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Contraindications and Cautions
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Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
.
Astragalus Complex
Ginkgo 2000mg
Bacopa Complex
Golden Seal 500mg
Bilberry 6000mg
Gotu Kola Complex
Boswellia Complex
Gut Flora Complex
Gymnema 4g
Broncafect
®
Broncafect Phytosynergist
®
Hawthorn
Burdock Complex
Herbal Throat Spray Phytosynergist®
Capsella Complex Phytosynergist®
HiPep
Cat’s Claw Complex
Horsechestnut Complex
Chaste Tree
LivCo®
ChelaCo
Livton® Complex
Colax
Nevaton®
Coleus Forte
ProstaCo
Cramplex
PulmaCo
Cranberry Complex
Rehmannia Complex
DermaCo
ResCo®
DiaCo Phytosynergist®
ResCo Phytosynergist®
DiGest
Rhodiola & Ginseng Complex
DiGest Phytosynergist
®
Saligesic
Dong Quai
Silymarin
Echinacea Premium
St John’s Wort 1.8g
Eleuthero
Thyroid Complex
Euphrasia Complex
Tribulus
Evening Primrose Oil
UriCo Phytosynergist®
Fe-Max Iron Tonic Phytosynergist®
Valerian Complex
Feverfew
Vitanox®
Ganoderma & Shiitake
Wild Yam Complex
Garlic 5000mg
Withania Complex
Wormwood Complex
3
Contraindications and Cautions
Liquid Extracts
Albizia 1:2
Gotu Kola 1:1
Ashwaganda 1:1
Gymnema 1:1
Astragalus 1:2
Hawthorn Berries 1:2
Bacopa 1:2
Horsechestnut 1:2
Bilberry 1:1
Horsetail 1:2
Black Cohosh 1:2
Korean Ginseng 1:2
Black Walnut Hulls 1:10
Licorice 1:1
Bladderwrack 1:1
Licorice High Grade 1:1
Bugleweed 1:2
Marshmallow Root 1:5 Glycetract
Bupleurum 1:2
Milk Thistle 1:1
Burdock 1:2
Milk Thistle 1:1 Glycetract
Calendula 1:2
Mistletoe 1:2
Californian Poppy 1:2
Motherwort 1:2
Cat’s Claw 1:2
Nettle Leaf 1:2
Celery Seed 1:2
Nettle Root 1:2
Chamomile High Grade 1:2
Oats Seed 1:1
Chaste Tree 1:2
Oregon Grape 1:2
Chinese Skullcap 1:2
Pau d’Arco 1:2
Cinnamon Quills 1:2
Poke Root 1:5
Cleavers 1:2
Red Clover 1:2
Coleus 1:1
Rehmannia 1:2
Corn Silk 1:1
Sage 1:2
Cramp Bark 1:2
Sarsaparilla 1:2
Damiana 1:2
Saw Palmetto 1:2
Dandelion Leaves 1:1
Schisandra 1:2
Dandelion Root 1:2
Skullcap 1:2
Dong Quai 1:2
St John’s Wort 1:2
Echinacea Premium Blend 1:2
St John’s Wort High Grade 1:2
Echinacea Purpurea 1:2
Tienchi Ginseng 1:2
Echinacea Purpurea 1:3 Glycetract
Turmeric 1:1
Eleuthero 1:2
Uva Ursi 1:2
Eyebright 1:2
Valerian 1:2
Garlic 1:1
White Peony 1:2
Ginger 1:2
Wild Yam 1:2
Ginkgo 2:1
Wormwood 1:5
Globe Artichoke 1:2
Yellow Dock 1:2
Golden Seal 1:3
4
Contraindications and Cautions
Introduction
This volume of contraindication and drug interaction information has been compiled by MediHerb® and Standard Process® as a resource for health care
professionals who recommend MediHerb herbal products distributed by Standard Process. In this volume, MediHerb and Standard Process have brought together
herb-specific information regarding cautions, potential adverse reactions and interactions with drugs. It is presented in summary form and is drawn from widely
used, authoritative herbal references. The reader should recognize, however, that the information presented has not been confirmed or agreed to by MediHerb or
Standard Process. For example, some information is based on in vitro data which has not been substantiated by clinical studies.
To provide basic information on contraindications and drug interactions, MediHerb and Standard Process referred to fifteen English language reference texts that
are used in the United States and worldwide. This compilation of information and references is presented for the convenience of health care professionals who
are encouraged to review the source literature directly. This volume should not be understood to be either complete or final. Information on herbs for health,
like information on other pharmacologically active compounds, is evolutionary. Health care professionals should be alert to new information and should use
reasonably available research materials to keep up-to-date. Readers are also advised that the information presented in this volume covers herbs and essential oils
(and not vitamins or minerals).
How to Use this Publication
The information is laid out in order of product name and by category starting with Tablets, Capsules and Phytosynergist® Liquid Complexes and followed by Liquid
Extracts.
A general caution appears after the product name. Below this, detailed information for each ingredient (herb and essential oil) is presented.
Example:
If looking for information on Albizia Complex, go to the Tablets, Capsules and Phytosynergist® Liquid Complexes category. The general caution is indicated
with the product name. Below this each of the component herbs in Albizia Complex (Chinese Skullcap, Albizia and Feverfew) are listed with the corresponding
information provided from the reference texts.
For ease of use the ingredients are listed in descending order with the ingredient of highest amount first. This presentation is consistent with the catalog and
product label.
Reference Text Information
Adverse Effects of Herbal Drugs (AEHD),1,2,3 volumes 1, 2 & 3 are P.A.G.M. DeSmet’s effort as Managing Editor to draw together information gathered from
available herbal pharmacovigilance sources, recognizing as well that the long history of traditional use of herbal medicines provide “a powerful tool, of course,
for the identification of adverse effects.” These books were relied upon by the American Herbal Products Association in compiling the Botanical Safety Handbook,
described below.
The British Herbal Compendium (BHC)4 is a handbook of scientific information on widely used plant drugs edited by Peter R. Bradley. Each volume is a
companion to the corresponding volume of the British Herbal Pharmacopoeia. The BHC is published by the Scientific Committee of the British Herbal Medicine
Association. The basic approach of the BHC is to bring together scientific information from a variety of sources to produce clear and concise summaries on
important aspects of individual plant drugs.
The Botanical Safety Handbook (BSH)5 was published in 1997 by the American Herbal Products Association, the trade association of the herbal supplement
industry in the United States. It’s authors include Association President Michael McGuffin and the President and Chief Executive Officer of the American Herbal
Pharmacopoeia, Roy Upton. The preface to the BSH succinctly states its goal:
The goal of the present work is to find a rational platform for the evaluation of herb safety, neither assuming that all natural substances are inherently safe,
as some popular references suggest, nor blindly accepting reports of toxicity from uncritical sources. In undertaking this task the Editors met with information
that presented significant challenges. Many authors utilize unreferenced data, perpetuate historical inaccuracies or display inherent biases against the use of
botanicals. Also, contemporary reviews of the toxicity of many herbs are not available. Nonetheless, the Editors are confident that the body of information
presented here is largely accurate. It is our sincere hope that readers of this work will find it to be a valuable reference and will address all useful criticisms to
our attention.
MediHerb’s Co-Founder, Kerry Bone, authored Clinical Applications of Ayurvedic and Chinese Herbs (CAACH)6 in October 1996 for the reason set forth in the
subtitle, as Monographs for the Western Herbal Practitioner. In his preface, Kerry Bone underscores the importance of looking to traditional sources for guidance:
As the pharmacological and clinical information on exotic plants accumulates, largely funded by the governments of India and China, western phytotherapists
face an important decision. Do they ignore this useful information, or do they attempt to incorporate these plants into their daily practice? However, there is
no need for any soul-searching since a traditional precedent already exists. The western system has continually adopted herbs from exotic locations. As global
communication reaches new heights, and the stresses of ever-increasing industrialization create diseases common to all countries, modern phytotherapy must
rise to the challenge. One aspect of meeting this challenge is the use of effective herbs, whatever their country of origin.
5
Contraindications and Cautions
The European Scientific Cooperation of Phytotherapy (ESCOP) first published monographs on the medicinal uses of plant drugs in March 1996 in loose-leaf
form as a series of fascicules. In 2003 the ESCOP monographs were completely revised and expanded and made available as a book.7 ESCOP is the European
umbrella organization of national associations of phytotherapy. Members include the trade associations from the major European Union countries. The ESCOP
Scientific Committee prepares the monograph as follows:
In preparing drafts, [the] ESCOP Scientific Committee has the advantage that it can incorporate the views, knowledge and experience, not only of
different nationalities, but also of individuals from different scientific and professional backgrounds, such as medical doctors, practicing phytotherapists,
pharmacognosists, pharmacologists and regulatory affairs specialists. The Committee, operating as two subcommittees, assesses information from published
scientific literature on each plant drug with the assistance of leading researchers on specific plants, who are invited to meetings of the Committee for
discussion and critical evaluation of the literature.
