About this Journal Submit a Manuscript Table of Contents
BioMed Research International
Volume 2013 (2013), Article ID 804086, 9 pages
http://dx.doi.org/10.1155/2013/804086
Review Article

Underestimating the Toxicological Challenges Associated with the Use of Herbal Medicinal Products in Developing Countries

Department of Health Sciences, Faculty of Science and ANDI Centre of Excellence for Biomedical and Biomaterials Research, University of Mauritius, Reduit, Mauritius

Received 30 April 2013; Accepted 20 August 2013

Academic Editor: Brad Upham

Copyright © 2013 Vidushi S. Neergheen-Bhujun. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. WHO, (World Health Organisation), 2008, http://www.who.int/mediacentre/factsheets/Fs134/en.
  2. M. Mosihuzzaman and M. I. Choudhary, “Protocols on safety, efficacy, standardization, and documentation of herbal medicine (IUPAC technical report),” Pure and Applied Chemistry, vol. 80, no. 10, pp. 2195–2230, 2008. View at Publisher · View at Google Scholar · View at Scopus
  3. EMA, (European Medicine Agency), 2010, http://www.ema.europa.eu/docs/en_GB/document_library/Other/2010/11/WC500099473.pdf.
  4. EFSA, “European food safety authority, guidance on safety assessment of botanicals and botanical preparations intended for use as ingredients in food supplements,” European Food Safety Authority Journal, vol. 7, p. 1249, 2009.
  5. K. Vasisht and V. Kumar, “Trade and production of herbal medicines and natural health products,” 2002, http://institute.unido.org/documents/M8_LearningResources/ICS/119.%20Trade%20and%20Production%20of%20Herbal%20Medicines%20and%20Natural%20Health%20Products.pdf.
  6. WHO, “Guidelines for the appropriate use of herbal medicines,” 1998, http://apps.who.int/medicinedocs/en/d/Jh2945e/11.html.
  7. J. K. Grover, S. Yadav, and V. Vats, “Medicinal plants of India with anti-diabetic potential,” Journal of Ethnopharmacology, vol. 81, no. 1, pp. 81–100, 2002. View at Publisher · View at Google Scholar · View at Scopus
  8. A. Gurib-Fakim, “Medicinal plants: traditions of yesterday and drugs of tomorrow,” Molecular Aspects of Medicine, vol. 27, no. 1, pp. 1–93, 2006. View at Publisher · View at Google Scholar · View at Scopus
  9. M. Modak, P. Dixit, J. Londhe, S. Ghaskadbi, and T. P. A. Devasagayam, “Indian herbs and herbal drugs used for the treatment of diabetes,” Journal of Clinical Biochemistry and Nutrition, vol. 40, no. 3, pp. 163–173, 2007. View at Publisher · View at Google Scholar · View at Scopus
  10. D. Tarak, N. D. Namsa, S. Tangjang et al., “An inventory of the ethnobotanicals used as anti-diabetic by a rural community of Dhemaji district of Assam, Northeast India,” Journal of Ethnopharmacology, vol. 138, no. 2, pp. 345–350, 2011. View at Publisher · View at Google Scholar · View at Scopus
  11. E. J. Adjanohoun, L. A. Assi, J. Eyme et al., Médecine traditionelle et pharmacopée: contribution aux etudes ethnobotaniques et floristiques a Maurice (Iles Maurice et Rodrigues), Agence de coopération culturelle et technique (ACCT), Paris, France.
