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Concerns regarding the Safety and Toxicity of Medicinal Plants

Article · August 2011

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Philomena George
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ISSN: 2231-3354
Received: 17-06-2011
Concerns regarding the safety and toxicity of
Revised on: 03-07-2011
Accepted: 14-07-2011
medicinal plants - An overview

Philomena George

ABSTRACT

All over the world, especially in developing countries herbal drugs are playing an
important role in health care programmes.This is because they are being cheap and locally
available. There is a general belief amongst the consumers globally that herbal drugs are always
safe because they are “natural". However evidences suggests otherwise. The mere fact that a
Philomena George product is "natural" may not signify that the product is safe. Although limited evidence suggests
Dept.of Biotechnology, that adverse effects associated with the use of herbal drugs are less likely to occur than with
Karunya University conventional drugs, theydo occur though usually mild and only affecting a small number of
Coimbatore, India people. Recent evidence suggests that some of the herbs considered to be safe over the last many
decades have proven to be associated with health hazards. Herbal remedies can act either as
agonists or antagonists that potentiate some drug therapies. Therefore , an understanding of
conventional drugs is an essential prerequisite for effective herbal therapeutics.The advancement
of technology has enabled the scientists to detect minute amounts of carcinogenic and toxic
chemicals in these herbs and recognize or evaluate potentially hazardous effects of some of the
herbs which had been used in traditional medicine since centuries.

Key words: Safety and Toxicity, herbal medicines/ drugs, side / hazardous effects,
Pharmaceuticals, Botanicals, Allergic, Contamination & adulteration

INTRODUCTION

Medicinal plant species which are being used, for treatment of particular diseases,on large
scale, are reported to be having serious side effects. Many drugs have originated from biologically
active plant chemicals, and their medicinal uses are attributed to various active chemicals found in
them. The major difference between using a medicinal plant and a chemical drug is that most
conventionally trained doctors with no formal training in plants which is of great concern to the
common man. Synthetic drugs usually consist of a single chemical, while medicinal plants can
contain complex mixture of 400 or more chemicals. It’s comparatively easy to figure out the
activity and side effects of a single chemical, but there is just no way scientists can map all the
complex interactions and synergies that might be taking place between all the various chemicals
found in a plant, or crude plant extract containing all these chemicals which is used traditionally .
*For Correspondence:
It is not unusual for a plant to contain a single documented cancer-causing chemical and also
Dr.Philomena George maybe five other chemicals that are anticancerous and which may counteract the one chemical
Professor having toxic effects. Overall, the plant extracst may even provide some type of anticancerous
Dept.of Biotechnology,
Karunya University, effects. The vast majority of medicinal herbs contain dozens of different compounds of great
Coimbatore, India complexity, often mucilages, tannins, polysaccharides etc. that may modulate and modify the
Email: [email protected]
.

effects of any "active principles".

