Important Information About Herbal Treatments

Considering taking herbal treatments? Important things you need to know before using herbal products.

Potential Harmful Substances in Herbal Products

It is not unusual for an individual to use both traditional herbal medicine, alternative treatments and Western medications at the same time. More and more Americans are using these approaches to treat health conditions. Many people feel that herbal/alternative products are more "natural" and safer than conventional drugs. Unfortunately, this is not always true and herbal products or very high doses of vitamins or minerals can have potential side effects, just like prescription and non-prescription (OTC) products. More than 20,000 commercial herbal products are available in the USA. China has, perhaps, classified more herbal medicines than any other country. Many countries have adapted their "traditional medicines" from Traditional Chinese Medicine (TCM), including Japan (Kampo medicine) and Korea. Herbs are typically used in combination with each other. There has been a worldwide rush to identify the active chemicals in traditional medicines, as well as to conduct scientifically rigorous studies to evaluate safety and efficacy.

Traditional Chinese Medicine, perhaps the best known in the West, is not the only source of alternative therapy. Native Americans, East Indian, Pacific Islanders, Latin Americans, Inuit, and many other cultures have developed treatments from herbs, minerals, or animal products.

Many patients using herbals/alternatives, often in addition to Western drugs, are not familiar with the potential side effects or possible drug-drug interactions or disease-herbal interactions that may place them at risk for a bad reaction.

Here are a few tips to consider if purchasing herbal/alternative treatments:

• Is the product manufactured in the United States?
• Is the manufacturer well known and reputable? (Ask your pharmacist.)

• Does the label list the name of the herb(s), the amount of the herb(s) in each dose in milligrams or grams, a lot number, and an expiration date? If you choose to use products brought in from other countries, read the label carefully with your pharmacist. Watch for names of prescription drugs such as ephedrine and phenobarbital, which have been found in herbal products.
• Does the label or product information list a toll free number you can call for more information?
• Call and ask how the raw herbs are accurately identified and how the product is tested for purity and potency. Some manufacturers will send a copy of their analysis to you and/or your physician, nurse or pharmacist. An independent laboratory (ConsumerLab.com) has tested some herbal products for purity and potency. Check their web site and select an approved product or a manufacturer that clearly provides quality control.
• Have you discussed the possible benefits and adverse effects of the product with your pharmacist and/or physician?

Are herbals safe?

Unlike prescription and over-the-counter medications, most herbal products are considered "dietary supplements" and do not have to be proven safe or effective before they are sold. Herbs are essentially crude drugs with the potential for both beneficial and harmful effects.

In some cases, the herbal content of a product is considerably more or less than the strength listed on the label. While most herbal products are safe, some products have been found to contain pesticides, heavy metals, toxic herbs or prescription medications.

What precautions should I take before using an herbal product?

Learn all you can about the product. Check for known side effects and interactions with medications or food. Talk with your doctor or pharmacist before you start taking a herbal product, especially if you have a health condition such as heart disease, high blood pressure, diabetes, thyroid problems, a neurological condition, or a psychiatric problem. Children and women who are pregnant or breast feeding should not take herbal products unless under the supervision of a competent physician. If you plan to have surgery, ask your physician if you should stop herbal alternative treatments before surgery.

What should I look for on the labels of herbal products?

The label should indicate the name of the herb, the form (e.g., powder or standardized extract), and the amount of the herb per dose in milligrams (mg) or grams (gm). A lot number and an expiration date should be included.

Can herbal medicines have serious side effects?

Yes. For example, ma huang (ephedra) can cause high blood pressure, huperzine A may slow the heart rate, and PC-SPES can cause blood clots. Stop taking herbal products immediately if side effects, a rash, or signs of an allergic reaction occur and contact your health care provider.

Can I take herbal products with the medications my doctor prescribed?

It is important to tell all your health care providers about any herbal products you take, since interactions with prescription drugs are possible. This is true even if herbal products are taken several hours apart from other medications. For example, Ginkgo biloba may increase the risk of bleeding in patients who take warfarin. Ma huang can increase the effects of stimulants, including decongestants, diet aids, and caffeine. It may also interact with theophylline, digoxin, antihypertensives, MAO inhibitors, and antidiabetic drugs.

Source: Rx Consultant newsletter article: Traditional Chinese Medicine The Western Use of Chinese Herbs by Paul C. Wong, PharmD, CGP and Ron Finley, RPh

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