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. |Favorite Table|Download (.pdf) Table 38–7. Examples of potential toxicity associated with some dietary supplements and herbal medicines.
|Product ||Common Use ||Possible Toxicity |
|Azarcon (Greta) ||Mexican folk remedy for abdominal pain, colic ||Contains lead |
|Comfrey ||Gastric upset, diarrhea ||Contains pyrrolizidine alkaloids, can cause hepatic veno-occlusive disease |
|Creatine ||Athletic performance enhancement ||Nausea, diarrhea, abdominal cramps; elevated serum creatinine |
|Ginkgo ||Memory improvement, tinnitus ||Antiplatelet effects, hemorrhage; abdominal pain, diarrhea |
|Ginseng ||Immune system; stress ||Decreased glucose; increased cortisol |
|Guarana ||Athletic performance enhancement, appetite suppression ||Contains caffeine: can cause tremor, tachycardia, vomiting |
|Kava ||Anxiety, insomnia ||Drowsiness, hepatitis, skin rash |
|Ma huang ||Stimulant; athletic performance enhancement ||Contains ephedrine: anxiety, insomnia, hypertension, tachycardia, seizures |
|Spirulina ||Body building ||Niacin-like flushing reaction |
|Yohimbine ||Sexual enhancement ||Hallucinations, hypertension, tachycardia |
|Zinc ||Cold/flu symptoms ||Nausea, oral irritation, anosmia |
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.
et al. Presence of banned drugs in dietary supplements following FDA recalls. JAMA. 2014 Oct 22–29; 312(16):1691–3.
et al. Botanicals and hepatotoxicity. Clin Pharmacol Ther. 2018 Sep;104(3):458–69.
et al. Urgent liver transplantation for dietary supplements: an under-recognized problem. Transplant Proc. 2017 Mar;49(2):322–5.