Traditional Remedies and Food Supplements
Since 1991, the Medical Toxicology Unit (MTU) at Guys’ Hospital, London, has been assessing the toxicological problems associated with the use of traditional and herbal remedies and dietary supplements. This assessment was carried out by evaluating reports to the National Poisons Information Service (London) [NPIS(L)] which provides emergency information to medical professionals. Relevant telephone enquiries to NPIS(L) were identified. Further case details were obtained by follow-up questionnaire, clinical consultation, toxicological analysis of samples from patients and/or products and botanical identification of plant material.
Of 1297 symptomatic enquiries evaluated there was a possible/confirmed association in 785 cases. Case series have been identified which substantiate previous reports, including liver problems following the use of Chinese herbal medicine for skin disorders, allergic reactions to royal jelly and propolis and heavy metal poisoning caused by remedies from the Indian subcontinent. Although the overall risk to public health appears to be low, certain groups of traditional remedies have been associated with a number of potentially serious adverse effects.
Considering the extent of use of herbal remedies and food supplements a comprehensive surveillance system for monitoring the adverse health effects of these products is essential. Surveillance of a large population is needed for the complex task of identifying the uncommon and unpredictable adverse effects which are potentially serious. In the UK, the Medicines Control Agency responded to the MTU report by recognising the need for vigilance and by incorporating adverse reactions reporting on unlicensed herbal remedies into their drug reaction monitoring function. As a further step to safeguard the patients/consumers an effective single regulatory system is required which would ensure the safety and quality of all herbal remedies and food supplements available in the UK.
KeywordsInternational Normalise Ratio Food Supplement Chinese Herbal Medicine Propolis Herbal Remedy
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- 1.Consumers Association. Healthy Choice. Which? Magazine. 1995 Nov: 8–13Google Scholar
- 4.Ministry of Agriculture Fisheries and Food. Dietary supplements and health foods. Report of the working group. London: MAFF, 1991Google Scholar
- 6.Jones KJ. Determining causation from case reports. In: Strom BL, editor. Pharmacoepidemiology. New York: Churchill Livingstone 1989: 275–88Google Scholar
- 8.Martindale. The Extra Pharmacopoeia. 28th ed. London: The Pharmaceutical Press London, 1989: 1635–68Google Scholar
- 9.ODonohue JW, Reid MA, Varghese A, et al. Micronodular cirrhosis and acute liver failure due to chronic copper self-intoxication. Eur J Gastroenterol Hepatol 1993; 5: 561–2Google Scholar
- 11.Perharic L, Shaw D. An appeal to pharmacists to report adverse effects of herbal and vitamin products. Pharmaceutical J 1994; 252: 479Google Scholar
- 13.Newall CA, Anderson LA, Phillipson JD. Herbal medicines a guide for health care professionals. London: The Pharmaceutical Press, 1996Google Scholar
- 18.Bensoussan A, Myers SP. Towards a safer choice. Report on the practice of traditional Chinese herbal medicine in Australia. Sydney: University of Western Sydney, Macarthur, 1996Google Scholar
- 25.Lekehal M, Pessayre D, Lereau JM, et al. Hepatotoxicity of the herbal medicine germander; metabolic activation of its furano diterpenoids by cytochrome P450 3A depletes cytoskelton-associated protein thiols and forms plasma membrane blebs in rat hepatocytes. Hepatology 1996; 24(1): 212–8PubMedCrossRefGoogle Scholar
- 27.Yu H, Zhong S, Chan K, et al. Pharmacognostical investigations on traditional Chinese medicinal herbs. J Pharmacy Pharmacol 1995; 47: 1129Google Scholar
- 28.But PHH. Attitudes and approaches of traditional Chinese medicine to herbal toxicity. J Natural Toxins 1995; 4(2): 207–15Google Scholar