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The use of herbal medicines, dietary supplements, and other alternative products has risen sharply since passage of the Dietary Supplement Health and Education Act (DSHEA) in 1994. In contrast to prescription or nonprescription drugs, these products do not require FDA approval before marketing. Premarketing evaluation of safety and efficacy is not mandated, and adherence to good manufacturing practices and quality control standards is not enforced. Consumers often mistakenly believe that these "natural" products are free of harm and may unknowingly be at risk for illness from the products and herb–drug and herb–disease interactions, particularly with "polysupplement" use. Table II–33 lists common selected products that are available as herbal remedies or dietary supplements or that have alternative uses, along with their potential toxicities.


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