Herbal Science Research - adverse effects

Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscoe): A review [...]

Site Editor — Fri, 02 Nov 2007 15:49:24 -0700

Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscoe): A review of recent research.: Food Chem Toxicol. 2007 Sep 18; Ali BH, Blunden G, Tanira MO, Nemmar A

Ginger (Zingiber officinale Roscoe, Zingiberacae) is a medicinal plant that has been widely used in Chinese, Ayurvedic and Tibb-Unani herbal medicines all over the world, since antiquity, for a wide array of unrelated ailments that include arthritis, rheumatism, sprains, muscular aches, pains, sore throats, cramps, constipation, indigestion, vomiting, hypertension, dementia, fever, infectious diseases and helminthiasis. Currently, there is a renewed interest in ginger, and several scientific investigations aimed at isolation and identification of active constituents of ginger, scientific verification of its pharmacological actions and of its constituents, and verification of the basis of the use of ginger in some of several diseases and conditions. This article aims at reviewing the most salient recent reports on these investigations. The main pharmacological actions of ginger and compounds isolated therefrom include immuno-modulatory, anti-tumorigenic, anti-inflammatory, anti-apoptotic, anti-hyperglycemic, anti-lipidemic and anti-emetic actions. Ginger is a strong anti-oxidant substance and may either mitigate or prevent generation of free radicals. It is considered a safe herbal medicine with only few and insignificant adverse/side effects. More studies are required in animals and humans on the kinetics of ginger and its constituents and on the effects of their consumption over a long period of time.

Euphorbia lactea sap keratouveitis: case report and review of the literature.

Site Editor — Thu, 04 Oct 2007 05:27:17 -0700

Euphorbia lactea sap keratouveitis: case report and review of the literature.: Cornea. 2007 Jul;26(6):749-52 Authors: Merani R, Sa-Ngiampornpanit T, Kerdraon Y, Billson F, McClellan KA

PURPOSE: To describe a case of Euphorbia lactea sap keratouveitis and to review all reported cases of ocular toxicity caused by Euphorbia species. METHODS: Case report and review of literature. RESULTS: A 79-year-old woman presented 34 hours after she felt some sap of an E. lactea plant spray into her right eye. Visual acuity was counting fingers at 1 m. Examination revealed ciliary injection, 90% corneal epithelial defect, marked stromal edema with Descemet folds, and anterior-chamber flare with a 1-mm hypopyon. There was no vitreitis, and funduscopy was unremarkable. No foreign body was seen on B scan ultrasound or computed tomography scan of the orbits. Corneal scraping excluded bacterial and herpetic keratitis. Intensive topical antibiotic therapy was started with cephalothin 5% and gentamicin 0.9%, and the pupil was dilated with atropine. Topical steroids were started once the epithelial defect had healed. Examination 11 weeks after the injury revealed minimal subepithelial corneal haze and marked improvement in visual acuity. CONCLUSIONS: To the best of our knowledge, this is only the third reported case of E. lactea sap keratouveitis. The clinical course of E. lactea sap keratouveitis is compared with that reported for other Euphorbia species.

PMID: 17592331 [PubMed - indexed for MEDLINE]

Gynura root induces hepatic veno-occlusive disease: a case report and review of the literature.

Site Editor — Mon, 11 Jun 2007 05:52:02 -0700

Gynura root induces hepatic veno-occlusive disease: a case report and review of the literature.: World J Gastroenterol. 2007 Mar 14;13(10):1628-31 Authors: Dai N, Yu YC, Ren TH, Wu JG, Jiang Y, Shen LG, Zhang J

Gynura root has been used extensively in Chinese folk medicine and plays a role in promoting microcirculation and relieving pain. However, its hepatic toxicity should not be neglected. Recently, we admitted a 62-year old female who developed hepatic veno-occlusive disease (HVOD) after ingestion of Gynura root. Only a few articles on HVOD induced by Gynura root have been reported in the literature. It is suspected that pyrrolizidine alkaloids in Gynura root might be responsible for HVOD. In this paper, we report a case of HVOD and review the literature.

