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Unlike prescription and over-the-counter pharmaceuticals, dietary supplements do not require FDA approval, do not undergo the same premarketing evaluation of safety and efficacy as drugs, and purveyors may or may not adhere to good manufacturing practices and quality control standards. Supplements may cause illness as a result of intrinsic toxicity, misidentification or mislabeling, drug-herb reactions, or intentional adulteration with pharmaceuticals. If you suspect a dietary supplement or herbal product may be the cause of an otherwise unexplained illness, contact the FDA (1-888-463-6332) or the regional poison control center (1-800-222-1222), or consult the following online database: https://www.fda.gov/food/dietary-supplements.

Table 38–7 lists selected examples of clinical toxicity from some of these products.

Table 38–7.Examples of potential toxicity associated with some dietary supplements and herbal medicines.
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Avigan  MI  et al. Scientific and regulatory perspectives in herbal and dietary supplement associated hepatotoxicity in the United States. Int J Mol Sci. 2016 Mar 3;17(3):331.
[PubMed: 26950122]
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Cohen  PA  et al. Presence of banned drugs in dietary supplements following FDA recalls. JAMA. 2014 Oct 22–29; 312(16):1691–3.
[PubMed: 25335153]
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Roytman  MM  et al. Botanicals and hepatotoxicity. Clin Pharmacol Ther. 2018 Sep;104(3):458–69.
[PubMed: 29920648]
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Wong  LL  et al. Urgent liver transplantation for dietary supplements: an under-recognized problem. Transplant Proc. 2017 Mar;49(2):322–5.
[PubMed: 28219592]

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