Abstract

Approximately 70% of the world’s population has been using medicinal herbs as a complementary or alternative medicine that has grown tremendously in both developed and developing countries over the past 20 years (World Health Organization Drugs Strategy 2002–2005). This increase in consumer demand for medicinal plants continues, although scientific data are rare to create safety and efficacy profiles. Its popularity is also related to easy availability, cost-effectiveness leading to better purchasing power, and various factors that perceive that they are generally safe. Herbs are often administered simultaneously with therapeutic drugs for the treatment of major ailments, and herb-drug interactions (HDIs) increase their potential. The main routes proposed for HDIs include cytochrome P450 (CYP450)-mediated inhibition or induction and transport and flow proteins. In our review, we highlighted herbal medicines used for the treatment of various diseases with pharmacokinetic, pharmacodynamic analysis and case reports together with their adverse effects and herb-drug interactions. Therefore, this review can be used as a quick reference database for physicians and healthcare professionals involved in therapy, aiming to maximize clinical outcomes by reducing the negative and toxic effects of plants along with avoiding herb-drug interactions.

Highlights

  • Herbal products are considered the best choice as complementary medicine in western countries, especially in the United States and Europe

  • In the context of the Medical Toxicology growing demand and use of herbal medicines for patients and the public, and the subsequent interests of the regulatory authorities, comprehensive research on the safety and effectiveness of herbal products, including the possibility of interactions when simultaneous application is required, should be encouraged. This is because all herbal medicines and dietary supplements are a complex mixture containing multiple active phyto-components that increase the possibility of herb-drug interaction (HDI)

  • We highlighted herbal medicines used for the treatment of various diseases with their adverse effects and herb-drug interactions, and stated recommendations for proper use of plants that might prevent possible risks for future incidents

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Summary

Introduction

Herbal products are considered the best choice as complementary medicine in western countries, especially in the United States and Europe. In the context of the Medical Toxicology growing demand and use of herbal medicines for patients and the public, and the subsequent interests of the regulatory authorities, comprehensive research on the safety and effectiveness of herbal products, including the possibility of interactions when simultaneous application is required, should be encouraged. This is because all herbal medicines and dietary supplements are a complex mixture containing multiple active phyto-components that increase the possibility of herb-drug interaction (HDI). We highlighted herbal medicines used for the treatment of various diseases with their adverse effects and herb-drug interactions, and stated recommendations for proper use of plants that might prevent possible risks for future incidents

Toxicological risks of plants and herbal products
Nephrotoxicity
Hepatotoxicity
Cardiotoxicity
Potential precautions of plants on hypertension
Neurotoxicity
Psychiatric and neurological adverse effects
Skin toxicity
Contamination of herbal medicines by tropane alkaloids
Herb-drug interactions with the plants including furanocoumarins
Toxicity of pyrrolizidine alkaloids
Adverse effects of anthraquinone derivatives
Adulterations
Heavy metal contaminations
Herb-drug interactions in the treatment of cardiovascular disorders (CVDs)
Herb-drug interactions with chemotherapeutic drugs
Herb-drug interactions with attention-deficit/hyperactivity disorder (ADHD) medication
Results
Herb-drug interactions (HDI) with chronic kidney disease (CKD) medication
Herb-drug interactions with menopause medication
10. Herb-micronutrient interactions
12. Criteria for risk assessment of herbal products
13. Possible ways to reduce the toxic effects of herbal products
14. Conclusion
Full Text
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