One of the strengths of Essential Oil Safety: A Guide for Health Care Professionals (EOS)8 is the presentation of concise profiles of essential oils. This includes
safety information for the oral use of essential oils – an area of traditional practice often ignored. The book provides information from a number of scientific
sources, including toxicological reports, in a transparent and reliable way. The function of the book, as described by the authors, is to reassure users of essential
oils by showing that many supposed dangers do not in fact exist and also to “to hoist some red flags” where appropriate.
The Therapeutic Guide to Herbal Medicine (TGHM),9 the Complete German Commission E Monographs, was published in 1998 by the American Botanical
Council, a non-profit organization dedicated to providing scientific information about botanicals. This volume translates the Commission E monographs, the only
substantial governmental review of herbal products. These monographs were published in the 1980s and early 1990s. The Commission has since disbanded.
Accordingly, some of the work of the Commission is no longer generally accepted as current. Nonetheless, the Commission’s work has substantial value to health
care professionals. The compiler of the translations, Mark Blumenthal, is founder and Executive Director of the American Botanical Council and is widely respected
as an herbal expert. In his foreword to this volume, Varro E. Tyler, Ph.D., Sc.D., Dean and Distinguished Professor of Pharmacognosy Emeritus, Purdue University
stated:
. . . in 1978, the Bundesgesundheitsamt (Federal Health Agency), now called the Federal Institute for Drugs and Medical Devices, established an expert
committee on herbal remedies, composed principally of members proposed by associations of the health professions, to evaluate the safety and efficacy
of phytomedicines. This so-called “Commission E” included physicians, pharmacists, pharmacologists, toxicologists, representatives of the pharmaceutical
industry, and lay persons. Its assessment is independent of the Federal Health Agency, which handles only the organizational details.
Unlike the United States Food and Drug Administration which evaluates drugs only in a passive manner based on data supplied by the manufacturer,
Commission E actively checks so-called bibliographic data independently. Such data include information obtained from clinical trials, field studies, collections of
single cases, scientific literature including facts published in the standard reference works, and expertise of medical associations. If controlled clinical data are
lacking, safety and efficacy can still be determined on the basis of information in the literature, the presence of supplemental data supporting clinical results,
and significant experimental studies supporting traditional use.
By 1993, about 300 such monographs had been prepared. Approximately two-thirds of them are positive assessments covering herbs that have been found to
be safe and effective; the remainder are negative (unapproved), usually because use of the drug presents an unsatisfactory risk-benefit ratio. Although critical
scientists and clinicians might quibble with a few of the findings in some of the monographs – I do so myself – it is necessary to remember that, taken as a
whole, they represent the most accurate information available in the entire world on the safety and efficacy of herbs and phytomedicines. As such, they are
worthy of careful study by anyone interested in any type of drug therapy. Ignorance of the Commission E monographs is ignorance of a substantial segment of
modern medicine.
Herbal Medicine (HM)10 is another book by Mark Blumenthal and his colleagues. It presents herbal information that expands on the German Commission E
monographs. Published in 2000, this volume is one of the few up-to-date publications available in the field. Each herbal monograph is extensively annotated and
referenced. Dr. Varro Tyler’s foreword to his volume articulated why this expanded text provides value to the field.
Although the pioneering judgments rendered by the Commission E on the safety and efficacy of over 380 herbs remain generally the best available, there is,
of course, always room for improvement. The medicinal potential of herbs has become the focus of more and more scientific and clinical studies in the field
in recent years. New information has provided additional insights and, in some cases, modified previous judgments. That is only to be expected in such a
dynamic field.
Therefore, Mark Blumenthal, Alicia Goldberg, and Josef Brinckmann have performed a substantial service to all those interested in herbal medicine by
expanding the content in the Commission E herb monographs of the most widely used herbs in America to include updated, detailed information on their
botany, history, composition, safety, efficacy, and therapeutic use. And for those who lamented its initial absence, an extensive list of published references
is provided, each of which is appropriately keyed to a specific statement in the monograph. This listing is followed by a compilation of additional literature
resources for those who want still more background information on a particular botanical.
In short, these expanded versions of selected original Commission E monographs would seem to fulfill all of the desires of those who felt that the original
version did not meet their expectations, or that its large size and price did not allow for its widest distribution and use. I am quite certain that this volume will
meet and even exceed those expectations and wishes. It is destined to occupy a prominent position on the shelf of useful herbal literature for the foreseeable
future.
6
Contraindications and Cautions
Principles and Practice of Phytotherapy (PPP)11 was coauthored by Simon Mills, Director, Centre for Complementary Health Studies, University of Exeter, UK, and
Secretary of the Board of Directors of ESCOP together with MediHerb’s Kerry Bone. Simon Mills also serves as Chairman of the British Herbal Medicine Association.
In his foreword, the highly respected American herbal scientist James A. Duke describes the Mills and Bone volume as follows:
These authors, representing respectively the traditions of Great Britain and Australia, have 40 years of clinical practice of herbal medicine between them. They
are also both solid scientists; able to apply rigorous scrutiny to the many claims made for their medicines. Every traditional claim offered forth in their book is
countered by an exhaustive pharmacological and phytochemical analysis. And excitingly new, the authors have comprehensively covered, and covered well:
herbal pharmacodynamics (effect of an active phytochemical at target site(s)) and pharmacokinetics, explaining what actually happens to the phytochemicals
in the body when humans consume herbal medicines, and how much of a phytochemical can be concentrated at the site. It is most exciting to read what the
authors have to say in this important and understudied area of herbal medicine. These pharmacokinetic observations alone would make the book worthwhile.
Pharmacist Melanie Johns Cupp of West Virginia University is the editor of Toxicology and Clinical Pharmacology of Herbal Products (TCPHP).12 In this
volume, the authors seek to provide “medical examiners, toxicologists, and health care providers with an objective review of the available information on the
pharmacology and toxicology of commonly used herbs.” They present data from case reports and include information of value to pathologists. Human, animal
and in vitro data are also presented along with information on pharmacology, therapeutics, and adverse effects. According to the author of the foreword, Steven
B. Karch, M.D., they have done an “excellent job in combining the scientific literature for reliable, peer-reviewed information about the most widely used herbal
products.”
The World Health Organization‘s Monographs on Selected Medicinal Plants (WHO) were first published in 1999 to promote international harmonization in the
quality control and use of herbal medicines and in the development of national formularies. Twenty-eight monographs were published in volume 1, with another
series published in 2001.13,14 The second part of each monograph describes the clinical applications of the plant material, including detailed pharmacological
information, contraindications, adverse effects and dosage.
One of the most recent additions to the scholarship of herbal therapy is A Clinical Guide to Blending Liquid Herbs (CGBLH)15 written by MediHerb’s Kerry Bone
and published in 2003 focuses solely on liquid herbal preparations and features monographs of 125 popular herbs. The monographs are written in an easy-to-read
and summarized format presenting safety and clinical information relevant to the health care professional. Additional pharmacological and clinical information is
provided for further study. In addition to the monographs, a chapter is devoted to explaining the principles of formulating liquid herbal mixtures for the individual
patient, with examples for key conditions presented. Simon Mills notes in the foreword that “[Kerry] combines many years of herbal research and a personal
commitment to producing the highest-quality herbal remedies with an equal experience in the consulting room with real patients. With this combination of skills,
he has produced the most important guide to herbal prescription so far.”
MediHerb and Standard Process encourage health care professionals to obtain these and other publications which describe the uses and cautions associated with
the use of herbs for health. As herbs grow in popularity, more sources of information will appear. Health care professionals have an obligation to keep up-to-date
on the growing literature of herbs for health in order to serve the needs of their patients.
In particular The Essential Guide to Herbal Safety by Kerry Bone and Simon Mills should be consulted. This accurate and comprehensive book presents an
extensive discussion of the principles of herbal safety and major issues relating to this important area. Leading international experts contribute to the book
providing a wealth of information on issues such as quality, interactions, adverse reactions, toxicity, allergy, contact sensitivity and idiosyncratic reactions. The
Essential Guide to Herbal Safety was the recipient of the American Botanical Council (ABC) James A. Duke Botanical Literature Award 2006, which honors the
singular outstanding contribution by a book to the knowledge and understanding of medicinal and aromatic plants.
NOTE: The information compiled in this volume is only as current as the references set forth above. For the most current scientific information regarding
any of the herbs used in MediHerb products, the following online databases are updated on a regular basis and can be searched by herb name:
http://ods.od.nih.gov/health.aspx
National Institutes of Health Office of Dietary Supplements International Bibliographic Information on Dietary Supplements (IBIDS) database.
http://www.ncbi.nlm.nih.gov/sites/entrez National Library of Medicine Medline database.
http://www.herbmed.org Alternative Medicine Foundation.
http://www.mediherb.com MediHerb Pty Ltd.
REFERENCES
1
de Smet PAGM, Keller K, Hansel R et al (eds). Adverse Effects of Herbal Drugs, Volume 1. Springer-Verlag, Berlin, 1992.
2
de Smet PAGM, Keller K, Hansel R et al (eds). Adverse Effects of Herbal Drugs, Volume 2. Springer-Verlag, Berlin, 1993.
3
de Smet PAGM, Keller K, Hansel R et al (eds). Adverse Effects of Herbal Drugs, Volume 3. Springer-Verlag, Berlin, 1997.