  12. A. Gurib-Fakim, medicinales de Maurice, Edition de l’Ocean Indien, Port Louis, Mauritius, 1995.
  13. M. A. Soobrattee, T. Bahorun, V. S. Neergheen, K. Googoolye, and O. I. Aruoma, “Assessment of the content of phenolics and antioxidant actions of the Rubiaceae, Ebenaceae, Celastraceae, Erythroxylaceae and Sterculaceae families of Mauritian endemic plants,” Toxicology in vitro, vol. 22, no. 1, pp. 45–56, 2008. View at Publisher · View at Google Scholar · View at Scopus
  14. M. C. Jonville, H. Kodja, L. Humeau et al., “Screening of medicinal plants from Reunion Island for antimalarial and cytotoxic activity,” Journal of Ethnopharmacology, vol. 120, no. 3, pp. 382–386, 2008. View at Publisher · View at Google Scholar · View at Scopus
  15. P. Rasoanaivo, A. Petitjean, S. Ratsimamanga-Urverg, and A. Rakoto-Ratsimamanga, “Medicinal plants used to treat malaria in Madagascar,” Journal of Ethnopharmacology, vol. 37, no. 2, pp. 117–127, 1992. View at Publisher · View at Google Scholar · View at Scopus
  16. H. S. Abdillahi, G. I. Stafford, J. F. Finnie, and J. Van Staden, “Ethnobotany, phytochemistry and pharmacology of Podocarpus sensu latissimo (s.l.),” South African Journal of Botany, vol. 76, no. 1, pp. 1–24, 2010. View at Publisher · View at Google Scholar · View at Scopus
  17. S. S. Semenya and A. Maroyi, “Medicinal plants used by the Bapedi traditional healers to treat diarrhoea in the Limpopo Province, South Africa,” Journal of Ethnopharmacology, vol. 144, pp. 395–401, 2012.
  18. J. A. Orwa, I. J. O. Jondiko, R. J. A. Minja, and M. Bekunda, “The use of Toddalia asiatica (L) Lam. (Rutaceae) in traditional medicine practice in East Africa,” Journal of Ethnopharmacology, vol. 115, no. 2, pp. 257–262, 2007. View at Publisher · View at Google Scholar · View at Scopus
  19. C. N. Muthaura, G. M. Rukunga, S. C. Chhabra, G. M. Mungai, and E. N. M. Njagi, “Traditional antimalarial phytotherapy remedies used by the Kwale community of the Kenyan Coast,” Journal of Ethnopharmacology, vol. 114, no. 3, pp. 377–386, 2007. View at Publisher · View at Google Scholar · View at Scopus
  20. R. N. Okigbo, C. L. Anuagasi, and J. E. Amadi, “Advances in selected medicinal and aromatic plants indigenous to Africa,” Journal of Medicinal Plant Research, vol. 3, no. 2, pp. 086–095, 2009. View at Scopus
  21. M. Y. Bele, D. A. Focho, E. A. Egbe, and B. G. Chuyong, “Ethnobotanical survey of the used of Annonaceae around mount Cameroon,” African Journal of Plant Science, vol. 5, pp. 237–247, 2011.
  22. S. S. Ningthoujam, A. D. Talukdar, K. S. Potsangbam, and M. D. Choudhary, “Traditional uses of herbal vapour therapy in Manipur, North East India: an ethnobotanical survey,” Journal of Ethnobotanical Survey, vol. 147, pp. 136–147, 2012.
  23. S. Shanmugam, K. Rajendra, and K. Suresh, “Traditional used of medicinal plants among the rural people in Sivagagangai district of Tamil Nadu, Southern India,” Asian Pacific Journal of Tropical Biomedicine, pp. S429–S434, 2012.
  24. C. S. Weckerle, R. Ineichen, F. K. Huber, and Y. Yang, “Mao's heritage: medicinal plant knowledge among the Bai in Shaxi, China, at a crossroads between distinct local and common widespread practice,” Journal of Ethnopharmacology, vol. 123, no. 2, pp. 213–228, 2009. View at Publisher · View at Google Scholar · View at Scopus
  25. B. Kumar-Saroj, D. Mani, and S. K. Mishra, “Scientific validation of polyherbal hepatoprotective formulation against paracetamol induced toxicity,” Asian Pacific Journal of Tropical Biomedicine, vol. 2, supplement 3, pp. S1742–S1746, 2012.
  26. K. Zeng, T. Zhang, H. Fu, G. Liu, and X. Wang, “Modified Wu-Zi-Yan-Zong prescription, a traditional Chinese polyherbal formula, suppresses lipopolysaccharide-induced neuroinflammatory processes in rat astrocytes via NF-κB and JNK/p38 MAPK signaling pathways,” Phytomedicine, vol. 19, no. 2, pp. 122–129, 2011. View at Publisher · View at Google Scholar · View at Scopus
  27. A. Azmat, K. Z. Ahmed, and B. Tariq, “Antinocciceptive effects of poly herbal oil extract,” Pakistan Journal of Pharmacy, vol. 23, pp. 1–7, 2006.
