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Episode of harmful use of herbal medicine — Clinical Guidelines

Overview

An episode of harmful use of herbal medicine refers to adverse outcomes resulting from inappropriate or excessive use of herbal remedies, often due to lack of standardized dosing, potential interactions, and insufficient pharmacovigilance. 1 2 17 19

Diagnosis

Clinical Presentation: Symptoms indicative of toxicity or adverse reactions, such as gastrointestinal disturbances, allergic reactions, or organ-specific dysfunction. 17 19

History Taking: Detailed inquiry into herbal remedies used, including types, dosages, and duration. 1 17

Laboratory Testing: Abnormal laboratory results that may correlate with herbal interference or interactions, requiring careful interpretation. 17

Exclusion of Other Causes: Ruling out other potential causes of symptoms through differential diagnosis. 17

Management

Discontinuation of Harmful Herbal Remedies: Immediate cessation of the implicated herbal medicine. 17 19

Supportive Care: Symptomatic treatment addressing specific adverse effects (e.g., antihistamines for allergic reactions). 17

Monitoring: Regular clinical and laboratory monitoring to assess recovery and manage complications. 17

Consultation: Collaboration with specialists (e.g., toxicologists, pharmacists) for complex cases. 1 17

Special Populations

Pediatrics: Increased vigilance due to higher susceptibility to herbal toxicities; pediatricians should be aware of herbal use and its potential risks. 4 17

Elderly: Consider polypharmacy risks and potential drug-herb interactions; careful review of all medications and supplements. 1 17

Key Recommendations

Enhance Pharmacovigilance Systems: Implement robust reporting mechanisms for adverse events related to herbal medicines to improve safety monitoring. (Evidence: Strong 2 10)

Educate Healthcare Providers: Increase awareness and knowledge among healthcare professionals regarding herbal toxicities and interactions to improve patient counseling and management. (Evidence: Moderate 16 11)

Patient Disclosure: Encourage patients to disclose all herbal remedies used to their healthcare providers to facilitate comprehensive care and risk assessment. (Evidence: Expert opinion 17)

References

1 Furuhashi H, Kimura I, Hirata A, Nakashima N. Validation of Temporal Definitions for Multidrug Use in Kampo Medicine. Studies in health technology and informatics 2025. link 2 Sethi SS, Bhardwaj T, Sethi SK, Kaur S, Rimpi, Baldi A. Advancing herbal medicine safety: the need for a global pharmacovigilance approach. Naunyn-Schmiedeberg's archives of pharmacology 2025. link 3 Phutrakool P, Pongpirul K. Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis. Systematic reviews 2022. link 4 Liu A. Pediatric Complementary Medicine. Pediatric annals 2021. link 5 Berwick S, Calev H, Matthews A, Mukhopadhyay A, Poole B, Talan J et al.. Mistaken Identity: Frequency and Effects of Gender-Based Professional Misidentification of Resident Physicians. Academic medicine : journal of the Association of American Medical Colleges 2021. link 6 Soós SÁ, Jeszenői N, Darvas K, Harsányi L. Complementary and alternative medicine: attitudes, knowledge and use among surgeons and anaesthesiologists in Hungary. BMC complementary and alternative medicine 2016. link 7 Emmerton L, Fejzic J, Tett SE. Consumers' experiences and values in conventional and alternative medicine paradigms: a problem detection study (PDS). BMC complementary and alternative medicine 2012. link 8 Culverhouse SE, Wohlmuth H. Factors affecting pharmacists' recommendation of complementary medicines - a qualitative pilot study of Australian pharmacists. BMC complementary and alternative medicine 2012. link 9 van Geffen EC, Meuwese E, Philbert D, Bouvy ML. Problems with medicine packages: experiences reported to a Dutch medicine reporting system. The Annals of pharmacotherapy 2010. link 10 Bian ZX, Tian HY, Gao L, Shang HC, Wu TX, Li YP et al.. Improving reporting of adverse events and adverse drug reactions following injections of Chinese materia medica. Journal of evidence-based medicine 2010. link 11 Ernst E. Ethics of complementary medicine: practical issues. The British journal of general practice : the journal of the Royal College of General Practitioners 2009. link 12 Shankar PR, Humagain B, Piryani RM, Jha N, Osti B. Establishing and strengthening a medicine and therapeutics committee in a medical college in Nepal: initial experiences. Pharmacy world & science : PWS 2009. link 13 Jeschke E, Ostermann T, Lüke C, Tabali M, Kröz M, Bockelbrink A et al.. Remedies containing Asteraceae extracts: a prospective observational study of prescribing patterns and adverse drug reactions in German primary care. Drug safety 2009. link 14 Ernst E. Complementary and alternative medicine for children: a good or a bad thing?. Archives of disease in childhood 2006. link 15 Abrahaam J. Herbs: where's the harm?. British journal of perioperative nursing : the journal of the National Association of Theatre Nurses 2004. link 16 Suchard JR, Suchard MA, Steinfeldt JL. Physician knowledge of herbal toxicities and adverse herb-drug interactions. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2004. link 17 Dasgupta A. Review of abnormal laboratory test results and toxic effects due to use of herbal medicines. American journal of clinical pathology 2003. link 18 Andrews GJ. Placing the consumption of private complementary medicine: everyday geographies of older peoples' use. Health & place 2003. link00068-0) 19 Pinn G. Adverse effects associated with herbal medicine. Australian family physician 2001. link 20 Capasso R, Izzo AA, Pinto L, Bifulco T, Vitobello C, Mascolo N. Phytotherapy and quality of herbal medicines. Fitoterapia 2000. link00173-8) 21 Drew AK, Myers SP. Safety issues in herbal medicine: implications for the health professions. The Medical journal of Australia 1997. link 22 De Smet PA. An introduction to herbal pharmacoepidemiology. Journal of ethnopharmacology 1993. link90016-x) 23 Flotte TJ, Bell DA. Role of skin lesions in the Salem witchcraft trials. The American Journal of dermatopathology 1989. link

Episode of harmful use of herbal medicine