4
British Herbal Medicine Association. British Herbal Compendium, Volume 1. BHMA, Bournemouth, 1992.
5
McGuffin M, Hobbs C, Upton R et al (eds). American Herbal Products Association’s Botanical Safety Handbook. CRC Press, Boca Raton, 1997.
6
Bone K. Clinical Applications of Ayurvedic and Chinese Herbs. Phytotherapy Press, Warwick, 1996.
7
ESCOP Monographs: The Scientific Foundation for Herbal Medicinal Products, 2nd Edition. ESCOP, European Scientific Cooperative on Phytotherapy, Exeter, 2003.
8
Tisserand R, Balacs T. Essential Oil Safety: A Guide for Health Care Professionals. Churchill Livingstone, Edinburgh, 1995.
9
Blumenthal M et al (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, 1998.
10
Blumenthal M et al (eds). Herbal Medicine: Expanded Commission E Monographs. American Botanical Council, Austin, 2000.
11
Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, 2000.
12
Cupp MJ (ed). Toxicology and Clinical Pharmacology of Herbal Products. Humana Press, Totowa, NJ, 2000.
13
World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 1. WHO, Geneva, 1999.
14
World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 2. WHO, Geneva, 2001.
15
Bone K. A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual Patient. Churchill Livingstone, St. Louis, 2003.
7
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Albizia Complex
Contraindicated in individuals with a known hypersensitivity to Feverfew, parthenolide or other members of the daisy family. Not to be used during pregnancy and
lactation unless otherwise directed by a qualified health care professional.
Chinese Skullcap
Scutellaria baicalensis root
1
Albizia
Albizia lebbek bark
No information. None known. (CAACH, 94) Since the herb contains
saponins, it may be a gastrointestinal irritant. It may
also be contraindicated or at least inappropriate in
topical application to open wounds, patients with celiac
disease, and some upper digestive irritations. (PPP, 46,
170)
None known. (CAACH, 95; CGBLH, 59)
Feverfew
Tanacetum parthenium leaf & stem
2b
None known. (ESCOPM, 493; PPP, 391; CGBLH, 219)
In vitro studies suggest that feverfew may inhibit
platelet aggregation (TCPHP, 102), however, results
from clinical trials suggest that normal clotting
mechanisms remain intact. (PPP, 387)
Traditionally contraindicated in cold conditions. (CGBLH,
83) Gastric discomfort occurs rarely. (AEHD2, 291)
Contraindication: pregnancy. Occasional mouth
ulceration and gastric disturbances have been reported,
but the incidence is low. Contact allergy is known but
rare. No major adverse effects with long-term use have
been recorded. (BHC, 97) Contraindicated in those with
known hypersensitivity to either feverfew, parthenolide
or other members of the Compositae family. (PPP, 391;
WHO2, 324; CGBLH, 219)
None known. (CGBLH, 83)
Andrographis Complex
Contraindicated in pregnancy and lactation. Contraindicated in known allergy to plants of the daisy family.
Echinacea
Echinacea angustifolia root
1
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Holy Basil
Ocimum tenuiflorum leaf
No information. Contraindicated during pregnancy and lactation. (WHO2, No information.
212)
Andrographis
Andrographis paniculata herb
2b
Holy Basil
Ocimum tenuiflorum leaf essential oil
No information. No information.
Note: Contraindication: pregnancy, (BSH, 9; CAACH, 100;
CGBLH, 65) lactation; known allergy to plants of the
Acanthaceae family. (WHO2, 20) High doses may cause
gastric discomfort, loss of appetite and vomiting, but
generally there are few side effects and it is non-toxic.
(CAACH, 99) Two cases of urticaria have been reported.
(WHO2, 21; CGBLH, 65)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (PPP, 266; CGBLH, 65)
No information.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
8
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Astragalus Complex
Contraindicated in known allergy to plants of the daisy family. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care
professional. Discontinue during an acute infection or fever.
Astragalus
Astragalus membranaceus root
1
Contraindications: not advisable in acute infections. (PPP, None known. (PPP, 277; WHO1, 56; BSH, 17; CGBLH,
277; CAACH, 19; CGBLH, 77)
77)
Echinacea
Echinacea purpurea root
1
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
Contraindicated in acute phase of infections, (PPP, 142,
539) pregnancy, lactation and in cases of known allergy
to plants of the Araliaceae family. (WHO2, 91)
Commission E noted a contraindication for hypertension.
(HM, 107; PPP, 539; TGHM, 125) Two clinical studies
recommend that Eleutherococcus not be administered
to patients with high blood pressure (HM, 107; TGHM,
62; BSH, 45), although a causal relationship to the use
of Eleutherococcus could not be established. (ESCOPM,
142) Caution is advised in cardiovascular disorders.
(CGBLH, 195)
Insomnia, palpitations, tachycardia and hypertension
have been rarely observed in association with clinical
studies. (BSH, 45; CGBLH, 195)
None known. (HM, 108; TGHM, 125; PPP, 539;
ESCOPM, 143) Reports that the herb may increase
serum digoxin levels, but not conclusive (PPP,
539) and the identity of the plant material as
Eleutherococcus was not established. (WHO2, 91)
Eleuthero
Eleutherococcus senticosus root
Note: 1
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
9
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Bacopa Complex
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional. Discontinue during an acute infection or
fever.
Schisandra
Schisandra chinensis fruit
1
Contraindicated in pregnancy, except to assist childbirth;
in the early stages of cough or rash and in excess heat
patterns. (CGBLH, 405) May be contraindicated in liver
carcinoma. (PPP, 192) Rare side effects of appetite
suppression, stomach upset, and urticaria are reported.
(BSH, 104)
None known. (CGBLH, 405)
Refer to the MediHerb Herb-Drug Interactions chart.
Bacopa
Bacopa monnieri herb
No information. Containing saponins, this herb is a potential
gastrointestinal irritant. (PPP, 46; CGBLH, 80)
None known. (CAACH, 101-102; CGBLH, 80)
Eleuthero
Eleutherococcus senticosus root
1
None known. (HM, 108; TGHM, 125; PPP, 539;
ESCOPM, 143) Reports that the herb may increase
serum digoxin levels, but not conclusive (PPP,
539) and the identity of the plant material as
Eleutherococcus was not established. (WHO2, 91)
Contraindicated in acute phase of infections, (PPP, 142,
539) pregnancy, lactation and in cases of known allergy
to plants of the Araliaceae family. (WHO2, 91)
Commission E noted a contraindication for hypertension.
(HM, 107; PPP, 539; TGHM, 125) Two clinical studies
recommend that Eleutherococcus not be administered
to patients with high blood pressure (HM, 107; TGHM,
62; BSH, 45), although a causal relationship to the use
of Eleutherococcus could not be established. (ESCOPM,
142) Caution is advised in cardiovascular disorders.
(CGBLH, 195)
Insomnia, palpitations, tachycardia and hypertension
have been rarely observed in association with clinical
studies. (BSH, 45; CGBLH, 195)
Refer to the MediHerb Herb-Drug Interactions chart.
Rosemary
No information.
No information. Adverse reactions are not noted for the daily dosage
of 10–20 drops. (TGHM, 48, 197) Based on the cineole
Rosmarinus officinalis leaf essential oil
content of the essential oil, caution may be warranted
in women wishing to conceive. (CGBLH, 389) At an oral
daily dose of 0.5 mL or above: should not be taken in
pregnancy; use with caution in epilepsy and fever. (EOS,
113-114, 165)
Bilberry 6000mg
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Bilberry
Vaccinium myrtillus fruit
Note: 1
Very high doses should be used cautiously in patients
with hemorrhagic disorders and in those taking warfarin
or antiplatelet drugs. (PPP, 301) Mild side effects
affecting the gastrointestinal, cutaneous and nervous
systems observed in a small percentage of patients.
(CGBLH, 93)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (HM, 18; TGHM, 88; ESCOPM, 346)
Possible interaction with warfarin and antiplatelet
drugs in very high doses. (PPP, 301)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
10
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Boswellia Complex
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Boswellia
Boswellia serrata gum oleoresin
1
No information.
Celery Seed
Apium graveolens fruit
2b, 2d
None known. (CGBLH, 134)
Apium graveolens can cause rare allergic reactions,
even ending in anaphylactic shock ('celery-carrotmugwort' allergic reaction). (TGHM, 320; BHC, 57)
Refer to the MediHerb Herb-Drug Interactions chart.
Can contain phototoxic furanocoumarins. (TGHM, 320)
The BHC recommends that celery is contraindicated in
kidney disorders and pregnancy, (BHC, 57) although
no evidence has been found for the contraindication in
pregnancy. (CGBLH, 134) As a diuretic, inappropriate and
possibly contraindicated in renal failure and diabetes.
(PPP, 222; BSH, 11)
Ginger
Zingiber officinale rhizome
2b, 2d
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Contraindicated in obstruction of bile passages; in case
of gallstones, use only after consulting with a physician.
