What adverse GI effects may be encountered in a patient using herbal supplements?
- It is estimated that one third to one half of the U.S. population uses herbal products in supplementary form and that 60% to 75% do not inform health care providers.
- Because herbal products are not regulated and their composition is not standardized, toxicity data are less clear than with regulated pharmaceuticals.
- However, popular products that may cause adverse GI effects include saw palmetto, Ginkgo biloba (nonspecific GI upset), garlic (nausea, diarrhea), ginseng (nausea, diarrhea), aloe (diarrhea, abdominal pain), and guar gum (obstruction).
- In addition, hepatotoxicity (ranging from asymptomatic enzyme elevation to fulminant necrosis) has been documented with germander, chaparral, senna, Atractylis, and Callilepis.
- Hepatotoxicity associated with the use of valerian, mistletoe, skullcap, and various Chinese herbal mixtures has been noted but awaits a cause-and-effect confirmation.
- The pyrrolizidine alkaloids in Crotalaria, Senecio, Heliotropium, and comfrey have long been implicated in cases of venoocclusive liver disease.