Studies have shown that effects produced by extracts of Fern), Viscum (Mistletoe) and Corynanthe (Yohimbe) can be
whole plants cannot be mimicked by administering isolated quoted as other examples. Laymen are advised to avoid internal
purified constituents of the plant(Philomena et al 2009). consumption of these herbs.
India and China are two of the largest countries in Asia,
which have the richest arrays of registered and relatively well- Side effects & interactions of some common herbs
known medicinal plants. The Indian subcontinent is well known for Following are some of the examples of side
its diversity of medicinal plants, forest products and the age-old effects/ adverse actions and interactions associated with the use of
healthcare traditions, there is an urgent need to establish these common herbal drugs used in traditional medicine routinely since
traditional values in both the national and international centuries.
perspectives realizing the ongoing developmental trends in
traditional knowledge and side effects caused by these medicinal Table 1. Comparison of adverse reactions in pharmaceuticals and botanicals.
plants ( Wu, Y. 1988).
Pharmaceuticals Botanicals (Dietary Supplements)
Those people who are already involved in pharmaceutical
therapies seeks herbal medical treatment more often. In many Adverse drug reactions to Reported fatalities from adverse reactions to
cases, herbalists would not treat the primary presenting symptom pharmaceutical medications were botanical supplements range from less than
responsible for more than 100,000 12 to 24 (at most).
undergoing drug treatment - be it ulcers treated with Zantac or fatalities per year, while non-fatal Adverse reactions to dietary supplements
cardiac arrythmia treated with Digoxin - but rather concentrate on adverse reactions serious enough to are not as well monitored as for
supporting other systems and functions stressed by the primary warrant hospitalization were pharmaceuticals. Even allowing for under-
symptom. This allows the body to recover because of healing reported for approximately 2.2 reporting, however, the documented number
million cases (Lazarou, 1998). of serious or life-threatening adverse
potential of the herbals. These capabilities are directed toward These statistics apply only to reactions to botanical medicines remains
repairing the presenting condition. In other cases, it can be a adverse drug reactions in which the extremely low. For current information on
priority to wean someone off drugs, e.g. steroids, in case of medication was appropriately adverse events reported to the FDA, visit
steroids, supportive therapy to restore adrenal function is vital. used.This places adverse reactions the FDA Center for Food Safety and
to pharmaceuticals as the fifth Applied Nutrition.
(Ernst, 2007). leading cause of mortality in the
U.S.
Safety and Toxicity of herbal medicines (Courtesy to Reports from Uni. of Minnesota 2009)
The explanation of “toxic” is ultimately a matter of
viewpoint. Many ordinary foods contain constituents that could be Toxic ingredients
allergic or considered as toxioc such as the alpha gliadin produced Botanical supplements containing toxic
by gluten in wheat,oats and rye, the cyanogenic glycosides in many constituents, such as liver toxins or carcinogens (chemicals with
fruit seeds, the thiocyanates of the Brassica vegetables, alkaloids of potential to cause cancer), do occasionally cause adverse reactions,
the Solanaceae and lectins of many pulses including soya and red but as a rule, these supplements are quickly withdrawn from the
kidney beans. These foods are generally regarded as safe market once a potential problem has been identified. Some may
throughout the world . Similarly, both life saving items such as still be sold in supplements imported from Asia or Europe.
water and oxygen - can kill in excessive, amounts, so the quantity The following is a partial list of botanicals with
is often an important consideration.( Boullata,and Nacen 2000; potentially toxic constituents: Aconite, Alfa alfa , Aloevera,
Ernst, 2007). Borage, Calamus, Chaparrel ,Coltsfoot, Comfrey ,Ephedra,
However, in practice, from a safety point of view three Germander , Ginkgo biloba, Ginseng, Glycyrrhiza glabra
groups of herbs can be identified. In the first group , there are a (Licorice) Isapghul, Sassafras , Senna , Silybum marianum , St.
handful of herbs that contain near pharmaceutical concentrations of John’s wort etc. A few of the above are briefly covered below.
poisonous constituents which should on no account be taken
internally by unqualified persons except in homeopathic potencies. Aconite: Aconite alkaloids contained in the root-stocks of
Examples are Atropa belladonna, Arnica spp, Aconitum plants of Aconitum family are accredited with analgesic and anti-
spp,,Digitalis spp (Mcrae, 1996). In the second group , are herbs inflammatory effects within several systems of traditional medicine
with very powerful actions, often causing,nausea or vomiting. and are still widely proposed for the treatment of rheumatism,
They are perfectly safe used under appropriate conditions. neuralgia and cardiac complaints.
Examples are,Lobelia and Eonymus spp. Alfa alfa: The herb widely used in Homeopathy, is said to
Certain contradictions can be seen in different countries . contain vitamins A, C, E and K as well as calcium, potassium,
viz., Ephedra is restricted, in the UK, perhaps with justification, phosphorus and iron. However it has been reported that the use of
but is available freely in the US. In the third group , with some this herb can induce Systemic Lupus Erythromatosus (SLE) like
scientific support, there is an idiosyncratic grouping of herbs syndrome in individuals predisposed to this condition.
which exhibit specific kinds of toxicity. The hepatotoxicity of Aloevera: Seventh most widely used herb for centuries as
pyrrolizidine-alkaloid-containing plants such as Comfrey a treatment for minor bruises and is increasingly being used in
(Symphytum) the best known among these.. Dryopteris (Male products for internal consumption. Long term use of aloe latex
 Journal of Applied Pharmaceutical Science 01 (06); 2011: 40-44