(TGHM, 222; HM, 382; WHO1, 121; PPP, 578; ESCOPM,
107) The herb should not be administered to patients
who suffer from stomach ulcers or hyperacidity. (BSH,
39; HM, 382) Occasional cases of allergic dermatitis
reported. (WHO1, 121; PPP, 578) Care should be
exercised with women wishing to conceive and patients
complaining of hair loss. (CGBLH, 436) Patients applying
topical doses should be cautioned against excessive
exposure to sunlight. (PPP, 578)
None known. (HM, 382; TGHM, 222; ESCOPM, 108)
High doses (>15 g/day) should not be given to
patients taking antiplatelet or anticoagulant drugs.
(PPP, 578; CGBLH, 436)
Turmeric
Curcuma longa rhizome
Note: 2b, 2d
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
No information.
Refer to the MediHerb Herb-Drug Interactions chart.
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
11
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Broncafect®
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation. Contraindicated in known
allergy to plants of the daisy family.
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Pleurisy Root
Asclepias tuberosa root
2b, 2d
Canadian regulations do not allow the herb as a nonNone known. (CGBLH, 374)
medicinal ingredient for oral use products. (BSH, 17)
However no adverse effects have been documented for
recommended dosages. (CGBLH, 374)
Echinacea
Echinacea purpurea root
1
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
Large doses can be laxative. (BSH, 74)
None known. (TGHM, 148; HM, 199; CGBLH, 456)
White Horehound
Marrubium vulgare herb
2b
Refer to the MediHerb Herb-Drug Interactions chart.
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
12
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Ginger
Zingiber officinale rhizome
2b, 2d
Thyme
Thymus vulgaris leaf essential oil
Contraindications, Cautions
and Potential Adverse Reactions
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
No information. None known for an oral daily dose of 0.5 mL or above.
(EOS, 113-114, 176) Substantial doses should be
avoided in pregnancy. (BSH, 116)
Interactions with Drugs
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Refer to the MediHerb Herb-Drug Interactions chart.
No information.
Broncafect Phytosynergist®
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation. Contraindicated in known
allergy to plants of the daisy family.
Echinacea
Echinacea angustifolia root
1
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
13
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Pleurisy Root
Asclepias tuberosa root
2b, 2d
Canadian regulations do not allow the herb as a nonNone known. (CGBLH, 374)
medicinal ingredient for oral use products. (BSH, 17)
However no adverse effects have been documented for
recommended dosages. (CGBLH, 374)
Thyme
Thymus vulgaris leaf
1
None known. (HM, 377; TGHM, 219; WHO1, 264;
Patients sensitive to birch pollen or celery may have
CGBLH, 431)
cross-sensitivity or possible adverse reaction to this
herb. Contact dermatitis has been reported. (WHO1,
264) Classifications and concerns for this herb are based
upon therapeutic use and dosage and may not be
relevant to its consumption as a spice. (BSH, 116)
Ginger
Zingiber officinale rhizome
2b, 2d
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Large doses can be laxative. (BSH, 74)
None known. (TGHM, 148; HM, 199; CGBLH, 456)
Product and Ingredient Name
Class
Licorice
Glycyrrhiza glabra root
Refer to the MediHerb Herb-Drug Interactions chart.
White Horehound
Marrubium vulgare herb
Note: 2b
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
14
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Burdock Complex
Contraindicated in pregnancy and lactation.
Burdock
Arctium lappa root
1
None known. (BHC, 46; TGHM, 318)
None known. (CGBLH, 118)
Sheep Sorrel
Rumex acetosella herb
2d
Individuals with a history of kidney stones should use
the herb cautiously. (BSH, 100)
No information.
Slippery Elm
Ulmus rubra stem bark
1
None known. (BHC, 204) Mucilage such as slippery elm None known. (BHC, 204)
is inappropriately prescribed in congestive bronchial and
catarrhal conditions. (PPP, 169) Since they have been
known to cause esophageal obstruction, mucilages
should be taken with plenty of water and large doses
should not be prescribed in tablet form. (PPP, 26)
Rhubarb
Rheum palmatum root
2b, 2c, 2d
Contraindicated in intestinal obstruction, acute intestinal
inflammation e.g. Crohn's disease, ulcerative colitis,
appendicitis, abdominal pain of unknown origin, (TGHM,
195) pregnancy, lactation and children under 10 years
of age. (ESCOPM, 420) In single incidents, cramp-like
discomforts of the gastrointestinal tract can occur. This
requires a dosage reduction. With chronic use or abuse
a range of side effects are possible due to disturbance
of water and electrolyte balance, especially potassium
deficiency which can lead to disorders of heart function
and muscular weakness. Pigment implantation into the
intestinal mucosa (pseudomelanosis coli) can occur but
it is harmless and usually reverses upon discontinuation
of the herb. (TGHM, 195)
Laxatives containing anthraquinone glycosides such as
rhubarb are also contraindicated in patients with bowel
disease, diarrhea and constipation associated with
bowel impermeability. (PPP, 173) They should not be
used for periods of more than 2 weeks without medical
advice. (ESCOPM, 420)
Abdominal spasm and pain may occur in those with
irritable colon. A non-clinically relevant discoloration of
urine may also occur. (ESCOPM, 420)
Although it is often recommended that individuals
with a history of kidney stones should use the herb
cautiously, on the basis of it containing oxalate, (BSH,
97) this side effect has not been established.
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
With long-term use or abuse, due to loss of
potassium, an increase in effectiveness of cardiac
glycosides and an effect on antiarrhythmic drugs
is possible. Potassium deficiency can be increased
by simultaneous application of thiazide diuretics,
corticosteroids or licorice root. (TGHM, 196)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
15
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Capsella Complex Phytosynergist®
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional.
Dong Quai
Angelica polymorpha (Angelica sinensis) root
2b
Contraindicated in bleeding or very heavy menstruation,
first trimester of pregnancy, tendency to spontaneous
abortion, acute viral infections such as colds or
influenza. (CAACH, 5-6; BSH, 11; PPP, 352; CGBLH,
182) Also contraindicated in diarrhea caused by weak
digestion and in hemorrhagic disease. (PPP, 352)
Headache may occur in sensitive individuals. (WHO2,
32) Cardiovascular side effects include excessive
bleeding. (TCPHP, 290) A case of gynecomastia in a
male has been reported. (CGBLH, 182) Dong quai has
two furanocoumarins (psoralen and bergapten), which
are photoreactive and have the potential to cause
severe photodermatitis. These furanocoumarins are also
photocarcinogenic. However, the risk of phototoxicity
in humans from ingestion of dong quai has not been
characterized. (TCPHP, 290-291)
Based on animal studies, caution is advised
for patients receiving chronic treatment with
anticoagulant drugs such as Coumadin (warfarin).
(PPP, 352)
Refer to the MediHerb Herb-Drug Interactions chart.
False Unicorn
Chamaelirium luteum root
2b
Excessive doses may produce nausea and vomiting.
None known. (BHC, 125; CGBLH, 204)
(BHC, 125) Canadian regulations do not allow this herb
as a non-medicinal ingredient for oral use products.
(BSH, 27) Very large doses are said to cause nausea and
vomiting. (CGBLH, 204)
Shepherd’s Purse
Capsella bursa-pastoris herb
2b, 2d
Large doses may cause heart palpitations; individuals
with history of kidney stones should use cautiously.
(BSH, 23; HM, 351)
None known. (TGHM, 208; HM, 352; CGBLH, 413)
Consult with a physician when patient has breast cancer
condition. (PPP, 244) The herb reduces testosterone
production from ovaries but not from adrenal glands.
(CAACH, 31)
None known. (CGBLH, 458) Should not be combined
with Fritillaria verticillata, Cuscuta japonica and
Rheum officinale. (WHO1, 199) Caution should
be exercised when used with estrogenic drugs or
anticoagulant drugs. (PPP, 244; CGBLH, 458)
White Peony
Paeonia lactiflora root
Note: 1
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
16
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Cat's Claw Complex
Contraindicated in pregnancy and lactation. Contraindicated in patients taking anticoagulant drugs. Contraindicated in known allergy to plants of the daisy family.
Cat’s Claw
Uncaria tomentosa inner stem bark
4
Pau d’Arco
1
Tabebuia avellanedae inner stem bark
None known. (CGBLH, 131)
Contraindicated in patients undergoing skin grafts and
organ transplants; hemophiliacs prescribed fresh blood
plasma; simultaneous administration of certain vaccines,
hormone therapies, thymus extracts, and insulin and
children under three years of age. (BSH, 119) Use
with caution in pregnancy and lactation. Diarrhea and
indigestion have been reported in several patients.
(CGBLH, 131)
Contraindicated with anticoagulants. (PPP, 504) Adverse
effects are not expected when consumed with the
recommended dosage. (PPP, 500) Caution is advised in
pregnancy. (CGBLH, 366)
Patients on anticoagulant therapy should not be
prescribed pau d’arco due to the warfarin-like action
of naphthoquinones at high doses. (PPP, 504)
Refer to the MediHerb Herb-Drug Interactions chart.
