedic herbal medicine products.

              R Saper, Ian Phillips, Stefanos Kales … (2004)
              Lead, mercury, and arsenic intoxication have been associated with the use of Ayurvedic herbal medicine product (HMPs). To determine the prevalence and concentration of heavy metals in Ayurvedic HMPs manufactured in South Asia and sold in Boston-area stores and to compare estimated daily metal ingestion with regulatory standards. Systematic search strategy to identify all stores 20 miles or less from Boston City Hall that sold Ayurvedic HMPs from South Asia by searching online Yellow Pages using the categories markets, supermarkets, and convenience stores, and business names containing the word India, Indian cities, and Indian words. An online national directory of Indian grocery stores, a South Asian community business directory, and a newspaper were also searched. We visited each store and purchased all unique Ayurvedic HMPs between April 25 and October 24, 2003. Concentrations (microg/g) of lead, mercury, and arsenic in each HMP as measured by x-ray fluorescence spectroscopy. Estimates of daily metal ingestion for adults and children estimated using manufacturers' dosage recommendations with comparisons to US Pharmacopeia and US Environmental Protection Agency regulatory standards. A total of 14 (20%) of 70 HMPs (95% confidence interval, 11%-31%) contained heavy metals: lead (n = 13; median concentration, 40 microg/g; range, 5-37,000), mercury (n = 6; median concentration, 20,225 microg/g; range, 28-104,000), and/or arsenic (n = 6; median concentration, 430 microg/g; range, 37-8130). If taken as recommended by the manufacturers, each of these 14 could result in heavy metal intakes above published regulatory standards. One of 5 Ayurvedic HMPs produced in South Asia and available in Boston South Asian grocery stores contains potentially harmful levels of lead, mercury, and/or arsenic. Users of Ayurvedic medicine may be at risk for heavy metal toxicity, and testing of Ayurvedic HMPs for toxic heavy metals should be mandatory.
              Article 0 comments Cited 111 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : +65-675-38777 , +65-625-43772 , dong_haur_phua@ttsh.com.sg,
                Bio :

                Dong-Haur Phua is an Emergency Physician and Clinical Toxicologist of the Emergency Medicine Department at Tan Tock Seng Hospital, Singapore. His research interest include elderly mistreatment, resuscitation, all aspect of clinical toxicology especially plants and herbal poisoning and decision making in clinical medicine.

                Journal
                Journal ID (nlm-ta): Int J Emerg Med
                Title: International Journal of Emergency Medicine
                Publisher: Springer-Verlag (London )
                ISSN (Print): 1865-1372
                ISSN (Electronic): 1865-1380
                Publication date (Electronic): 10 June 2009
                Publication date PMC-release: 10 June 2009
                Publication date Collection: June 2009
                Volume: 2
                Issue: 2
                Pages: 69-76
                Affiliations
                [1 ]Emergency Department, Tan Tock Seng Hospital, 11 Jalan, Tan Tock Seng, S(308433) Singapore
                [2 ]Rocky Mountain Poison and Drug Center, Denver, CO USA
                [3 ]Emergency Medicine, University of Colorado, Denver, CO USA
                Article
                Publisher ID: 105
                DOI: 10.1007/s12245-009-0105-z
                PMC ID: 2700222
                PubMed ID: 20157447
                SO-VID: 04365cc4-056d-4925-92f4-ab1653ae852d
                Copyright © © Springer-Verlag London Ltd 2009
                History
                Date received : 6 June 2008
                Date accepted : 17 April 2009
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag London Ltd 2009

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: toxicity,drug contamination,herbals,herb-drug interaction,poisoning,dietary supplements
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: toxicity, drug contamination, herbals, herb-drug interaction, poisoning, dietary supplements

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