could results in potassium deficiency so the laxatives containing substances and anti-allergic activity. Earlier research reports have
anthraquinone glycosides should not be used continuously for shown that glycyrrhizin stimulates the excretion of hormones by
longer than 1-2 weeks owing to the danger of electrolyte the adrenal cortex. Lately however it has been observed that one of
imbalance. the active ingredients, glycyrrhizinic acid, when taken in large
Certain medications can interact positively or negatively quantities, can promote sodium and water retention as well as
with the glycosides contained in the drug. potassium depletion, making it risky for people with blood
Comferey: The herb was used by Greek Physicians in the pressure, kidney or heart disease. Potential unwanted effects
first century as a safe drug in the form of poultice to heal wounds include edema and hypertension due to excessive use. (DHom John
and as a tea to help knit broken bones. In late 1970,s scientists Claydon, 2010)
discovered that it contains pyrrolizidine alkaloids which are known Sassafras: The herb has been used in traditional medicine
to be hepatotoxic and has been associated with obstruction of blood since centuries in North America for the treatment of rheumatism,
flow to the liver, possibly leading to hepatotoxic reactions besides arthritis, cold and flu. The root bark contains small amount of a
being a risk for cancer. potent carcinogen toxic to liver if taken in large quantities or over
Ephedra: The herb has been used in traditional Chinese extended period of time.
medicine since antiquity for the treatment of respiratory ailments. Senna: Senna, another so called weight loss herbal drug
The drug has been advertised as a supposedly safe, natural product used traditionally for constipation, can have adverse effects on the
for weight loss, body building and mood evaluation. Recently the heart because regular consumption is reported to deplete the body
drug became highly controversial due to its use in slimming of potassium causing fatalities. Other adverse reactions include
formulas and products claiming to deliver a "legal high" resulting grand mal seizures, circulatory failure, hypertension and
in serious health hazards. Ephedra has many side effects including anaphylactic reaction.
restlessness, irritability, increased blood pressure and heart rhythm Silybum marianum: Silymarin obtained from the herb
disorders. The alkaloid ephedrine contained in ephedra herb can Silybum marianum and widely promoted as a liver tonic,has been
cause serious toxic reactions ranging from liver damage to severe associated with cerebral hemorrhage, hepatic coma and
high blood pressure and heart problems. neuropathy.
Ginkgo biloba: Ginkgo fruits and seeds have been used St. John’s wort: An anti depressant and dietary
medicinally for thousands of years as a supplement to improve supplement has a potential market in Europe and America. A
mental alertness and related memory problems. Researchers have significant drug interaction between St. John’s wort and Indinavir,
shown that the extract is a potent inhibitor of platelet-activating a protease,inhibitor used to treat infection was reported in a study,
factor and long term use has been associated with increased conducted by the N.I.H in USA. Based on these results, it is
bleeding time, spontaneous hemorrhage and sub dural haematomas expected that the herb may significantly decrease blood
(Rowin and Lewis, 1996). Concentration(FDA Guide lines)
Ginseng: Fourth most widely used Chinese medicinal
herb for the treatment of a variety of conditions since times Need for regulatory controls on herbal drugs
immemorial, Ginseng is used as a general tonic and is claimed to Most serious side effects originate from overuse or misuse
increase body's resistance to stress and builds up general vitality of such medicines. The likelihood of side effects increases when
besides treating hypertension, diabetes, depression, (Punnonen and the production and sale of such products is largely uncontrolled
Lukola 1980). Lately the herb has been reported to cause and or unregulated and the consumer is not adequately informed
hypertension and mastalgia as documented side effects. Taking about their proper uses. While in some countries herbal medicines
Ginseng may keep blood thinners from working correctly resulting are regulated through official controls and rigorous manufacturing
in problems with blood clotting ( Becker, 1996). standards, this is not so everywhere. In Germany, for example,
Isapghul: Isapghul which is considered to be the safest where herbal products are sold as "phytomedicines" they are
and largely used for its demulcent and laxative properties since subject to the same criteria for their safety, efficacy and quality as
centuries is reported to have adverse reactions including applicable to other drugs. Regulatory controls are therefore
bronchospasm, asthma and intestinal obstruction. If swallowed considered necessary to safeguard Drug interactions with herbal
dried it may cause oesophageal obstruction. drugs. So it is always wise to consult a qualified medical
Liquorice (Glycyrrhiza glabra): if we look at use of practitioner having clinical herbal experience in case of any doubt
liquorice from a western perspective, we see that its use has about the compatibility of herb and the drugs you intend to take
changed little over 3,000 years. Traditionally liquorice root has (WHO Reports, 1997, 2002).
been used to treat many ailments including asthma, stomach and The current emphasis is on screening the environment for
duodenal ulcers, singles (caused by a Herpes virus), arthritis, man-made genotoxic and carcinogenic compounds .They detracts
chronic depression etc. It has demulcent (soothing to irritated from studies on the possible health hazard or beneficial effects of
membranes), expectorant properties, and also stimulates mucous naturally occurring agents to which humans are daily exposed in
secretions of the trachea. Other activities include significant anti- their day to day life . The simple phenolics, belong to this category
inflammatory effects, a protecting effect on the liver against toxic of compounds. They are ubiquitous among plants, used as food
 Journal of Applied Pharmaceutical Science 01 (06); 2011: 40-44