  28. M. Ouedraogo, T. Baudoux, C. Stévigny et al., “Review of current and “omics” methods for assessing the toxicity (genotoxicity, teratogenicity and nephrotoxicity) of herbal medicines and mushrooms,” Journal of Ethnopharmacology, vol. 140, no. 3, pp. 492–512, 2012. View at Publisher · View at Google Scholar · View at Scopus
  29. O. Pelkonen, M. Pasanen, J. C. Lindon et al., “Omics and its potential impact on R&D and regulation of complex herbal products,” Journal of Ethnopharmacology, vol. 140, no. 3, pp. 587–593, 2012. View at Publisher · View at Google Scholar · View at Scopus
  30. M. M. Rao, A. K. Meena, and G. Galib, “Detection of toxic heavy metals and pesticide residue in herbal plants which are commonly used in the herbal formulations,” Environmental Monitoring and Assessment, vol. 181, no. 1–4, pp. 267–271, 2011. View at Publisher · View at Google Scholar · View at Scopus
  31. WHO, (World Health Organisation), 2007, http://apps.who.int/medicinedocs/documents/s14878e/s14878e.pdf.
  32. R. A. Street, “Heavy metals in medicinal plant products—an African perspective,” South African Journal of Botany, vol. 82, pp. 67–74, 2012.
  33. R. G. Garret, “Natural sources of metals in the environment,” in Proceedings of the International Symposium on Metal Ions in Biology and Medicine, vol. 6, pp. 508–510, May 2000.
  34. A. O. Affum, D. O. Shiloh, and D. Adomako, “Monitoring of arsenic levels in some ready-to-use anti-malaria herbal products from drug sales outlets in the Madina area of Accra, Ghana,” Food and Chemical Toxicology, vol. 56, pp. 131–135, 2013.
  35. P. A. Cohen and E. Ernst, “Safety of herbal supplements: a guide for cardiologists,” Cardiovascular Therapeutics, vol. 28, no. 4, pp. 246–253, 2010. View at Publisher · View at Google Scholar · View at Scopus
  36. A. White, “Writing case reports—author guidelines for acupuncture in medicine,” Acupuncture in Medicine, vol. 22, no. 2, pp. 83–86, 2004. View at Scopus
  37. J. M. Rothstein, “Case reports: still a priority,” Physical Therapy, vol. 82, no. 11, pp. 1062–1063, 2002. View at Scopus
  38. S. K. Hung, S. Hillier, and E. Ernst, “Case reports of adverse effects of herbal medicinal products (HMPs): a quality assessment,” Phytomedicine, vol. 18, no. 5, pp. 335–343, 2011. View at Publisher · View at Google Scholar · View at Scopus
  39. E. Ernst, “Cardiovascular adverse effects of herbal medicines: a systematic review of the recent litarature,” Canadian Journal of Cardiology, vol. 19, no. 7, pp. 818–827, 2003. View at Scopus
  40. E. Ernst, “Serious psychiatric and neurological adverse effects of herbal medicines—a systematic review,” Acta Psychiatrica Scandinavica, vol. 108, no. 2, pp. 83–91, 2003. View at Publisher · View at Google Scholar · View at Scopus
  41. R. T. Tovar and R. M. Petzel, “Herbal toxicity,” Disease-A-Month, vol. 55, no. 10, pp. 592–641, 2009. View at Publisher · View at Google Scholar · View at Scopus
  42. R. Teschke, W. Schmidt-Taenzer, and A. Wolff, “Spontaneous reports of assumed herbal hepatotoxicity by black cohosh: is the liver-unspecific Naranjo scale precise enough to ascertain causality?” Pharmacoepidemiology and Drug Safety, vol. 20, no. 6, pp. 567–582, 2011. View at Publisher · View at Google Scholar · View at Scopus
  43. R. Teschke, X. Glass, and J. Schulze, “Herbal hepatotoxicity by Greater Celandine (Chelidonium majus): causality assessment of 22 spontaneous reports,” Regulatory Toxicology and Pharmacology, vol. 20, pp. 567–582, 2011. View at Scopus
  44. J.-L. Vanherweghem, M. Depierreux, C. Tielemans et al., “Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs,” The Lancet, vol. 341, no. 8842, pp. 387–391, 1993. View at Publisher · View at Google Scholar · View at Scopus
  45. M. Heinrich, J. Chan, S. Wanke, C. Neinhuis, and M. S. J. Simmonds, “Local uses of Aristolochia species and content of nephrotoxic aristolochic acid 1 and 2-A global assessment based on bibliographic sources,” Journal of Ethnopharmacology, vol. 125, no. 1, pp. 108–144, 2009. View at Publisher · View at Google Scholar · View at Scopus
  46. R. Javaid, M. Aslam, Q. Nizami, and R. Javaid, “Role of antioxidant herbal drugs in renal disorders: an overview,” Free Radicals and Antioxidants, vol. 2, pp. 1–5, 2012.
