Using Herbal Supplements Safely

Patients need education about the potential pitfalls of taking herbal supplements.

Herbal supplements, sometimes referred to as “botanicals,” have been used for medicinal purposes for many centuries and they continue to gain popularity among consumers today. These supplements are marketed for the prevention and management of many disease states and ailments. Currently, an estimated 75% of the world’s population have used or are using some type of herbal supplement.

In the United States, an estimated 1 in 5 adults has used at least 1 natural product in the past year. Examples of some of the most common herbal supplements sold in this country include echinacea, flaxseed, ginseng, ginkgo, saw palmetto, St John’s wort, black cohosh, evening primrose, milk thistle, and garlic.

As the popularity of these supplements continues to increase, some people elect to use these supplements in place of traditional medications. It is important that the consumer be informed about the safe use of herbal supplements before taking them. There are several factors to consider prior to using these natural supplements. While these are considered to be natural supplements, they may still cause several types of drug/supplement interactions and serious adverse effects, as well as exacerbate certain medical conditions. Patients with certain medical conditions are at a greater risk of developing adverse effects when using herbal supplements.

Are Herbal Supplements Safe?

The Food and Drug Administration (FDA) regulates herbs and other dietary supplements differently from traditional medications. The standards of safety and efficacy that traditional medications have to meet before gaining approval to be marketed do not apply to these types of supplements. The Dietary Supplement Health and Education Act has exempted manufacturers of herbal supplements from these regulations (see www.fda.gov/ Regulatory Information/Legislation/).

Before Using An Herbal Supplement

If you are considering using an herbal supplement, you should be aware that many herbal supplements may interact with both prescription and nonprescription medications and can cause some very serious interactions and adverse effects. For example, the herbal supplement St John’s wort is known to interact with numerous medications such as antidepressants, blood thinners, allergy medications, drugs that suppress the immune system, birth control pills, and cardiovascular drugs such as digoxin. The herbal supplements feverfew, ginger, and ginkgo can interact with some drugs used for breast cancer and a host of other medications. Other examples of potential drug/herbal interactions can be found in Table 1. Table 2 lists popular herbal products and possible side effects.

If you have allergies, especially allergies to plants, weeds, or pollen, you should consult your primary health care provider before taking herbal supplements. Patients taking blood thinners should also always consult their primary health care provider before using any of these supplements. Since older individuals may have a greater incidence of having multiple medical conditions and are more likely to take multiple medications, it is imperative that they also consult with their primary health care provider before using any herbal supplements to avoid any possible interactions or contraindications.

Always talk to your doctor before taking an herbal supplement if you have any of the following health problems:

• Blood clotting disorders
• Cancer
• Diabetes
• An enlarged prostate gland
• Epilepsy
• Glaucoma
• Heart disease
• Hypertension
• Immune system disorders
• Thyroid problems
• Parkinson’s disease
• History of liver or kidney problems
• History of stroke

Make sure you discuss the issue of using herbal supplements with your primary health care provider to help you make a safe choice. Remember, “natural” does not always mean safe and free of adverse effects. When it comes to your health, always ask questions when in doubt.

Resources

For more information on herbal supplements, visit the National Institutes of Health’s Center for Alternative and Complementary Medicine website: http://nccam.nih.gov/health/supplements/wiseuse.htm.

The National Institutes of Health Medline Plus website lists many of the most common herbal supplements and information about their uses, dosages, adverse effects, and drug interactions: www.nlm.nih.gov/medlineplus/druginfo/herb_All.html.

If you experience an adverse reaction to an herbal supplement, you may report the possible reaction to the Food and Drug Administration at www.FDA.gov/ medwatch or contact them at 1-800- FDA-1088.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.