Echinacea
Echinacea purpurea root
1
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Chaste Tree
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Chaste Tree
Vitex agnus-castus fruit
Note: 2b, 2d
Contraindicated in conjunction with progesterone drugs,
the contraceptive pill, or HRT. (PPP, 332; BSH, 123;
ESCOPM, 9) The herb may aggravate pure spasmodic
dysmenorrhea not associated with PMS. (PPP, 332) Rare
occurrences of itching, urticaria and headache have
been reported. (PPP, 333; BSH, 123; HM, 63; TGHM,
108; ESCOPM, 9; CGBLH, 142) Should be used cautiously
during pregnancy and only in the early stages for
treating insufficient corpus luteal function. (CGBLH, 142)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
May interact antagonistically with dopamine
receptor antagonists, progesterone drugs,
contraceptive pill or HRT. (PPP, 332; HM, 63; TGHM,
108; CGBLH, 142)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
17
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
ChelaCo
Contraindicated in known allergy to Garlic. Contraindicated in lactation. Not to be used during pregnancy unless otherwise directed by a qualified health care
professional. In anemia and cases where iron supplementation is required, do not take simultaneously with meals or iron supplements.
Hawthorn
Crataegus monogyna herb flowering tops
Milk Thistle
Silybum marianum fruit
Garlic
Allium sativum bulb
Note: 1
1
2c
Occasional side effects include gastrointestinal disorders,
palpitation, headache, dizziness, circulatory disturbances,
sleeplessness and inner agitation. (CGBLH, 270) A
physician must be consulted in cases where symptoms
continue unchanged for longer than six weeks or when
fluid accumulates in the legs. Medical diagnosis is
absolutely necessary when pains occur in the region of
the heart, spreading out to the arms, upper abdomen
or the area around the neck, or in cases of respiratory
distress (shortness of breath). (TGHM, 143; ESCOPM, 99;
WHO2, 77) In 1997, it was noted that in Canada, the
herb carries new drug status and is not approved, as
self-treatment of cardiovascular conditions is deemed
inappropriate. (TCPHP, 257)
Hawthorn preparations may have a potentiating
effect which may necessitate a smaller dosage
of digitalis,(PPP, 446; BSH, 37) though this action
has not been confirmed. (HM, 186) Hawthorn
preparations may act in synergy with beta-blockers
and other hypotensive drugs. Modification of drug
dosage may be required. (PPP, 446; CGBLH, 270;
TCPHP, 257)
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
None known. (PPP, 560; HM, 261; TGHM, 170)
Contraindication with gastrointestinal disturbance; in
rare instances, there may be changes to the flora of
the intestine, or allergic reactions. (TGHM, 134; HM,
145; BSH, 6; BHC, 106) Fresh garlic, extracts or oil may
also cause heartburn, nausea, vomiting, and diarrhea if
taken on an empty stomach. (WHO1, 26)
Garlic intake should be discontinued 10 days before
surgery. (PPP, 200)
May increase the risk of postoperative bleeding.
(WHO1, 25; ESCOPM, 15; AEHD3, 229) Contact allergy
is noted. (AEHD1, 74; WHO1, 26) Hematologic concern
based upon in vitro data and case reports for garlic and
garlic oil. [Editor’s note: the results of case reports are
conflicting.] (TCPHP, 110, 111, 301)
None known. (TGHM, 134) Garlic’s antiplatelet effect
might be dangerous in patients taking warfarin
or antiplatelet agents such as aspirin, ticlopidine,
clopidogrel, or dipyridamole. (TCPHP, 118; HM, 115;
WHO1, 25) An interaction has been observed in two
patients taking warfarin. (ESCOPM, 15)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart
(under Hawthorn and Tannin- or OPC-containing
herbs).
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
18
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Colax
Contraindicated in closure of the gallbladder and in known allergy to plants of the daisy family. Use only with professional supervision in gallstones. This product
contains Rhamnus purshiana (Cascara). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because
Cascara may worsen these conditions and be harmful to your health. Consult your health care professional if you have frequent diarrhea or if you are pregnant, nursing,
taking medication, or have a medical condition.
Cascara
Rhamnus purshiana stem bark
2b, 2d
Contraindicated in intestinal obstruction, acute intestinal
inflammation e.g. Crohn's disease, ulcerative colitis,
appendicitis; abdominal pain of unknown origin, colic,
hemorrhoids, nephritis (TGHM, 104; HM, 49; WHO2,
264) pregnancy, lactation, (BHC, 52) children under
10 years of age and patients with severe dehydration
states with water and electrolyte depletion. (ESCOPM,
414) Fresh or inadequately prepared cascara bark
should not be used because severe vomiting and
intestinal spasm can result. (CGBLH, 127)
In single incidents, cramp-like discomforts of the
gastrointestinal tract can occur. This requires a dosage
reduction. With chronic use or abuse a range of side
effects are possible due to disturbance of water and
electrolyte balance, especially potassium deficiency
which can lead to disorders of heart function and
muscular weakness. Pigment implantation into the
intestinal mucosa (pseudomelanosis coli) can occur but
it is harmless and usually reverses upon discontinuation
of the herb. (TGHM, 105; HM, 49)
Laxatives containing anthraquinone glycosides such as
cascara are also contraindicated in patients with bowel
disease, diarrhea and constipation associated with
bowel impermeability. (PPP, 173) They should not be
used for periods of more than 2 weeks without medical
advice. (ESCOPM, 414; WHO2, 264)
Abdominal spasm and pain may occur in those with
irritable colon. A non-clinically relevant discoloration of
urine may also occur. (ESCOPM, 414)
Increased intestinal transit time may result in
reduced absorption of orally administered drugs.
(WHO2, 264)
With long-term use or abuse, due to loss of
potassium, an increase in effectiveness of cardiac
glycosides and an effect on antiarrhythmic drugs
is possible. Potassium deficiency can be increased
by simultaneous application of thiazide diuretics,
corticosteroids or licorice root. (TGHM, 105; HM, 49)
Refer to the MediHerb Herb-Drug Interactions chart.
Dandelion Root
Taraxacum officinale root
None known. (TGHM, 119; HM, 80, 81; ESCOPM,
No information. Contraindicated or at least inappropriate in the
503; CGBLH, 173)
following: (1) obstructed bile ducts, (2) unconjugated
hyperbilirubinemia, (3) acute or severe hepatocellular
disease, (4) septic cholecystitis (where there is risk of
peritonitis), (5) intestinal spasm or ileus, (6) liver cancer
and (7) gall bladder empyema. (PPP, 187; BHC, 73,
76; ESCOPM, 503; BSH, 114) In case of gallstones, first
consult a physician. (HM, 80, 81) May cause superacidic
stomach problems. (BSH, 114)
Yellow Dock
Rumex crispus root
2d
Use with caution in pregnancy. (CGBLH, 474)
Contraindicated or at least inappropriate in constipation
associated with bowel irritability, bowel disease,
diarrhea. (PPP, 173) Individuals with a history of kidney
stones should use cautiously. (BSH, 100)
None known. (CGBLH, 474)
Refer to the MediHerb Herb-Drug Interactions chart.
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
19
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Product and Ingredient Name
Class
Dill Seed
Anethum graveolens seed
1
May be contraindicated or inappropriate in
gastroesophageal reflux. (This applies to leaf and
essential oil.) (PPP, 29, 171)
None known. (TGHM, 121)
Chamomile
Matricaria recutita flower
1
Contraindicated in known allergy to chamomile or
other members of the Compositae family. (CGBLH, 137)
May cause rare contact allergy. (BHC, 155) Allergic
concern based upon case reports. (TCPHP, 301) Highly
concentrated hot tea is noted as emetic. (BSH, 74)
German Standard License requires the following label:
“The infusion should not be used near the eyes.” (BSH,
74) The pollen contained in these infusions appears to
be responsible for the allergic reaction. (CGBLH, 138)
None known. (TGHM, 107; HM, 60; BHC, 155) Avoid
concomitant administration of chamomile during
iron intake. In anemia and cases for which iron
supplementation is required, chamomile should
not be taken simultaneously with meals or iron
supplements. (CGBLH, 137-138)
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
Coleus Forte
Contraindicated in hypotension. Contraindicated in gastric or duodenal ulcers unless otherwise directed by a qualified health care professional. Not to be used during
pregnancy and lactation unless otherwise directed by a qualified health care professional. Do not use this product while taking any prescription drug(s) without the
advice of your prescribing physician.
Coleus
Coleus forskohlii root
No information. Contraindicated in hypotension. (CAACH, 106) Use
cautiously in peptic ulcer. (CGBLH, 156)
Forskolin has the ability to potentiate many
drugs. Use cautiously in patients taking prescribed
medication, especially hypotensive and antiplatelet
drugs. (CAACH, 106; CGBLH, 156)
Refer to the MediHerb Herb-Drug Interactions chart.
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
20
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Cramplex
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Corydalis
Corydalis ambigua tuber
Caution is advised in patients concurrently
No information. Contraindication: pregnancy. (CAACH, 28) Caution is
consuming powerful analgesics. (PPP, 232)
advised in prescribing for children, and patients with
neurological disease, depression, psychosis, liver and
kidney disease or those with a history of allergic or
anaphylactic reactions. (PPP, 232) Herbal sedatives
such as corydalis are also contraindicated in patients
with depression and insomnia marked by increasing
restlessness during the early hours of the morning. (PPP,
233)
Raspberry Leaf
Rubus idaeus leaf
1
Use cautiously in patients with highly inflamed,
ulcerated or damaged gastrointestinal tissue. (PPP, 37)
No adverse effects expected in pregnancy or lactation,
but confining use to the second and third trimesters is
more appropriate. (CGBLH, 381)
Tannin-containing herbs may reduce the absorption
of pharmacological substances e.g. metal ions
(iron supplements) and thiamine. Avoid concurrent
consumption. (PPP, 37, 103)
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
Wild Yam
Dioscorea villosa root & rhizome
1
Cramp Bark
Viburnum opulus stem bark
None known. (CGBLH, 164)
No information. Nausea and vomiting may occur with large doses.
