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An Evaluation of Selected Herbal Reference Texts and Comparison to Published Reports of Adverse Herbal Events

  • Original Research Article
  • Published:
Adverse Drug Reactions and Toxicological Reviews

Abstract

Objective

There has been a recent proliferation of medical reference texts intended to guide practitioners whose patients use herbal therapies. We systematically assessed six herbal reference texts to evaluate the information they contain on herbal toxicity.

Methods

We selected six major herbal references published from 1996 to 2000 to evaluate the adequacy of their toxicological information in light of published adverse events. To identify herbs most relevant to toxicology, we reviewed herbal-related calls to our regional California Poison Control System, San Francisco division (CPCS-SF) in 1998 and identified the 12 herbs (defined as botanical dietary supplements) most frequently involved in these CPCS-SF referrals. We searched Medline (1966 to 2000) to identify published reports of adverse effects potentially related to these same 12 herbs. We scored each herbal reference text on the basis of information inclusiveness for the target 12 herbs, with a maximal overall score of 3.

Results

The herbs, identified on the basis of CPCS-SF call frequency were: St John’s wort, ma huang, echinacea, guarana, ginkgo, ginseng, valerian, tea tree oil, goldenseal, arnica, yohimbe and kava kava. The overall herbal reference scores ranged from 2.2 to 0.4 (median 1.1). The Natural Medicines Comprehensive Database received the highest overall score and was the most complete and useful reference source. All of the references, however, lacked sufficient information on management of herbal medicine overdose, and several had incorrect overdose management guidelines that could negatively impact patient care.

Conclusion

Current herbal reference texts do not contain sufficient information for the assessment and management of adverse health effects of botanical therapies.

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Acknowledgements

This work was supported in part by a grant (K23 AT00069-01) from the National Center for Complementary and Alternative Medicine, National Institutes of Health.

This work was presented as a poster at the 2000 North American Congress of Clinical Toxicology Conference, 16 September 200, Tucson, AZ. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Departments of Medicine and Clinical Pharmacy, and the California Poison Control System, San Francisco Division, University of California, San Francisco, California, USA

    Christine A. Haller, Ilene B. Anderson, Susan Y. Kim & Paul D. Blanc

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  1. Christine A. Haller
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  2. Ilene B. Anderson
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  3. Susan Y. Kim
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  4. Paul D. Blanc
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Correspondence to Christine A. Haller.

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Haller, C.A., Anderson, I.B., Kim, S.Y. et al. An Evaluation of Selected Herbal Reference Texts and Comparison to Published Reports of Adverse Herbal Events. Adv Drug React Toxicol Rev 21, 143–150 (2002). https://doi.org/10.1007/BF03256189

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