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

European Journal of Clinical Pharmacology volume 69, pages 295–307 (2013)Cite this article

Abstract

Purpose

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).

Methods

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

Results

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.

Conclusions

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.

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References

  1. Hunt K, Ernst E (2010) Patients’ use of CAM: results from the Health Survey for England 2005. Focus Altern Complement Ther 15(2):101–103

    Google Scholar 

  2. Vocus/PRWeb (2012) http://www.prweb.com/releases/herbal_supplements/herbal_remedies/prweb9260421.htm. Accessed 9 March 2012

  3. Ernst E, Pittler MH, Wider B, Boddy K (2006) The desktop guide to complementary and alternative medicine, 2nd edn. Elsevier Mosby, Edinburgh

    Google Scholar 

  4. Linde K, Knüppel L (2005) Large-scale observational studies of hypericum extracts in patients with depressive disorders—a systematic review. Phytomedicine 12:148–157

    Article  PubMed  CAS  Google Scholar 

  5. But PPH, Tomlinson B (1996) Adulteration of herbal products can cause poisoning. Br Med J 313:117

    Article  CAS  Google Scholar 

  6. Ernst E (2002) Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review. J Intern Med 252(2):107–113

    Article  PubMed  CAS  Google Scholar 

  7. Huang WF, Wen KC, Hsiao ML (1997) Adulteration by synthetic therapeutic substances of traditional chinese medicines in Taiwan. J Clin Pharmacol 37:334–350

    Google Scholar 

  8. Snyman T, Stewart MJ, Grove A, Steenkamp V (2005) Adulteration of South African traditional herbal remedies. Ther Drug Monit 27:86–89

    Article  PubMed  Google Scholar 

  9. Ang HH (2008) Lead contamination in Eugenia dyeriana herbal preparations from different commercial sources in Malaysia. Food Chem Toxicol 46(6):1969–1975

    Article  PubMed  CAS  Google Scholar 

  10. Ang HH, Lee KL (2006) Contamination of mercury in tongkat Ali hitam herbal preparations. Food Chem Toxicol 44(8):1245–1250

    Article  PubMed  CAS  Google Scholar 

  11. Miller LG, Hume A, Harris IM et al (2001) Adulteration: its various meanings. Pharmacotherapy 21(6):770–771

    Article  PubMed  CAS  Google Scholar 

  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):100–106

    Article  PubMed  Google Scholar 

  13. World Health Organisation (2012) WHO guidelines for assessingquality of herbal medicineswith reference to contaminantsand residues. Available at: www.who.int/medicinedocs/index/assoc/s14878e/s14878e.pdf. Accessed 9 March 2012

  14. Corrigan D (2003) European herbal medicines regulations. Focus Alt Complement Ther 8(2):169–170

    Google Scholar 

  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):37–41

    Article  PubMed  Google Scholar 

  16. Oxman AD, Guyatt GH (1991) Validation of an index of the quality of review articles. J Clin Epidemiol 44(11):1271–1278

    Article  PubMed  CAS  Google Scholar 

  17. Ernst E (2000) Adverse effects of herbal drugs in dermatology. Br J Dermatol 143:923–929

    Article  PubMed  CAS  Google Scholar 

  18. Ernst E, Thompson CJ (2001) Heavy metals in traditional Chinese medicines: a systematic review. Clin Pharmacol Ther 70(6):497–504

    Article  PubMed  CAS  Google Scholar 

  19. Ernst E (2002) Toxic heavy metals and undeclared drugs in Asian herbal medicines. Trends Pharmacol Sci 23(3):136–139

    Article  PubMed  CAS  Google Scholar 

  20. Ernst E, Pittler MH (2002) Risks associated with herbal medicinal products. Wien Med Wschr 152:183–189

    Article  PubMed  CAS  Google Scholar 

  21. Ernst E (2002) Heavy metals in traditional Indian remedies. Eur J Clin Pharmacol 57(12):891–896

    Article  PubMed  CAS  Google Scholar 

  22. Ernst E (2003) Serious psychiatric and neurological adverse effects of herbal medicines—a systematic review. Acta Psychiatr Scand 108:83–91