(CGBLH, 100) Canadian regulations do not allow cramp
bark as a non-medicinal ingredient for oral use products.
(BSH, 122)
Ginger
Zingiber officinale rhizome
2b, 2d
Note: Large doses produce emesis. (BSH, 42) Oral use may
cause irritation of the gastric mucous membranes and
reflux. (CGBLH, 464) Also classified as choleretic and
cholagogue, the herb is either contraindicated or at
least inappropriate in the following: (1) obstructed bile
ducts, (2) unconjugated hyperbilirubinemia, (3) acute
or severe hepatocellular disease, (4) septic cholecystitis
(where there is risk of peritonitis), (5) intestinal spasm
or ileus, and (6) liver cancer. (PPP, 187)
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (CGBLH, 464) Consult physician when
patient is being treated with estrogen-promoting
drugs. (PPP, 46, 245) The herb is contraindicated
or at least inappropriate when there is already
prescription of strong anti-inflammatory medication.
(PPP, 149)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
21
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Cranberry Complex
Contraindicated in kidney disease. Contraindicated in pregnancy and lactation.
Crataeva
Crataeva nurvala stem bark
No information. None known. (CGBLH, 168)
None known. (CGBLH, 168)
Uva Ursi
Arctostaphylos uva-ursi leaf
2b, 2d
Should not be given with treatments that will
lead to the production of acidic urine (leading to a
reduction of antibacterial effect). The high tannin
content could interfere with the absorption of some
nutrients. (CGBLH, 444)
Cranberry
Vaccinium macrocarpon fruit
Buchu
Barosma betulina leaf essential oil
Note: Large doses may cause nausea and vomiting. (HM, 391;
BHC, 212) May also cause cramping and constipation,
due to high tannin content. Not suitable for longterm use. (PPP, 284; ESCOPM, 536; CGBLH, 444)
Contraindications: kidney disorders, renal failure, which
may be theoretical, and pregnancy. (BHC, 212; PPP, 223,
284; BSH, 13; ESCOPM, 536-537)
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
No information. Ingestion of large amounts of cranberry juice (more
than 3 liters per day) may result in diarrhea and other
gastrointestinal symptoms. (TCPHP, 158)
No information.
No information. Constituents in the essential oil can cause irritation.
(TGHM, 317) At an oral daily dose of 0.5 mL or above:
use with caution; should not be taken in pregnancy and
children up to 2 years of age. (EOS, 113-114, 124)
No information.
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
22
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
DermaCo
Contraindicated in pregnancy and lactation.
Oregon Grape
Berberis aquifolium (Mahonia aquifolium) root & rhizome
2b
Berberine, an alkaloid constituent of this herb, may
Canadian regulations require bilingual label warning
potentiate other drugs which displace the protein
against use in pregnancy and is an unacceptable nonbinding of bilirubin. (PPP, 295)
medicinal ingredient in oral use products. (BSH, 73)
Contraindicated in pregnancy, and jaundiced neonates.
(CGBLH, 80) This herb is classified as a choleretic and
cholagogue. It is either contraindicated or at least
inappropriate in the following: (1) obstructed bile ducts,
(2) unconjugated hyperbilirubinemia, (3) acute or
severe hepatocellular disease, (4) septic cholecystitis
(where there is risk of peritonitis), (5) intestinal spasm
or ileus, and (6) liver cancer. (PPP, 187) As an alterative,
this herb may be provocative to skin disease, and
care needs to be taken to reduce the prospects of
exacerbations. (PPP, 254)
Sarsaparilla
Smilax ornata root & rhizome
1
Risks: taking the herb may lead to gastric irritation and
temporary kidney impairment (diuresis). The absorption
of simultaneously administered substances may be
increased. The elimination of other substances (e.g.,
hypnotics) is accelerated. This can cause an uncontrolled
condition of increased or decreased action of herbs
taken simultaneously. (TGHM, 372) These concerns are
theoretical, and not established by animal studies or
case reports. (CGBLH, 397)
Commission E advises of potential drug interactions
with hypnotics, digitalis glycosides, and bismuth.
However, no other reference substantiates these
concerns. (BSH, 108) Such concerns would be
alleviated by not taking sarsaparilla simultaneously
with drug medication. (CGBLH, 397)
Cleavers
Galium aparine herb
1
This herb may be provocative to skin disease, and care
needs to be taken to reduce the prospects for major
exacerbations. (PPP, 254)
None known. (BHC, 61; CGBLH, 152)
Burdock
Arctium lappa root
1
None known. (BHC, 46; TGHM, 318)
None known. (CGBLH, 118)
Yellow Dock
Rumex crispus root
2d
Use with caution in pregnancy. (CGBLH, 474)
Contraindicated or at least inappropriate in constipation
associated with bowel irritability, bowel disease,
diarrhea. (PPP, 173) Individuals with a history of kidney
stones should use cautiously. (BSH, 100)
None known. (CGBLH, 474)
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
23
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
DiaCo Phytosynergist®
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation. Contraindicated in known
allergy to plants of the daisy family.
Echinacea
Echinacea angustifolia root
1
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Elder Flower
Sambucus nigra flower
1
Diuretic mechanism indicates potassium loss, a
potassium supplement may be indicated. (PPP, 221)
None known. (HM, 104; TGHM, 124; CGBLH, 191)
Lime Flower
Tilia cordata flower
1
Regulated in the U.S. as an allowable flavoring agent in
alcoholic beverages only. (BSH, 116) Allergic reaction
occurs rarely. (AEHD2, 304; CGBLH, 318)
None known. (HM, 241; TGHM, 342) Avoid
concomitant administration of lime flower during
iron intake. In anemia and cases for which iron
supplementation is required, lime flower should
not be taken simultaneously with meals or iron
supplements. (CGBLH, 318)
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
Yarrow
Achillea millefolium herb
2b
Yarrow is an antispasmodic and may be contraindicated None known. (HM, 421; TGHM, 234; CGBLH, 471)
or inappropriate in gastric and enteric poisoning
incidents. (PPP, 172) May increase menstrual blood
flow, not by uterine contraction, but by regulating the
blood vessels in the uterus. (BSH, 171) Contraindication:
known hypersensitivity to Yarrow or other Compositae.
(BHC, 228; HM 421; TGHM, 233) Some authorities
advise immediate cessation of treatment in the event
of “itching and inflammatory changes in the skin” for
persons prone to allergies to Asteraceae (Compositae).
(BSH, 3) Thujone-containing varieties should be avoided
during pregnancy and lactation. (CGBLH, 471)
Ginger
Zingiber officinale rhizome
2b, 2d
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Refer to the MediHerb Herb-Drug Interactions chart.
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
24
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
25
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
DiGest
Contraindicated in gastric or duodenal ulcers unless otherwise directed by a qualified health care professional. Contraindicated in closure of the gallbladder. Use only
with professional supervision in gallstones. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Dandelion Root
Taraxacum officinale root
None known. (TGHM, 119; HM, 80, 81; ESCOPM,
No information. Contraindicated or at least inappropriate in the
503; CGBLH, 173)
following: (1) obstructed bile ducts, (2) unconjugated
hyperbilirubinemia, (3) acute or severe hepatocellular
disease, (4) septic cholecystitis (where there is risk of
peritonitis), (5) intestinal spasm or ileus, (6) liver cancer
and (7) gall bladder empyema. (PPP, 187; BHC, 73,
76; ESCOPM, 503; BSH, 114) In case of gallstones, first
consult a physician. (HM, 80, 81) May cause superacidic
stomach problems. (BSH, 114)
Tangerine
Citrus reticulata fruit peel
1
No information.
No information.
Milk Thistle
Silybum marianum fruit
1
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
None known. (PPP, 560; HM, 261; TGHM, 170)
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Contraindicated in gastric and duodenal ulcers,
hyperacidity and when gastric irritation and
inflammation are present. (BHC, 110; BSH, 56;
TGHM, 135; HM, 150; ESCOPM, 174; CGBLH, 224)
Contraindicated or at least inappropriate in conditions
classed as ‘cold-dry’ in early medicine, involving ready
shivering with dry cough and notably some kidney
diseases. (PPP, 173) Headaches may occasionally occur
in persons sensitive to bitter substances. (TGHM, 135;
BSH, 56; ESCOPM, 175) Doses at the higher end of the
recommended range in liquid form may cause nausea
in some people. (CGBLH, 224) May not be welltolerated by persons with high blood pressure. (BSH,
56)
None known. (HM, 151; TGHM, 135; ESCOPM, 175;
CGBLH, 224)
Ginger
Zingiber officinale rhizome
2b, 2d
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
Refer to the MediHerb Herb-Drug Interactions chart.