Differences in perceived risks and benefits of herbal, over-the-counter conventional, and prescribed conventional, medicines [..

Site Editor — Wed, 06 Jun 2007 00:18:00 -0700

Differences in perceived risks and benefits of herbal, over-the-counter conventional, and prescribed conventional, medicines, and the implications of this for the safe and effective use of herbal products.: Complement Ther Med. 2007 Jun; 15(2): 84-91. Authors: Lynch N, Berry D

OBJECTIVES: To investigate people's views about the efficacy and specific risks of herbal, over-the-counter (OTC) conventional, and prescribed conventional medicines, and their likelihood of taking a second (herbal or OTC conventional) product in addition to a prescribed medicine. METHODS: Experiment 1 (1 factor within-participant design); Experiment 2 (1 factor between-participant design). Convenience samples of general population were given a hypothetical scenario and required to make a number of judgements. RESULTS: People believed herbal remedies to be less effective, but less risky than OTC and prescribed conventional medicines. Herbal medicines were not seen as being safer simply because of their easier availability. Participants indicated that they would be more likely to take a herbal medicine than a conventional OTC medicine in addition to a prescribed medicine, and less likely to consult their doctor in advance. CONCLUSION: People believe that herbal medicines are natural and relatively safe and can be used with less caution. People need to be given clear information about the risks and benefits of herbal medicines if they are to use such products safely and effectively.

Cutaneous vasculitis in two patients taking an herbal supplement containing black cohosh.

Site Editor — Wed, 06 Jun 2007 00:08:27 -0700

Cutaneous vasculitis in two patients taking an herbal supplement containing black cohosh.: J Am Acad Dermatol. 2007 May;56(5 Suppl):S124-6 Authors: Ingraffea A, Donohue K, Wilkel C, Falanga V

PMID: 17434040 [PubMed - indexed for MEDLINE]

Case report: acute unintentional carbachol intoxication.

Site Editor — Wed, 30 May 2007 01:29:44 -0700

Case report: acute unintentional carbachol intoxication.: Crit Care. 2006;10(3):R84 Authors: Schulz M, Graefe T, Stuby K, Andresen H, Kupfermann N, Schmoldt A

INTRODUCTION: Intoxications with carbachol, a muscarinic cholinergic receptor agonist are rare. We report an interesting case investigating a (near) fatal poisoning. METHODS : The son of an 84-year-old male discovered a newspaper report stating clinical success with plant extracts in Alzheimer's disease. The mode of action was said to be comparable to that of the synthetic compound 'carbamylcholin'; that is, carbachol. He bought 25 g of carbachol as pure substance in a pharmacy, and the father was administered 400 to 500 mg. Carbachol concentrations in serum and urine on day 1 and 2 of hospital admission were analysed by HPLC-mass spectrometry. RESULTS: Minutes after oral administration, the patient developed nausea, sweating and hypotension, and finally collapsed. Bradycardia, cholinergic symptoms and asystole occurred. Initial cardiopulmonary resuscitation and immediate treatment with adrenaline (epinephrine), atropine and furosemide was successful. On hospital admission, blood pressure of the intubated, bradyarrhythmic patient was 100/65 mmHg. Further signs were hyperhidrosis, hypersalivation, bronchorrhoea, and severe miosis; the electrocardiographic finding was atrio-ventricular dissociation. High doses of atropine (up to 50 mg per 24 hours), adrenaline and dopamine were necessary. The patient was extubated 1 week later. However, increased dyspnoea and bronchospasm necessitated reintubation. Respiratory insufficiency was further worsened by Proteus mirabilis infection and severe bronchoconstriction. One week later, the patient was again extubated and 3 days later was transferred to a peripheral ward. On the next day he died, probably as a result of heart failure. Serum samples from the first and second days contained 3.6 and 1.9 mg/l carbachol, respectively. The corresponding urine concentrations amounted to 374 and 554 mg/l. CONCLUSION: This case started with a media report in a popular newspaper, initiated by published, peer-reviewed research on herbals, and involved human failure in a case history, medical examination and clinical treatment. For the first time, an analytical method for the determination of carbachol in plasma and urine has been developed. The analysed carbachol concentration exceeded the supposed serum level resulting from a therapeutic dose by a factor of 130 to 260. Especially in old patients, intensivists should consider intoxications (with cholinergics) as a cause of acute cardiovascular failure.

Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey.

Site Editor — Fri, 25 May 2007 02:19:14 -0700

Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey.: Altern Ther Health Med. 2007 Mar-Apr;13(2):30-5 Authors: Bush TM, Rayburn KS, Holloway SW, Sanchez-Yamamoto DS, Allen BL, Lam T, So BK, Tran de H, Greyber ER, Kantor S, Roth LW

CONTEXT: Patients often combine prescription medications with herbal and dietary substances (herein referred to as herbal medicines). A variety of potential adverse herb-drug interactions exist based on the pharmacological properties of herbal and prescription medications. OBJECTIVE: To determine the incidence of potential and observed adverse herb-drug interactions in patients using herbal medicines with prescription medications. DESIGN: Consecutive patients were questioned about their use of herbal medicines in 6 outpatient clinics. Patients reporting use of these products provided a list of their prescription medications, which were reviewed for any potential adverse herb-drug interactions using a comprehensive natural medicine database. Any potential adverse herb-drug interactions prompted a review of the patient's chart for evidence of an observed adverse herb-drug interaction. MAIN OUTCOME MEASURE: The rate of potential and observed adverse herb-drug interactions. RESULTS: Eight hundred four patients were surveyed, and 122 (15%) used herbal medicines. Eighty-five potential adverse herb-drug interactions were found in 49 patients (40% of herbal medicine users). Twelve possible adverse herb-drug interactions in 8 patients (7% of herbal medicine users) were observed. In all 12 cases, the severity scores were rated as mild, including 8 cases of hypoglycemia in diabetics taking nopal (prickly pear cactus). CONCLUSIONS: A substantial number of potential adverse herb-drug interactions were detected and a small number of adverse herb-drug interactions observed, particularly in diabetics taking nopal. Screening for herbal medicine usage in 804 patients did not uncover any serious adverse interactions with prescription medications.

Antidotes for acute cardenolide (cardiac glycoside) poisoning.

Site Editor — Sat, 20 Jan 2007 16:33:32 -0800

Antidotes for acute cardenolide (cardiac glycoside) poisoning.: Cochrane Database Syst Rev. 2006;(4):CD005490 Authors: Roberts DM, Buckley NA