    Article  PubMed  CAS  Google Scholar 

  23. Ernst E (2003) Serious adverse effects of unconventional therapies for children and adolescents: a systematic review of recent evidence. Eur J Pediatr 162:72–80

    PubMed  Google Scholar 

  24. Gabardi S, Munz K, Ulbricht C (2007) A review of dietary supplement-induced renal dysfunction. Clin J Am Soc Nephrol 2(4):757–765

    Article  PubMed  CAS  Google Scholar 

  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):179–215

    Article  PubMed  Google Scholar 

  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):73–80

    PubMed  Google Scholar 

  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):58–114

    Article  PubMed  CAS  Google Scholar 

  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):71–114

    Article  PubMed  Google Scholar 

  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):54–90

    Article  PubMed  Google Scholar 

  30. Basch E, Ulbricht C, Harrison M et al (2003) Alfalfa (Medicago sativa L.): a clinical decision support tool. J Herb Pharmacother 3(2):69–90

    PubMed  Google Scholar 

  31. Saad B, Azaizeh H, bu-Hijleh G, Said O (2006) Safety of traditional Arab herbal medicine. Evid Based Complement Altern Med 3(4):433–439

    Article  Google Scholar 

  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):79–93

    PubMed  Google Scholar 

  33. Basch E, Conquer J, Culwell S et al (2012) Green tea (Camellia sinensis) Natural Standard Professional Monograph. Available at: http://www.naturalstandard.com/databases/herbssupplements/all/camellia.asp. Accessed 21 Jan 2012

  34. Armbruester N, Bryan K, Costa D et al (2012) Cinnamon (Cinnamomum spp.) Natural Standard Professional Monograph, pp 1–70. Available at: http://www.naturalstandard.com/databases/herbssupplements/all/cassia.asp. Accessed 21 Jan 2012

  35. Ceurvels J, Davis M, Clubb J et al (2012) Blue cohosh (Caulophyllum thalictroides) Natural Standard Professional Monograph. Available at: http://www.naturalstandard.com/databases/herbssupplements/all/caulophyllum.asp. Accessed 21 Jan 2012

  36. McLaren J, Swift W, Dillon P, Allsop S (2008) Cannabis potency and contamination: a review of the literature. Addiction 103(7):1100–1109

    Article  PubMed  Google Scholar 

  37. Pittler MH, Ernst E (2003) Systematic review: hepatotoxic events associated with herbal medicinal products. Ailment Pharmacol Ther 18:451–471

    Article  CAS  Google Scholar 

  38. Ernst E (2002) Adverse effects of unconventional therapies in the elderly: a systematic review of the recent literature. J Am Aging Assoc 25:11–20

    Google Scholar 

  39. Ernst E (2003) Cardiovascular adverse effects of herbal medicines: a systematic review of the recent literature. Can J Cardiol 19:818–827

    PubMed  CAS  Google Scholar 

  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):769–778

    Article  PubMed  CAS  Google Scholar 

  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):10–20

    Article  PubMed  CAS  Google Scholar 

  42. Hung SK, Hillier S, Ernst E (2011) Case reports of adverse effects of herbal medicinal products (HMPs): a quality assessment. Phytomedicine 18(5):335–343

    Article  PubMed  Google Scholar 

  43. World Health Organisation (2005) National policy on traditional medicine and regulation of herbal medicines. World Health Organisation, Geneva

    Google Scholar 

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Authors and Affiliations

  1. Complementary Medicine, Peninsula Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK

    Paul Posadzki, Leala Watson & Edzard Ernst

Authors
  1. Paul Posadzki
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  2. Leala Watson
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  3. Edzard Ernst
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Corresponding author

Correspondence to Paul Posadzki.

Appendix

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Table 4 Search strategy for MEDLINE
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Posadzki, P., Watson, L. & Ernst, E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol 69, 295–307 (2013). https://doi.org/10.1007/s00228-012-1353-z

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  • DOI: https://doi.org/10.1007/s00228-012-1353-z

Keywords

  • Adulteration
  • Contamination
  • Herbal medicine
  • Systematic reviews