Gentian
Gentiana lutea root
2d
Tangerine
Citrus reticulata fruit peel essential oil
No information. No information.
No information.
Chamomile
Matricaria recutita flower essential oil
No information. No information.
No information.
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
26
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
DiGest Phytosynergist®
Contraindicated in known allergy to plants of the daisy family. Contraindicated in gastric or duodenal ulcers unless otherwise directed by a qualified health care
professional. Contraindicated in closure of the gallbladder. Use only with professional supervision in gallstones. Not to be used during pregnancy and lactation unless
otherwise directed by a qualified health care professional.
Chamomile
Matricaria recutita flower
1
Contraindicated in known allergy to chamomile or
other members of the Compositae family. (CGBLH, 137)
May cause rare contact allergy. (BHC, 155) Allergic
concern based upon case reports. (TCPHP, 301) Highly
concentrated hot tea is noted as emetic. (BSH, 74)
German Standard License requires the following label:
“The infusion should not be used near the eyes.” (BSH,
74) The pollen contained in these infusions appears to
be responsible for the allergic reaction. (CGBLH, 138)
None known. (TGHM, 107; HM, 60; BHC, 155) Avoid
concomitant administration of chamomile during
iron intake. In anemia and cases for which iron
supplementation is required, chamomile should
not be taken simultaneously with meals or iron
supplements. (CGBLH, 137-138)
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
Dandelion Root
Taraxacum officinale root
None known. (TGHM, 119; HM, 80, 81; ESCOPM,
No information. Contraindicated or at least inappropriate in the
503; CGBLH, 173)
following: (1) obstructed bile ducts, (2) unconjugated
hyperbilirubinemia, (3) acute or severe hepatocellular
disease, (4) septic cholecystitis (where there is risk of
peritonitis), (5) intestinal spasm or ileus, (6) liver cancer
and (7) gall bladder empyema. (PPP, 187; BHC, 73,
76; ESCOPM, 503; BSH, 114) In case of gallstones, first
consult a physician. (HM, 80, 81) May cause superacidic
stomach problems. (BSH, 114)
Echinacea
Echinacea angustifolia root
1
Milk Thistle
Silybum marianum seed
Gentian
Gentiana lutea root
Note: 1
2d
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
None known. (PPP, 560; HM, 261; TGHM, 170)
Refer to the MediHerb Herb-Drug Interactions chart.
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
None known. (HM, 151; TGHM, 135; ESCOPM, 175;
Contraindicated in gastric and duodenal ulcers,
hyperacidity and when gastric irritation and inflammation CGBLH, 224)
are present. (BHC, 110; BSH, 56; TGHM, 135; HM, 150;
ESCOPM, 174; CGBLH, 224) Contraindicated or at least
inappropriate in conditions classed as ‘cold-dry’ in early
medicine, involving ready shivering with dry cough and
notably some kidney diseases. (PPP, 173) Headaches
may occasionally occur in persons sensitive to bitter
substances. (TGHM, 135; BSH, 56; ESCOPM, 175) Doses
at the higher end of the recommended range in liquid
form may cause nausea in some people. (CGBLH, 224)
May not be well-tolerated by persons with high blood
pressure. (BSH, 56)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
27
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Dong Quai
Do not use in severe menorrhagia. Contraindicated in the first trimester of pregnancy, especially in higher doses. Not to be used during pregnancy and lactation unless
otherwise directed by a qualified health care professional.
Dong Quai
Angelica polymorpha (Angelica sinensis) root
2b
Contraindicated in bleeding or very heavy menstruation,
first trimester of pregnancy, tendency to spontaneous
abortion, acute viral infections such as colds or
influenza. (CAACH, 5-6; BSH, 11; PPP, 352; CGBLH,
182) Also contraindicated in diarrhea caused by weak
digestion and in hemorrhagic disease. (PPP, 352)
Headache may occur in sensitive individuals. (WHO2,
32) Cardiovascular side effects include excessive
bleeding. (TCPHP, 290) A case of gynecomastia in a
male has been reported. (CGBLH, 182) Dong quai has
two furanocoumarins (psoralen and bergapten), which
are photoreactive and have the potential to cause
severe photodermatitis. These furanocoumarins are also
photocarcinogenic. However, the risk of phototoxicity
in humans from ingestion of dong quai has not been
characterized. (TCPHP, 290-291)
Based on animal studies, caution is advised
for patients receiving chronic treatment with
anticoagulant drugs such as Coumadin (warfarin).
(PPP, 352)
Refer to the MediHerb Herb-Drug Interactions chart.
Echinacea Premium
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Contraindicated in known allergy to plants of the daisy
family.
Echinacea
Echinacea angustifolia root
Echinacea
Echinacea purpurea root
Note: 1
1
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
28
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Eleuthero
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Discontinue during an acute infection or fever.
Eleuthero
Eleutherococcus senticosus root
1
Contraindicated in acute phase of infections, (PPP, 142,
539) pregnancy, lactation and in cases of known allergy
to plants of the Araliaceae family. (WHO2, 91)
Commission E noted a contraindication for hypertension.
(HM, 107; PPP, 539; TGHM, 125) Two clinical studies
recommend that Eleutherococcus not be administered
to patients with high blood pressure (HM, 107; TGHM,
62; BSH, 45), although a causal relationship to the use
of Eleutherococcus could not be established. (ESCOPM,
142) Caution is advised in cardiovascular disorders.
(CGBLH, 195)
Insomnia, palpitations, tachycardia and hypertension
have been rarely observed in association with clinical
studies. (BSH, 45; CGBLH, 195)
None known. (HM, 108; TGHM, 125; PPP, 539;
ESCOPM, 143) Reports that the herb may increase
serum digoxin levels, but not conclusive (PPP,
539) and the identity of the plant material as
Eleutherococcus was not established. (WHO2, 91)
Refer to the MediHerb Herb-Drug Interactions chart.
Euphrasia Complex
Contraindicated in pregnancy and lactation. Contraindicated in known allergy to Golden Rod.
Eyebright
Euphrasia officinalis herb
1
No contraindications noted. (PPP, 376; CGBLH, 203)
Golden Rod
Solidago virgaurea herb
2d
None known. (HM, 180; ESOPM, 1996, 1; TGHM,
In chronic kidney disorders, a physician should be
139; CGBLH, 246)
consulted. (BSH, 108) Irrigation therapy (copious fluid
intake) is contraindicated in case of edema due to
impaired heart and kidney function. (HM, 180; TGHM,
139) Contraindicated in known allergy to golden rod.
Allergic reactions may occur in susceptible patients
sensitized to plants from the Compositae family. (CGBLH,
246)
Echinacea
Echinacea purpurea root
1
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (TGHM, 330; PPP, 376; CGBLH, 202)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Golden Seal
Hydrastis canadensis root & rhizome
2b
Contraindicated in hypertensive conditions, pregnancy
Berberine, an alkaloid constituent of this herb, may
and jaundiced neonates (PPP, 294; CGBLH, 250) Fresh
reinforce the effects of other drugs which displace
plant may cause irritation to the mucosa. (BSH, 62)
the protein binding of bilirubin. (PPP, 295)
Canadian regulations do not allow golden seal as a nonmedicinal ingredient for oral use products. (BSH, 62)
Cayenne
Capsicum annuum fruit
1
When administered in low doses caution is advised in
patients with hyperacidity, reflux, inflammatory bowel
disorders and chronic nephritis. (PPP, 171) Large doses
may cause strong gastrointestinal irritation. (BSH, 23)
None known for internal ingestion, (HM, 54;
TGHM, 178) although pungent principles may
increase absorption rates and metabolism of some
pharmacological agents. (PPP, 103)
Refer to the MediHerb Herb-Drug Interactions chart.
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
29
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Evening Primrose Oil
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Evening Primrose Oil
Oenothera biennis seed
1
None known. (TGHM, 189) Avoid concomitant use
May have potential to instigate undiagnosed
with phenothiazines. (PPP, 371; WHO2, 226)
temporal lobe epilepsy, especially in those receiving
phenothiazines, but not conclusive. (PPP, 371) Headache
and mild gastrointestinal disturbances have been
Refer to the MediHerb Herb-Drug Interactions chart.
reported. EPO inhibited plasma platelet factor 4 in one
clinical trial. (WHO2, 226)
Fe-Max Iron Tonic Phytosynergist®
Contraindicated in hemochromatosis and high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation.
Codonopsis
Codonopsis pilosula root
1
None known. (CGBLH, 154)
None known. (CGBLH, 154)
Nettle Leaf
Urtica dioica leaf
1
Contraindication: patients who are allergic to nettle
stings should not apply the fresh or unprocessed
dried leaves topically. (PPP, 496) Irrigation therapy
(copious fluid intake) is not advised if edema exists
due to impaired heart or kidney function. (TGHM, 216)
Occasional (rare) allergic reactions have been observed.
(BHC, 166)
None known. (TGHM, 216; ESCOPM, 522; CGBLH,
343)
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Ashwaganda
Withania somnifera root
2b, 2d
High dosages of alkaloids from Withania exhibit
prolonged hypotensive, bradycardiac and respiratory
stimulant actions, may also have depressant effect on
higher cerebral centers; sedative effects have also been
demonstrated. (CAACH, 138)
None known. (PPP, 601; CGBLH, 73) May potentiate
the effects of barbiturates. (BSH, 124)
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
30
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Ginger
Zingiber officinale rhizome
2b, 2d
Stevia
Stevia rebaudiana leaf
1
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and an
increase in gastric secretory activity leading to heartburn.