BACKGROUND: Cardenolides are naturally occurring plant toxins which act primarily on the heart. While poisoning with the digitalis cardenolides (digoxin and digitoxin) are reported worldwide, cardiotoxicity from other cardenolides such as the yellow oleander are also a major problem, with tens of thousands of cases of poisoning each year in South Asia. Because cardenolides from these plants are structurally similar, acute poisonings are managed using similar treatments. The benefit of these treatments is of interest, particularly in the context of cost since most poisonings occur in developing countries where resources are very limited. OBJECTIVES: To determine the efficacy of antidotes for the treatment of acute cardenolide poisoning, in particular atropine, isoprenaline (isoproterenol), multiple-dose activated charcoal (MDAC), fructose-1,6-diphosphate, sodium bicarbonate, magnesium, phenytoin and anti-digoxin Fab antitoxin. SEARCH STRATEGY: We searched MEDLINE, EMBASE, the Controlled Trials Register of the Cochrane Collaboration, Current Awareness in Clinical Toxicology, Info Trac, www.google.com.au, and Science Citation Index of studies identified by the previous searches. We manually searched the bibliographies of identified articles and personally contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials where antidotes were administered to patients with acute symptomatic cardenolide poisoning were identified. DATA COLLECTION AND ANALYSIS: We independently extracted data on study design, including the method of randomisation, participant characteristics, type of intervention and outcomes from each study. We independently assessed methodological quality of the included studies. A pooled analysis was not appropriate. MAIN RESULTS: Two randomised controlled trials were identified, both were conducted in patients with yellow oleander poisoning. One trial investigated the effect of MDAC on mortality, the relative risk (RR) was 0.31 (95% confidence interval (CI) 0.12 to 0.83) indicating a beneficial effect. The second study found a beneficial effect of anti-digoxin Fab antitoxin on the presence of cardiac dysrhythmias at two hours post-administration; the RR was 0.60 (95% CI 0.44 to 0.81). Other benefits were also noted in both studies and serious adverse effects were minimal. Studies assessing the effect of antidotes on other cardenolides were not identified. One ongoing study investigating the activated charcoal for acute yellow oleander self-poisoning was also identified. AUTHORS' CONCLUSIONS: There is some evidence to suggest that MDAC and anti-digoxin Fab antitoxin may be effective treatments for yellow oleander poisoning. However, the efficacy and indications of these interventions for the treatment of acute digitalis poisoning is uncertain due to the lack of good quality controlled clinical trials. Given pharmacokinetic differences between individual cardenolides, the effect of antidotes administered to patients with yellow oleander poisoning cannot be readily translated to those of other cardenolides. Unfortunately cost limits the use of antidotes such as anti-digoxin Fab antitoxin in developing countries where cardenolide poisonings are frequent. More research is required using relatively cheap antidotes which may also be effective.

Evidence-based systematic review of saw palmetto by the Natural Standard Research Collaboration.

Site Editor — Fri, 19 Jan 2007 18:42:13 -0800

Evidence-based systematic review of saw palmetto by the Natural Standard Research Collaboration.: J Soc Integr Oncol. 2006;4(4):170-86 Authors: Ulbricht C, Basch E, Bent S, Boon H, Corrado M, Foppa I, Hashmi S, Hammerness P, Kingsbury E, Smith M, Szapary P, Vora M, Weissner W

Here presented is an evidence-based systematic review including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

The Induction of CYP1A2, CYP2D6 and CYP3A4 by Six Trade Herbal Products in Cultured Primary Human Hepatocytes.

Site Editor — Sat, 13 Jan 2007 21:34:04 -0800

The Induction of CYP1A2, CYP2D6 and CYP3A4 by Six Trade Herbal Products in Cultured Primary Human Hepatocytes.: Basic Clin Pharmacol Toxicol. 2007 Jan; 100(1): 23-30 Authors: Hellum BH, Hu Z, Nilsen OG

The aim of this study was to evaluate the in vitro inductive potential of six commonly used trade herbal products on CYP1A2, CYP2D6 and CYP3A4 metabolic activities. Herbal components were extracted from the trade products in a way that ensured a composition equal to that present in the original product. Primary human hepatocytes and specific CYP substrates were used. Classic inducers were used as positive controls and herbal extracts were added in in vivo-relevant concentrations. Metabolites were determined by high performance liquid chromatography (HPLC). St. John's wort and common valerian were the strongest inducing herbs. In addition to induction of CYP3A4 by St. John's wort, common valerian and Ginkgo biloba increased the activity of CYP3A4 and 2D6 and CYP1A2 and 2D6, respectively. A general inhibitory potential was observed for horse chestnut, Echinacea purpurea and common sage. St. John's wort inhibited CYP3A4 metabolism at the highest applied concentration. Horse chestnut might be a herb with high inhibition potentials in vivo and should be explored further at lower concentrations. We show for the first time that G. biloba may exert opposite and biphasic effects on CYP1A2 and CYP2D6 metabolism. Induction of CYP1A2 and inhibition of CYP2D6 were found at low concentrations; the opposite was observed at high concentrations. CYP2D6 activity, regarded generally as non-inducible, was increased by exposure to common valerian (linear to dose) and G. biloba (highest concentration). An allosteric activation is suggested. From the data obtained, G. biloba, common valerian and St. John's wort are suggested as candidates for clinically significant CYP interactions in vivo.

