Positive Health Online

Abstract

KLEPSER and KLEPSER, Division of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Iowa, Iowa City 52242 USA. teresa-klepser@uiowa.edu discuss unsafe and potentially safe herbal therapies .

Background

Methodology

Results

Herbal therapy use is increasing in the United States; however, most pharmacists are not adequately prepared educationally to meet request from patients for information regarding herbal products. Pharmacists have to work in an environment in which there is relatively little regulation of herbal therapies by the FDA. Certain herbs have been identified as unsafe, including borage, calamus, coltsfoot, comfrey, life root, sassafras, chaparral, germander, licorice, and ma huang . Potentially safe herbs include feverfew, garlic, ginkgo, Asian ginseng, saw palmetto, St Johns wort, and valerian . Clinical trials have evaluated feverfew for migraine prevention and rheumatoid arthritis ; garlic for hypertension, hyperlipidaemia and infections; ginkgo for circulatory disturbances and dementia; ginseng for fatigue and cancer prevention; and saw palmetto for benign prostatic hyperplasia . Also studied in formal trials have been St Johns wort for depression and valerian for insomnia. The results from the clinical trials suggest efficacy of some herbal therapies for certain conditions. German Commission E, a regulatory body which evaluates the safety and efficacy of herbs on the basis of clinical trials, cases and other scientific literature, has established indications and dosage recommendations for many herbal therapies.

Conclusion

Pharmacists have a responsibility to become educated regarding herbal therapies in order to help patients discern fact from fiction, avoid harm and gain what benefits may be available.

References

Klepser TB and Klepser ME. Unsafe and potentially safe herbal therapies. American Journal of Health-system Pharmacy 56(2): 125-38. Jan 15 1999.

Comment

Comments (Michael McIntyre, Chairman of the European Herbal Practitioners Association: It is inaccurate to say that all these herbs listed are unsafe. Liquorice is a common ingredient of sweets so it can hardly be said to be unsafe. In huge doses, it may raise blood pressure because it has a mild mineralocorticoid effect but this hardly makes it unsafe. Ma Huang (Ephedra sinica) obviously contains ephedrine. It is entirely safe in the hands of a trained herbalist who knows that it is contraindicated if someone is taking an MAOI, has high blood pressure, an enlarged prostate, glaucoma, heart disease, tacchycardia, or is a professional athlete. I use it every day in my practice and have never had a single adverse effect. Borage, comfrey liferoot and coltsfoot are all attacked for causing liver damage because they contain pyrrolizidine alkaloids. But after extensive discussions, the UK authorities have permitted the use of comfrey leaf because the PA levels are so very low. This is also true of coltsfoot and borage leaf. Comfrey is completely safe as an ointment since PAs cannot pass through the skin. Life root has higher amounts of PAs and we no longer use it. I think the same may be true for Sassafras. It is true that there is evidence that chaparral and germander may cause liver damage and we have agreed not to use these plants. Calamus it is claimed may cause cancer but evidence for this is shaky and it continues to be a major herb legally in use in the UK.