additives, and ingested daily in milligram quantities. They are also quality control are extremely rare, but when they do occur, they
known to induce double-strand DNA breaks, DNA adducts, can be serious. These types of safety hazards are seen more
mutations and chromosome aberrations in a great variety of test frequently in herbal supplements imported from India, China, or
systems. However, both in vitro and in vivo assays have proved other countries where quality control procedures are less stringent
that they can suppress the genotoxic activity of numerous than in this country (Reports from University of Minnesota, 2007-
carcinogenic compounds. Some studies on animal models revealed 2011).
that, phenolics induce precancerous lesions, papillomas and
cancers, act as cocarcinogens, and exert a promoting effect in CONCLUSIONS
various rodent assays. At the initiation and promotion stages
The traditional medical systems are part of a time-tested
induced by carcinogens and promoters of different molecular
culture and honored by people still today. For more than 3,000
structures. phenolics have proved to be potent inhibitors of
years, these traditions have successfully set an example of natural
carcinogenesis . The extent to which a health hazard or protective
resource use in curing many complex diseases. Many advantages
activity of complex dietary mixtures is due to their phenolic
of such eco-friendly traditions exist. The plants used for various
content needs to be confirmed by further research. In addition,
therapies are readily available, easy to transport, and have a
these multiple, occasionally contradictory functions of simple
relatively long shelf life. The most important advantage of herbal
phenolics make it difficult to propose their use as chemopreventive
medicine is the minimal side effects, and relatively low cost
agents (Stich 1991).
compared to the synthetic medicines. The success of medicinal
plants sector mainly depends on the awareness and interest of the
Allergic reactions
farmers as well as its other stakeholders, supportive government
Allergic reactions are a possibility, just as they are with
policies, availability of assured markets, profitable price levels, and
many foods and pharmaceuticals. Those who have allergies, should
assess to simple and appropriate agro-techniques.
look for contraindications in the research and consult with their
The successful establishments of medicinal plants sector
healthcare providers. Day to day use vegetables such as
may help in raising rural employment, boost commerce around the
cucumber,peanuts etc.can also be allergic to some
world, and contribute to the health of millions .On the contrary,
even the best drug becomes a potent poison if used incorrectly. A
Improper dosage / usage
study by the European organisation of cosmetic ingredients,
Adverse reactions may also result from inappropriate or
industries and services has found that some 27 toxic substances
improper usage, such as excess dosage. In these cases, the problem
exist in the 350 plants used in the cosmetic ingredient, a result that
lies not with the botanical supplements, but with a failure of
consumers should be warned about, the reports finds. With
communication. Similar errors occur with pharmaceutical
consumers increasingly making the switch to natural and botanical-
medicines as well, the solution in both cases includes proper
based products because they are believed to be safer, the need to
education and effective communication.
communicate potentially dangerous toxins in such products is all
the more pressing (Pitman, 2005). Euromonitor recently drew
Food/drug interactions
attention to research that shows that while the global market for
In practice, the most frequent adverse reactions to
cosmetic and toiletry products is expected to grow at just 1 per cent
botanical medicines typically originate from interactions with
a year through to 2009, the market for natural-based cosmetic
prescription medicines, other dietary supplements, or in some
products, which includes botanicals, is expected to grow at 9 per
cases, with foods. Jenetzky and Morreale (1997).
cent per year between 2003 and 2009 to reach a value of $5.8
Brinker (1998) has identified the most potentially serious
billion (Pitman, 2005).
or life-threatening botanical/pharmaceutical interactions, wherein
To conclude, not all botanical/pharmaceutical interactions
the botanical:
are harmful. For example, in some cases, botanicals can enhance
 Affects absorption of drugs the effect of a pharmaceuticals, thus allowing individuals to reduce
 Enhances potassium loss if given with diuretics their dosage Even a potent poison becomes the best drug on proper
 Interacts with monoamine oxidase inhibitors dosage administration.
 Interacts with cardiac glycosides
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