Reporting associations between dietary supplements and adverse events.

Site Editor — Sat, 06 Jan 2007 00:16:05 -0800

Reporting associations between dietary supplements and adverse events.: Mayo Clin Proc. Author: Michael McGuffin
To the Editor: The article by Gange et al, published in the April 2006 issue of Mayo Clinic Proceedings, purported to document an association between bitter orange peel extract and variant angina in a borderline-obese 57-year-old man. However, the authors’ identification of bitter orange as the offending ingredient must be considered speculative. It would be no more accurate to assume that any of the other 9 ingredients in the supplement, or the drugs, or other supplements the patient was taking concomitantly, were the cause of the patient’s angina.

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[Acute hepatitis due to kava-kava and St John's Wort: an immune-mediated mechanism?]

Site Editor — Wed, 04 Oct 2006 19:03:18 -0700

[Acute hepatitis due to kava-kava and St John's Wort: an immune-mediated mechanism?]: Dtsch Med Wochenschr. 2006 Aug 25;131(34-35):1880-1; author reply 1882-3 Authors: Teschke R

Acute generalised exanthematous pustulosis induced by the herbal remedy Ginkgo biloba.

Site Editor — Wed, 04 Oct 2006 18:47:49 -0700

Acute generalised exanthematous pustulosis induced by the herbal remedy Ginkgo biloba.: Med J Aust. 2006 Jun 5; 184(11): 583-4 Pennisi RS

Acute generalised exanthematous pustulosis (AGEP) is a clinical reaction pattern that is induced, in over 90% of cases, by systemic drugs (most frequently antibacterial drugs). This is the first reported case of AGEP caused by the herbal remedy Ginkgo biloba.

A review of the bioactivity of south African herbal teas: rooibos (Aspalathus linearis) and honeybush (Cyclopia intermedia).

Site Editor — Wed, 04 Oct 2006 18:38:30 -0700

A review of the bioactivity of south African herbal teas: rooibos (Aspalathus linearis) and honeybush (Cyclopia intermedia).: Phytother Res. 2006 Aug 23; McKay DL, Blumberg JB

Rooibos (Aspalathus linearis) and honeybush (Cyclopia intermedia) are popular tisanes in their native South Africa and have a growing worldwide market. Both herbal teas are used traditionally for medicinal purposes and are rich in polyphenols with rooibos a rare source of the dietary dihydrochalcones, aspalathin and nothofagin. The principal polyphenols in honeybush include the xanthone mangiferin and the flavonones hesperitin and isokuranetin. Despite their divergent phytochemical and nutrient compositions, rooibos and honeybush share potent antioxidant and antimutagenic activities in vitro. Animal model studies indicate both herbal teas possess potent antioxidant, immune-modulating and chemopreventive actions. However, human studies of rooibos are limited and of honeybush are absent. No adverse effects of rooibos or honeybush consumption as tisanes have been reported. Copyright (c) 2006 John Wiley & Sons, Ltd.

Acute renal failure induced by a Brazilian variety of propolis.

Site Editor — Fri, 09 Jun 2006 07:15:57 -0700

Acute renal failure induced by a Brazilian variety of propolis.: Am J Kidney Dis. 2005 Dec;46(6):e125-9 Authors: Li YJ, Lin JL, Yang CW, Yu CC

Propolis is a resinous substance collected by honeybees and used in hive construction and maintenance. Cumulative evidence suggests that propolis may have anti-inflammatory, antibiotic, antioxidant, antihepatotoxic, and antitumor properties. In addition to topical applications, products containing propolis have been used increasingly as dietary supplements. Although reports of allergic reactions are not uncommon, propolis is reputed to be relatively nontoxic. Its systemic toxicity is rarely reported and hence may be underestimated. This is the first report of propolis-induced acute renal failure. A 59-year-old man required hemodialysis for acute renal failure. The patient had cholangiocarcinoma and had ingested propolis for 2 weeks before presentation. Renal function improved after propolis withdrawal, deteriorated again after reexposure, and then returned to a normal level after the second propolis withdrawal. This case indicates that propolis can induce acute renal failure and emphasizes the need for vigilance and care when propolis is used as a medicine or dietary supplement.

