TABLE 1791 Some Generally Safe Herbal Agents

Some of the moderately unsafe herbal preparations include absinthe (wormwood), black cohosh, comfrey, juniper, and lobelia. Absinthe (wormwood)—which is popular in Europe and is being produced there in clandestine laboratories—is a toxic liquor that contains volatile oils that produce psychosis, intellectual deterioration, ataxia, headache, vomiting, and diarrhea. Absinthe is used as a flavoring in alcoholic drinks.

Black (or blue) cohosh contains an estrogen-like compound and has been used to delay or treat menopause. It may cause nausea, vomiting, dizziness, and weakness.

Comfrey is used as a digestive stimulant in teas. It has, however, been linked to liver toxicity and hepatic carcinoma. The toxic action comes from the formation of pyrroles that act on DNA.

Juniper is used as a diuretic but may also be hallucinogenic. Toxicity also includes renal toxicity, nausea, and vomiting.

Lobelia is used for asthma and as an expectorant. Other uses include smoking it as a marijuana substitute for its mild euphoric effect. The active ingredients include lobeline, atropine, and scopolomine, which can produce anticholinergic symptoms.

Some herbs that are unsafe but are commonly found on store shelves include chaparral, ephedra, nutmeg, and yohimbine.

Chaparral is derived from the leaves of the creosote bush and is used for its antioxidant effects as a potential cancer preventative. It is also felt to be effective in pain control but is felt to be hepatotoxic.

Ephedra is used in weight loss and has been implicated in multiple toxic deaths. This herbal agent is contraindicated for patients with hypertension, diabetes, or glaucoma.

Nutmeg is used for dyspepsia, muscle aches, and arthritis. It contains terpines, ethers, and myristicin. Myristicin can produce hallucinations (at about 2 to 4 teaspoonfuls of ground nutmeg). At various dosages, it can also produce gastrointestinal upset, agitation, coma, miosis, and hypertension.

Yohimbine is thought to be an aphrodisiac. Toxic effects include hallucinations, weakness, hypertension and paralysis. Yohimbine, if combined with pheopropanolamine, can lead to a stroke through marked elevation of the blood pressure.

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