  47. C. Y. Ou, C. Z. Chen, C. H. Lee, C. C. Lin, H. Y. Chang, and T. R. Hsiue, “Pulmonary function change in patients with Sauropus androgynus-related obstructive lung disease 15 years later,” Journal of the Formosan Medical Association, pp. 1–5, 2012.
  48. T. K. Jones and B. M. Lawson, “Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication,” Journal of Pediatrics, vol. 132, no. 3 I, pp. 550–552, 1998. View at Publisher · View at Google Scholar · View at Scopus
  49. M. Haden, D. A. Marshall, and B. Murphy, “Toxic levels of glycosides in herbal medication: a potential cause of hyperkalaemia,” Scottish Medical Journal, vol. 56, p. 236, 2011.
  50. T. Y. K. Chan, H. P. Tam, C. K. Lai, and A. Y. W. Chan, “A multidisciplinary approach to the toxicologic problems associated with the use of herbal medicines,” Therapeutic Drug Monitoring, vol. 27, no. 1, pp. 53–57, 2005. View at Publisher · View at Google Scholar · View at Scopus
  51. A. M. Schoepfer, A. Engel, K. Fattinger et al., “Herbal does not mean innocuous: ten cases of severe hepatotoxicity associated with dietary supplements from Herbalifef products,” Journal of Hepatology, vol. 47, no. 4, pp. 521–526, 2007. View at Publisher · View at Google Scholar · View at Scopus
  52. S. A. Jordan, D. G. Cunningham, and R. J. Marles, “Assessment of herbal medicinal products: challenges, and opportunities to increase the knowledge base for safety assessment,” Toxicology and Applied Pharmacology, vol. 243, no. 2, pp. 198–216, 2010. View at Publisher · View at Google Scholar · View at Scopus
  53. O. Pelkonema, K. Abass, and J. Wiesner, “Thujone and thujone-containing herbal medicinal and botanical products,” Toxicological Assessment Regulatory Toxicology and Pharmacology, vol. 65, pp. 100–107, 2013.
  54. S. Russo, M. Mastropasqua, M. A. Mosetti, C. Persegani, and A. Paggi, “Low doses of liquorice can induce hypertension encephalopathy,” American Journal of Nephrology, vol. 20, no. 2, pp. 145–148, 2000. View at Scopus
  55. R. S. Padiyara and S. F. Khan, “A review of commonly used herbal medicines,” Illinois Council of Health-System Pharmacists ICHP Keeposted, vol. 9, pp. 22–36, 2006.
