European Journal of Clinical Pharmacology

, Volume 69, Issue 3, pp 295–307 | Cite as

Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews

Review Article



The aim of this overview of systematic reviews is to summarise and critically evaluate the evidence from systematic reviews of the adulteration and contamination of herbal medicinal products (HMPs).


Five electronic databases were searched to identify all relevant systematic reviews.


Twenty-six systematic reviews met our inclusion criteria. The most commonly HMPs were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively.


Collectively these data suggest that there are reasons for concerns with regards to the quality of HMPs. Adulteration and contamination of HMPs can cause serious adverse effects. More stringent quality control and its enforcement seem to be necessary to avoid health risks.


Adulteration Contamination Herbal medicine Systematic reviews 


  1. 1.
    Hunt K, Ernst E (2010) Patients’ use of CAM: results from the Health Survey for England 2005. Focus Altern Complement Ther 15(2):101–103Google Scholar
  2. 2.
  3. 3.
    Ernst E, Pittler MH, Wider B, Boddy K (2006) The desktop guide to complementary and alternative medicine, 2nd edn. Elsevier Mosby, EdinburghGoogle Scholar
  4. 4.
    Linde K, Knüppel L (2005) Large-scale observational studies of hypericum extracts in patients with depressive disorders—a systematic review. Phytomedicine 12:148–157PubMedCrossRefGoogle Scholar
  5. 5.
    But PPH, Tomlinson B (1996) Adulteration of herbal products can cause poisoning. Br Med J 313:117CrossRefGoogle Scholar
  6. 6.
    Ernst E (2002) Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review. J Intern Med 252(2):107–113PubMedCrossRefGoogle Scholar
  7. 7.
    Huang WF, Wen KC, Hsiao ML (1997) Adulteration by synthetic therapeutic substances of traditional chinese medicines in Taiwan. J Clin Pharmacol 37:334–350Google Scholar
  8. 8.
    Snyman T, Stewart MJ, Grove A, Steenkamp V (2005) Adulteration of South African traditional herbal remedies. Ther Drug Monit 27:86–89PubMedCrossRefGoogle Scholar
  9. 9.
    Ang HH (2008) Lead contamination in Eugenia dyeriana herbal preparations from different commercial sources in Malaysia. Food Chem Toxicol 46(6):1969–1975PubMedCrossRefGoogle Scholar
  10. 10.
    Ang HH, Lee KL (2006) Contamination of mercury in tongkat Ali hitam herbal preparations. Food Chem Toxicol 44(8):1245–1250PubMedCrossRefGoogle Scholar
  11. 11.
    Miller LG, Hume A, Harris IM et al (2001) Adulteration: its various meanings. Pharmacotherapy 21(6):770–771PubMedCrossRefGoogle Scholar
  12. 12.
    Zhang J, Wider B, Shang H, Li X, Ernst E (2012) Quality of herbal medicines: challenges and solutions. Complement Ther Med 20(1–2):100–106PubMedCrossRefGoogle Scholar
  13. 13.
    World Health Organisation (2012) WHO guidelines for assessingquality of herbal medicineswith reference to contaminantsand residues. Available at: Accessed 9 March 2012
  14. 14.
    Corrigan D (2003) European herbal medicines regulations. Focus Alt Complement Ther 8(2):169–170Google Scholar
  15. 15.
    Ernst E, Posadzki P, Lee MS (2011) Complementary and alternative medicine (CAM) for sexual dysfunction and erectile dysfunction in older men and women: an overview of systematic reviews. Maturitas 70(1):37–41PubMedCrossRefGoogle Scholar
  16. 16.
    Oxman AD, Guyatt GH (1991) Validation of an index of the quality of review articles. J Clin Epidemiol 44(11):1271–1278PubMedCrossRefGoogle Scholar
  17. 17.
    Ernst E (2000) Adverse effects of herbal drugs in dermatology. Br J Dermatol 143:923–929PubMedCrossRefGoogle Scholar
  18. 18.
    Ernst E, Thompson CJ (2001) Heavy metals in traditional Chinese medicines: a systematic review. Clin Pharmacol Ther 70(6):497–504PubMedCrossRefGoogle Scholar
  19. 19.
    Ernst E (2002) Toxic heavy metals and undeclared drugs in Asian herbal medicines. Trends Pharmacol Sci 23(3):136–139PubMedCrossRefGoogle Scholar
  20. 20.
    Ernst E, Pittler MH (2002) Risks associated with herbal medicinal products. Wien Med Wschr 152:183–189PubMedCrossRefGoogle Scholar
  21. 21.
    Ernst E (2002) Heavy metals in traditional Indian remedies. Eur J Clin Pharmacol 57(12):891–896PubMedCrossRefGoogle Scholar
  22. 22.
