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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:

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.
Lim  DY  et al. Collective exposure to lead from an approved natural product-derived drug in Korea. Ann Occup Environ Med. 2019 Aug 26;31:e20.
[PubMed: 31620297]  
Roytman  MM  et al. Botanicals and hepatotoxicity. Clin Pharmacol Ther. 2018 Sep;104(3):458–69.
[PubMed: 29920648]  
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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