Herbal products are an extremely profitable segment of the dietary supplement industry. As a matter of fact, US consumers spent close to $12.8 billion in 2012 on herbal products whose indications varied from weight loss and allergy relief, to treatment of depression and diabetes.
By H.S. Nemr
With the current consumer’s growing interest in alternative medicine, we have reached a point where no matter what ailment a person has, there is a supposed herbal treatment for it.
General advice to patients
Patients and healthcare practitioners should always keep in mind that herbal remedies are medicines. As with any other medicine, they have the potential to cause adverse effects and therefore should be used with care. Herbal remedies can interact with other medicines. This could result in the other medicines having reduced or enhanced effects, including side-effects. When consulting your doctor or pharmacist, always inform them about any herbal medicines you are taking.
In the growing trend of resorting to alternative and presumably “safer” therapies, patients and healthcare practitioners should keep in mind that “natural” does not mean “safe”. Many plants can be poisonous to humans. Unlicensed or non-agency regulated herbal product brands may be contaminated with intoxicants or undeclared ingredients.
Are any particular groups at risk?
In many cases the safe use of herbal medicines has not been established in:
- Pregnant women.
- Breastfeeding mothers.
- Elderly patients.
If you are due to have a surgical operation always remember to tell your doctor about any herbal medicines you are taking. Some herbal medicines could alter the effects of anesthetics or blood clotting medications.
Any patient with a history of liver complaints or any other serious health condition is advised not to take any herbal medicine without informing his clinician.
Which herbal medicines have been assessed by regulatory agencies?
In the United Kingdom, the Medicines and Healthcare products Regulatory Agency (MHRA) is issuing a Product License (PL) number or a Traditional Herbal Registration (THR) number to licensed herbal medicines. This number can be found on the product label and indicates that it meets assured standards.
In the United States, The US congress passed the “Dietary Supplement Health and Education Act” (DSHEA) in 1994. Under this act, herbal product manufacturers are not required to obtain pre-market approval by the FDA before making their product available to consumers. DSHEA also includes provisions that allow herbal product manufacturers to make certain statements about the supplement’s effects on the well being of the consumer without having these statements evaluated by the FDA.
Under section four of DSHEA, the burden of showing that a product is impure or adulterated falls on the FDA. Herbal manufacturers do not have to prove their products as being safe for consumption. In other words, the product can remain on the market even if consumers or scientists raise concerns about the product’s safety.
Advice for consumers when buying herbal medicines
1- Remember that the quality, strength and usage of individual herbal products may vary widely.
2- Treat with caution claims about safety that are not backed by credible evidence. Be wary of products making claims such as:
- The herbal remedy is “100% safe”
- Herbal remedies are “safe because they are natural”
- This herbal medicine “has no side effects”
- “Chinese medicines will not interfere with the effects of any western medicine”
- You can avoid Chinese medicines interfering with other medicines if you take them an hour apart.
3- Beware of any product suggesting that the consumer should stop taking, or change the dosage of, a prescribed medicine. You should always consult your doctor about making changes to your prescribed medication.
- Treat with caution any herbal medicine that makes medicinal claims for the product (that is claims to prevent, treat, or cure illnesses). These claims could be misleading.
4- Beware of any product if:
- It is not properly labeled.
- It does not have information about safe usage.
- The herbal practitioner cannot or will not give a list of ingredients.
5- Apparently similar herbal medicines may be accompanied by different patient information. Do not assume that the brand with fewer warnings is necessarily safer to use.
6- Avoid buying herbal medicines over the Internet. There is an international trade in poor quality unregulated herbal products online and many of these sold products have been found containing banned pharmaceutical ingredients or heavy metals.
7- If a product refers to licenses granted in certain countries there may be no guarantees that the product actually complies with requirements or standards that a consumer in the UK or the USA would expect in a licensed product.
What to do if you experience an adverse reaction to your herbal medicine?
All medicines, including herbal medicines, may cause side effects or unwanted reactions.
Once a patient experiences a reaction to an herbal medicine, he should discontinue use and inform his doctor or pharmacist.
H.S. Nemr is a graduate of BAU pharmacy school. He is currently a medication safety officer at Johns Hopkins Aramco Healthcare system.
- Dietary Supplement Health and Education Act of 1994, Public Law 103-417, 103rd Congress
- How natural are “Natural Herbal Remedies”? A Saudi perspective, Toxicological reviews 2002, volume 21
- Medicines and Healthcare products Regulatory Agency (MHRA) website, accessed March 2008, www.mhra.gov.uk