    Ernst E (2003) Serious psychiatric and neurological adverse effects of herbal medicines—a systematic review. Acta Psychiatr Scand 108:83–91PubMedCrossRefGoogle Scholar
  23. 23.
    Ernst E (2003) Serious adverse effects of unconventional therapies for children and adolescents: a systematic review of recent evidence. Eur J Pediatr 162:72–80PubMedGoogle Scholar
  24. 24.
    Gabardi S, Munz K, Ulbricht C (2007) A review of dietary supplement-induced renal dysfunction. Clin J Am Soc Nephrol 2(4):757–765PubMedCrossRefGoogle Scholar
  25. 25.
    Ulbricht C, Costa D, Grimes Serrano J et al (2010) An evidence-based systematic review of spearmint by the Natural Standard Research Collaboration. J Diet Suppl 7(2):179–215PubMedCrossRefGoogle Scholar
  26. 26.
    Ulbricht C, Weissner W, Hashmi S et al (2009) Essiac: systematic review by the Natural Standard Research Collaboration. J Soc Integr Oncol 7(2):73–80PubMedGoogle Scholar
  27. 27.
    Ulbricht C, Conquer J, Costa D et al (2011) An evidence-based systematic review of saffron (Crocus sativus) by the Natural Standard Research Collaboration. J Diet Suppl 8(1):58–114PubMedCrossRefGoogle Scholar
  28. 28.
    Ulbricht C, Brendler T, Gruenwald J et al (2005) Lemon balm (Melissa officinalis L.): an evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother 5(4):71–114PubMedCrossRefGoogle Scholar
  29. 29.
    Ulbricht C, Chao W, Costa D, Nguyen Y, Seamon E, Weissner W (2009) An evidence-based systematic review of green-lipped mussel (Perna canaliculus) by the Natural Standard Research Collaboration. J Diet Suppl 6(1):54–90PubMedCrossRefGoogle Scholar
  30. 30.
    Basch E, Ulbricht C, Harrison M et al (2003) Alfalfa (Medicago sativa L.): a clinical decision support tool. J Herb Pharmacother 3(2):69–90PubMedGoogle Scholar
  31. 31.
    Saad B, Azaizeh H, bu-Hijleh G, Said O (2006) Safety of traditional Arab herbal medicine. Evid Based Complement Altern Med 3(4):433–439CrossRefGoogle Scholar
  32. 32.
    Sweeney B, Vora M, Ulbricht C, Basch E (2005) Evidence-based systematic review of dandelion (Taraxacum officinale) by natural standard research collaboration. J Herb Pharmacother 5(1):79–93PubMedGoogle Scholar
  33. 33.
    Basch E, Conquer J, Culwell S et al (2012) Green tea (Camellia sinensis) Natural Standard Professional Monograph. Available at: Accessed 21 Jan 2012
  34. 34.
    Armbruester N, Bryan K, Costa D et al (2012) Cinnamon (Cinnamomum spp.) Natural Standard Professional Monograph, pp 1–70. Available at: Accessed 21 Jan 2012
  35. 35.
    Ceurvels J, Davis M, Clubb J et al (2012) Blue cohosh (Caulophyllum thalictroides) Natural Standard Professional Monograph. Available at: Accessed 21 Jan 2012
  36. 36.
    McLaren J, Swift W, Dillon P, Allsop S (2008) Cannabis potency and contamination: a review of the literature. Addiction 103(7):1100–1109PubMedCrossRefGoogle Scholar
  37. 37.
    Pittler MH, Ernst E (2003) Systematic review: hepatotoxic events associated with herbal medicinal products. Ailment Pharmacol Ther 18:451–471CrossRefGoogle Scholar
  38. 38.
    Ernst E (2002) Adverse effects of unconventional therapies in the elderly: a systematic review of the recent literature. J Am Aging Assoc 25:11–20Google Scholar
  39. 39.
    Ernst E (2003) Cardiovascular adverse effects of herbal medicines: a systematic review of the recent literature. Can J Cardiol 19:818–827PubMedGoogle Scholar
  40. 40.
    Lynch E, Braithwaite R (2005) A review of the clinical and toxicological aspects of ‘traditional’ (herbal) medicines adulterated with heavy metals. Expert Opin Drug Saf 4(4):769–778PubMedCrossRefGoogle Scholar
  41. 41.
    Wang GW, Hu WT, Huang BK, Qin LP (2011) Illicium verum: a review on its botany, traditional use, chemistry and pharmacology. J Ethnopharmacol 136(1):10–20PubMedCrossRefGoogle Scholar
  42. 42.
    Hung SK, Hillier S, Ernst E (2011) Case reports of adverse effects of herbal medicinal products (HMPs): a quality assessment. Phytomedicine 18(5):335–343PubMedCrossRefGoogle Scholar
  43. 43.
    World Health Organisation (2005) National policy on traditional medicine and regulation of herbal medicines. World Health Organisation, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Complementary Medicine, Peninsula Medical SchoolUniversity of ExeterExeterUK

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