Severe acute poisoning with homemade Aconitum napellus capsules: toxicokinetic and clinical data.

Site Editor — Fri, 09 Jun 2006 04:34:17 -0700

Severe acute poisoning with homemade Aconitum napellus capsules: toxicokinetic and clinical data.: Clin Toxicol (Phila). 2005;43(7):873-6 Authors: Moritz F, Compagnon P, Kaliszczak IG, Kaliszczak Y, Caliskan V, Girault C

Aconitum napellus is an extremely dangerous plant that contains various toxic diterpenoid alkaloids, mainly aconitine primarily concentrated in the roots. We report a case of acute intoxication of a 21-year-old man admitted to our Emergency Department after the ingestion, in order to sleep, of three homemade Aconitum napellus capsules. Capsules were measured to contain 237 mg of root and 19 microg of aconitine. The patient experienced the first symptoms on wakening 5 hours later with generalized paresthesia, nausea, diarrhea, vertigo, thoracic pain dyspnea, and dyschromatopsia. At admission, 7 hours after intake electrocardiographic analysis showed a sinusal bradycardia with polymorphic and bigeminal ventricular extrasystolia. Cardiovascular and neurological symptoms disappeared, respectively within 11 and 13 hours of ingestion. The patient was discharged from the ICU on day 2. Plasmatic concentrations at H7, H9, H14 H19, and after ingestion were, respectively, of 1.75, 0.75, 0.35, and 0.02 ng/mL. The calculated half-life of aconitine was 3 hours. To our knowledge, this is the first reported case with an aconitine toxicokinetic-effect relationship. The authors stress that clinicians must be aware of possible occurrence of acute poisoning with Aconitum napellus in European countries and in the United States as herbal medicine is becoming increasingly popular.

Fatal seizures due to potential herb-drug interactions with Ginkgo biloba.

Site Editor — Fri, 09 Jun 2006 04:21:25 -0700

Fatal seizures due to potential herb-drug interactions with Ginkgo biloba.: J Anal Toxicol. 2005 Oct;29(7):755-8 Authors: Kupiec T, Raj V

Alternative therapy including herbal drugs and complementary medicine is becoming increasingly popular. However, the rise in the incidence of herb-drug interactions is causing concern, especially in the absence of warning labels addressing potential adverse effects. We present the case of a 55-year-old male who suffered a fatal breakthrough seizure, with no evidence of non-compliance with his anticonvulsant medications. The autopsy report revealed subtherapeutic serum levels for both anticonvulsants Depakote and Dilantin. Concomitant with his prescribed medications, the decedent was also self-medicating with a cornucopia of herbal supplements and nutraceuticals, prominent among which was Ginkgo biloba. Ginkgo, an herbal extract from the leaves of the Ginkgo biloba tree, has been used medicinally for centuries and has been touted as a cure for a variety of medical conditions. The induction of Cytochrome P450 enzymes by components of herbal drugs has been known to affect the metabolism of various drugs. Dilantin is primarily metabolized by CYP2C9, and secondarily metabolized by CYP2C19. Valproate metabolism is also modulated in part by CYP2C9 and CYP2C19. A recent study revealed significant inductive effect of ginkgo on CYP2C19 activity. CYP2C19 induction by ginkgo could be a plausible explanation for the subtherapeutic levels of Dilantin and Depakote. Additionally, ginkgo nuts contain a potent neurotoxin, which is known to induce seizure activity. Evidence of other herbal drugs diminishing the efficacy of anticonvulsant medication does exist; however, there has been only one other documented instance of ginkgo potentiating seizure activity in the presence of anticonvulsant therapy. Highlighting the potential adverse effects and drug interactions of ginkgo on the packaging of the drug may help prevent inadvertent use in vulnerable individuals.