  56. T. C. Theoharides, “Sudden death of a healthy college student related to ephedrine toxicity from a Ma Huang-containing drink,” Journal of Clinical Psychopharmacology, vol. 17, no. 5, pp. 437–439, 1997. View at Publisher · View at Google Scholar · View at Scopus
  57. H. H. Schmeiser, M. Stiborovà, and V. M. Arlt, “Chemical and molecular basis of the carcinogenicity of Aristolochia plants,” Current Opinion in Drug Discovery and Development, vol. 12, no. 1, pp. 141–148, 2009. View at Scopus
  58. X. Chen, E. S. Serag, K. B. Sneed, and S. Zhou, “Herbal bioactivation, molecular targets and the toxicity relevance,” Chemico-Biological Interactions, vol. 192, no. 3, pp. 161–176, 2011. View at Publisher · View at Google Scholar · View at Scopus
  59. C. W. Cheng, W. Ko, S. G. Fan, L. Song, and Z. X. Bian, “Evidence-based management of herb-drug interaction in cancer chemotherapy,” Explore, vol. 6, no. 5, pp. 324–329, 2010. View at Scopus
  60. E. Mills, V. M. Montori, P. Wu, K. Gallicano, M. Clarke, and G. Guyatt, “Interaction of St John's wort with conventional drugs: systematic review of clinical trials,” British Medical Journal, vol. 329, no. 7456, pp. 27–30, 2004. View at Scopus
  61. L. Henderson, Q. Y. Yue, C. Bergquist, B. Gerden, and P. Arlett, “St John's wort (Hypericum perforatum): drug interactions and clinical outcomes,” British Journal of Clinical Pharmacology, vol. 54, no. 4, pp. 349–356, 2002. View at Publisher · View at Google Scholar · View at Scopus
  62. G. W. Barone, B. J. Gurley, B. L. Ketel, M. L. Lightfoot, and S. R. Abul-Ezz, “Drug interaction between St. John's wort and cyclosporine,” Annals of Pharmacotherapy, vol. 34, no. 9, pp. 1013–1016, 2000. View at Scopus
  63. C. Ioannides, “Pharmacokinetic interactions between herbal remedies and medicinal drugs,” Xenobiotica, vol. 32, no. 6, pp. 451–478, 2002. View at Publisher · View at Google Scholar · View at Scopus
  64. T. Y. Jeong, B. K. Park, J. H. Cho, Y. Kim, Y. C. Ahn, and C. G. Son, “A prospective study on the safety of herbal medicines, used alone or with conventional medicines,” Journal of Ethnopharmacology, vol. 143, pp. 884–888, 2012.
  65. Q. N. Zhu, D. Zhang, T. Jin, Q. Wu, J. LiuJ, and Y. F. Lu, “Rutaecarpine effects on expression of hepatic phase-1, phase-2 metabolism and transporter genes as a basis of herb-drug interactions,” Journal of Ethnopharmacology, vol. 147, pp. 215–219, 2013.
  66. K. Noh, Y. M. Seo, S. K. Lee et al., “Effects of rutaecarpine on the metabolism and urinary excretion of caffeine in rats,” Archives of Pharmacal Research, vol. 34, no. 1, pp. 119–125, 2011. View at Publisher · View at Google Scholar · View at Scopus
  67. Y. Ueng, T. Tsai, M. Don, R. Chen, and T. Chen, “Alteration of the pharmacokinetics of theophylline by rutaecarpine, an alkaloid of the medicinal herb Evodia rutaecarpa, in rats,” Journal of Pharmacy and Pharmacology, vol. 57, no. 2, pp. 227–232, 2005. View at Publisher · View at Google Scholar · View at Scopus
  68. K. L. Sang, S. R. Bista, H. Jeong et al., “The effects of rutaecarpine on the pharmacokinetics of acetaminophen in rats,” Archives of Pharmacal Research, vol. 30, no. 12, pp. 1629–1634, 2007. View at Scopus
  69. R. H. J. Mathijssen, J. Verweij, P. De Bruijn, W. J. Loos, and A. Sparreboom, “Effects of St. John's wort on irinotecan metabolism,” Journal of the National Cancer Institute, vol. 94, no. 16, pp. 1247–1249, 2002. View at Scopus
  70. P. Smith, J. M. Bullock, B. M. Booker, C. E. Haas, C. S. Berenson, and W. J. Jusko, “The influence of St-John’s wort on the pharmacokinetics and protein binding of imatinib mesylate,” Pharmacotherapy, vol. 24, pp. 1508–1514, 2004.
  71. A. K. L. Goey, K. D. Mooiman, J. H. Beijnen, J. H. M. Schellens, and I. Meijerman, “Relevance of in vitro and clinical data for predicting CYP3A4-mediated herb-drug interactions in cancer patients,” Cancer Treatment Reviews, vol. 39, no. 7, pp. 773–783, 2013. View at Publisher · View at Google Scholar
  72. WHO, 2009, International Regulatory Cooperation for Herbal Medicines (IRCH), http://www.who.int/medicines/areas/traditional/geninfo/en/index.html.
  73. D. Kong, X. Li, and H. Zhang, “Where is the hope for drug discovery? Let history tell the future,” Drug Discovery Today, vol. 14, no. 3-4, pp. 115–119, 2009. View at Publisher · View at Google Scholar · View at Scopus