Toxic Epidermal Necrolysis: Analysis of Clinical Course and SCORTEN-based Comparison of Mortality Rate and Treatment Modalities.

Site Editor — Fri, 09 Jun 2006 04:04:21 -0700

Toxic Epidermal Necrolysis: Analysis of Clinical Course and SCORTEN-based Comparison of Mortality Rate and Treatment Modalities in Korean Patients.: Acta Derm Venereol. 2005;85(6):497-502 Authors: Kim KJ, Lee DP, Suh HS, Lee MW, Choi JH, Moon KC, Koh JK

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition, we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13-year period (1990-2003) at the Asan Medical Center was performed. The mean involved body surface area was 49+/-17%. All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8+/-5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5%, 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR) = 0.425; 95% CI, 0.011-2.368), whereas corticosteroid therapy showed no such difference (SMR = 1.004; 95% CI, 0.369-2.187).

Chinese herb nephropathy.

Site Editor — Fri, 09 Jun 2006 03:58:48 -0700

Chinese herb nephropathy.: Proc (Bayl Univ Med Cent). 2000 Oct;13(4):334-337 Authors: Meyer MM, Chen TP, Bennett WM

In 1994, a 44-year-old woman progressed from normal renal function to advanced renal failure and end-stage renal disease within 8 months. Biopsy revealed extensive interstitial fibrosis with focal lymphocytic infiltration. She received a cadaveric renal transplant in January 1996 and had an uneventful posttransplant course. As a result of a minor motor vehicle accident, the patient had received acupuncture and Chinese herbal medicine for pain relief approximately 5 months before the onset of renal symptoms. After the transplant, analysis of the herbal remedies clearly indicated the presence of aristolochic acid in 2 of the 6 Chinese herbs ingested. Ingestion of aristolochic acid has been linked to a newly defined entity, Chinese herb nephropathy (CHN). This article discusses the history of CHN and its implication in the current case and in other recent similar cases and makes recommendations to avoid future problems caused by unregulated use of herbal medicines. This is the first reported case of CHN in the USA.

Muscle damage induced by black cohosh (Cimicifuga racemosa).

Site Editor — Fri, 09 Jun 2006 03:53:42 -0700

Muscle damage induced by black cohosh (Cimicifuga racemosa).: Phytomedicine. 2006 Jan; 13(1-2): 115-8 Minciullo PL, Saija A, Patafi M, Marotta G, Ferlazzo B, Gangemi S

Extracts of black cohosh (Cimicifuga racemosa) are commonly used for the treatment of symptoms associated with menopause. Adverse events with black cohosh are rare, mild and reversible. A few number of serious adverse events, including hepatic and circulatory conditions, have been also reported, but without a clear causality relationship. We report the case of a woman with severe asthenia and very high blood levels of creatine phosphokinase and lactate dehydrogenase. The patient referred to take a dietary supplement derived from black cohosh for ameliorating menopause vasomotor symptoms. To exclude a possible involvement of this product, the patient was suggested to discontinue this therapy. After suspicion the patient showed a progressive normalization of biochemical parameters and improvement of clinical symptoms. We can hypothesise a causative role for black cohosh in the muscle damage observed in this patient. Factors suggesting an association between black cohosh and the observed myopathy included the temporal relationship between use of herbal product and asthenia and the absence of other identified causative factors. Rechallenge with the suspected agent was inadvisable for ethic reasons because of the risk of a serious relapse. This is the first time that asthenia associated with high muscle enzymes serum levels by black cohosh has been reported. In our opinion, this report is of interest because of the widespread diffusion of use of black cohosh as an alternative medicine for relief from menopausal symptoms.

[Soothing effect of Ganoderma lucidum antlered form on cyclophosphamide-induced adverse reaction]

Site Editor — Fri, 09 Jun 2006 03:51:06 -0700

[Soothing effect of Ganoderma lucidum antlered form on cyclophosphamide-induced adverse reaction]: Gan To Kagaku Ryoho. 2005 Oct;32(11):1586-8 Authors: Nonaka Y, Ishibashi H, Nakai M, Shibata H, Kiso Y, Abe S

The immunological functions of Ganoderma lucidum antlered form (AF) (Rokkaku-Reishi in Japanese), a variant type of Ganoderma lucidum, were investigated in C57BL/6 mice treated with cyclophosphamide (CY). Ganoderma lucidum AF alleviated CY-induced decrease in body weight and abnormal increase in blood neutrophil level, when the mice were fed a diet containing 2.5% Ganoderma lucidum AF starting one week before CY treatment (150 mg/kg, ip). The recovery of CD8+ and NK1.1+ cells in the spleen was accelerated in Ganoderma lucidum AF group compared to the control group. Ganoderma lucidum AF also both alleviated CY-induced splenic lymphopenia and suppressed the abnormal increase in splenocytes 7 days after CY treatment. These results suggest that ingestion of Ganoderma lucidum AF is beneficial for improvement of quality of life reduced by anti-cancer chemotherapeutic drugs such as CY.

Allergic contact dermatitis induced by rosemary leaf extract in a cleansing gel.

Site Editor — Fri, 09 Jun 2006 03:50:38 -0700

Allergic contact dermatitis induced by rosemary leaf extract in a cleansing gel.: J Dermatol. 2005 Aug;32(8):667-9 Authors: Inui S, Katayama I

We report a rare case of allergic contact dermatitis due to an extract of rosemary (Rosmarinus officinalis). A 23-year-old woman had begun to notice itchy erythema on her face around one month before presentation. She used various cosmetics and a cleansing gel containing rosemary leaf extract. From the patch test results, she reacted positively to the cleansing gel (1% in distilled water) and the rosemary leaf extract (0.1% in distilled water), one of its ingredients.

Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects.

Site Editor — Fri, 09 Jun 2006 03:28:25 -0700

Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects.: Pain Manag Nurs. 2005 Dec;6(4):145-167 Authors: Wirth JH, Hudgins JC, Paice JA

To find holistic treatment with effective pain relief and few side effects, Americans spend billions of dollars annually on complementary and alternative medicine, including herbal therapies. Despite extensive use, the lack of regulatory scrutiny of these herbal supplements contributes to the paucity of reliable clinical data assessing their efficacy and safety. This review summarizes the existing studies investigating the efficacy of herbal therapies as a treatment for pain. Possible side effects, potential drug-herb interactions, and information about common herbal therapies are also summarized. MEDLINE, AMED, and the Cochrane Library databases were searched for the period from January 1966 to June 2005. Uses, dosages, routes of administration, and side effects were summarized. Strength of empirical evidence also was evaluated. This review found few well-controlled clinical studies. Furthermore, these studies documented limited efficacy of herbal therapies to treat pain. The information presented here may be used to further educate nurses and patients on the use of herbal therapies as well as direct future research efforts.

'Safe' painkiller is leading cause of liver failure

Site Editor — Fri, 09 Jun 2006 03:25:32 -0700

Safe painkiller is leading cause of liver failure - Accidental overdoses of a popular painkiller - known as acetaminophen in the US and paracetamol in the UK - cause many cases of acute liver failure in the US.

? Iatrogenic phytophotodermatitis resulting from herbal treatment of an allergic contact dermatitis.

Site Editor — Fri, 09 Jun 2006 03:10:56 -0700

? Iatrogenic phytophotodermatitis resulting from herbal treatment of an allergic contact dermatitis. - Clin Exp Dermatol. 2006 Jan;31(1):39-41 Authors: Moloney FJ, Parnell J, Buckley CC

Summary Phytophotodermatitis commonly occurs in skin exposed to sunlight after contact with plants containing furocoumarins. While it is recognized that the consumption of plants or vegetables containing furocoumarins can potentially trigger a phytophotodermatitis, there have been no reports to date of a phytophotodermatitis triggered by an ingested herbal remedy. We describe the case of a 56-year-old farmer who developed an extensive photo-induced dermatitis after ingesting a herbal decoction prescribed for his chronic hand dermatitis.