(PPP, 401; ESCOPM, 548) Topical application may cause
contact dermatitis in sensitive patients. (PPP, 401)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
None known. (BSH, 110)
No information.
Refer to the MediHerb Herb-Drug Interactions chart.
Feverfew
Contraindicated in individuals with a known hypersensitivity to Feverfew, parthenolide or other members of the daisy family. Not to be used during pregnancy and
lactation unless otherwise directed by a qualified health care professional.
Feverfew
Tanacetum parthenium leaf & stem
2b
Contraindication: pregnancy. Occasional mouth
ulceration and gastric disturbances have been reported,
but the incidence is low. Contact allergy is known but
rare. No major adverse effects with long-term use have
been recorded. (BHC, 97) Contraindicated in those with
known hypersensitivity to either feverfew, parthenolide
or other members of the Compositae family. (PPP, 391;
WHO2, 324; CGBLH, 219)
None known. (ESCOPM, 493; PPP, 391; CGBLH, 219)
In vitro studies suggest that feverfew may inhibit
platelet aggregation (TCPHP, 102), however, results
from clinical trials suggest that normal clotting
mechanisms remain intact. (PPP, 387)
Ganoderma & Shiitake
Contraindicated in cases of known allergy to Shiitake. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Shiitake
Lentinula edodes mushroom
1
No information.
No information.
Reishi
Ganoderma lucidum mushroom
1
Rare side effects (dryness of the mouth, throat, and
nasal area; itchiness; stomach upset; nosebleed; bloody
stools) have been recorded after 3 to 6 months of
continuous use. One instance of skin rash was observed
following consumption of Reishi wine. (BSH, 55)
No information.
Garlic 5000mg
Contraindicated in known allergy to Garlic. Contraindicated in lactation. Not to be used during pregnancy unless otherwise directed by a qualified health care professional.
Garlic
Allium sativum bulb
Note: 2c
Contraindication with gastrointestinal disturbance; in
rare instances, there may be changes to the flora of
the intestine, or allergic reactions. (TGHM, 134; HM,
145; BSH, 6; BHC, 106) Fresh garlic, extracts or oil may
also cause heartburn, nausea, vomiting, and diarrhea if
taken on an empty stomach. (WHO1, 26)
Garlic intake should be discontinued 10 days before
surgery. (PPP, 200)
May increase the risk of postoperative bleeding.
(WHO1, 25; ESCOPM, 15; AEHD3, 229) Contact allergy
is noted. (AEHD1, 74; WHO1, 26) Hematologic concern
based upon in vitro data and case reports for garlic and
garlic oil. [Editor’s note: the results of case reports are
conflicting.] (TCPHP, 110, 111, 301)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 134) Garlic’s antiplatelet effect
might be dangerous in patients taking warfarin
or antiplatelet agents such as aspirin, ticlopidine,
clopidogrel, or dipyridamole. (TCPHP, 118; HM, 115;
WHO1, 25) An interaction has been observed in two
patients taking warfarin. (ESCOPM, 15)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
31
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Ginkgo 2000mg
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Ginkgo
Ginkgo biloba leaf
2d
Adverse reactions: headaches, mild gastrointestinal
disturbances, and allergic skin reactions are possible.
(WHO1, 163; PPP, 414; TGHM, 138; HM, 166; AEHD3,
59; BSH, 57; ESCOPM, 179) Contraindicated in
hypersensitivity or intolerance to Ginkgo preparations.
(TGHM, 137; WHO1, 162; ESCOPM, 179) Hematologic
and neurologic concern based on case reports. (TCPHP,
301) Isolated episodes of spontaneous bleeding have
been reported. (CGBLH, 233)
None known. (TGHM, 138; WHO1, 163) Caution
should be exercised when prescribing Ginkgo with
warfarin or aspirin. (PPP, 414; HM, 167) (Although
no interactions with substances that inhibit blood
coagulation have been observed in controlled
studies. (ESCOPM, 179)) The effect of plateletaggregation inhibitors may be increased. (HM, 167)
Refer to the MediHerb Herb-Drug Interactions chart.
Golden Seal 500mg
Contraindicated in pregnancy, lactation and patients with high blood pressure.
Golden Seal
Hydrastis canadensis root & rhizome
2b
Contraindicated in hypertensive conditions, pregnancy
Berberine, an alkaloid constituent of this herb, may
and jaundiced neonates (PPP, 294; CGBLH, 250) Fresh
reinforce the effects of other drugs which displace
plant may cause irritation to the mucosa. (BSH, 62)
the protein binding of bilirubin. (PPP, 295)
Canadian regulations do not allow golden seal as a nonmedicinal ingredient for oral use products. (BSH, 62)
Gotu Kola Complex
Contraindicated in known allergy to Gotu Kola. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Gotu Kola
Centella asiatica herb
1
Grape Seed
Vitis vinifera seed
No information. No information.
None known. (WHO1, 83; CGBLH, 254)
Canadian regulations do not allow the herb as a nonmedicinal ingredient for oral use products. (BSH, 26)
Allergic contact dermatitis has been associated with
topical application, but it is a low risk. Further testing
revealed that these reactions may be due to other
ingredients in the preparations. (WHO1, 83; CGBLH, 255)
Contraindicated in known allergy and allergy to plants
of the Umbelliferae (carrot) family. (WHO1, 82; CGBLH,
254)
No information.
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
Ginkgo
Ginkgo biloba leaf
Note: 2d
Adverse reactions: headaches, mild gastrointestinal
disturbances, and allergic skin reactions are possible.
(WHO1, 163; PPP, 414; TGHM, 138; HM, 166; AEHD3,
59; BSH, 57; ESCOPM, 179) Contraindicated in
hypersensitivity or intolerance to Ginkgo preparations.
(TGHM, 137; WHO1, 162; ESCOPM, 179) Hematologic
and neurologic concern based on case reports. (TCPHP,
301) Isolated episodes of spontaneous bleeding have
been reported. (CGBLH, 233)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 138; WHO1, 163) Caution
should be exercised when prescribing Ginkgo with
warfarin or aspirin. (PPP, 414; HM, 167) (Although
no interactions with substances that inhibit blood
coagulation have been observed in controlled
studies. (ESCOPM, 179)) The effect of plateletaggregation inhibitors may be increased. (HM, 167)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
32
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Gut Flora Complex
Contraindicated in pregnancy and lactation. Contraindicated in patients taking anticoagulant drugs.
Anise
Pimpinella anisum fruit essential oil
No information. Avoid in those with sensitivity to anethole. Preparations At an oral daily dose of 0.5 mL or above: use with
caution in those taking acetominophen. (EOS,
containing the essential oil should not be used during
113-114, 117)
pregnancy and lactation. (ESCOPM, 37) [Editor’s note:
This information is based on a caution in humans at an
oral daily dose of 0.5 mL or above of the essential oil
and antifertility effects demonstrated in an animal study
using very high doses (50–80 mg/kg of the constituent
anethole, about 870–1400 mg/kg for the best quality
essential oil).]
At an oral daily dose of 0.5 mL or above: use with
caution in alcoholism, estrogen-dependent cancers, liver
disease, endometriosis. (EOS, 113-114, 117)
Pau d’Arco
Tabebuia avellanedae stem
1
Contraindicated with anticoagulants. (PPP, 504) Adverse
effects are not expected when consumed with the
recommended dosage. (PPP, 500) Caution is advised in
pregnancy. (CGBLH, 366)
Patients on anticoagulant therapy should not be
prescribed pau d’arco due to the warfarin-like action
of naphthoquinones at high doses. (PPP, 504)
Refer to the MediHerb Herb-Drug Interactions chart.
Andrographis
Andrographis paniculata herb
2b
Oregano
Origanum vulgare leaf essential oil
No information. None known for an oral daily dose of 0.5 mL or above.
(EOS, 113-114, 156)
Contraindication: pregnancy, (BSH, 9; CAACH, 100;
CGBLH, 65) lactation; known allergy to plants of the
Acanthaceae family. (WHO2, 20) High doses may cause
gastric discomfort, loss of appetite and vomiting, but
generally there are few side effects and it is non-toxic.
(CAACH, 99) Two cases of urticaria have been reported.
(WHO2, 21; CGBLH, 65)
None known. (PPP, 266; CGBLH, 65)
No information.
Gymnema 4g
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Gymnema
Gymnema sylvestre leaf
No information. Since it contains saponins, this herb may be a
gastrointestinal irritant. (PPP, 46)
None known. (CGBLH, 267) [Editor's note: Particular
care should be exercised where the patient is taking
insulin or oral hypoglycemic drugs.]
Refer to the MediHerb Herb-Drug Interactions chart
(under Hypoglycemic herbs).
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
33
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Hawthorn
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Hawthorn
Crataegus monogyna herb flowering top
1
Occasional side effects include gastrointestinal disorders,
palpitation, headache, dizziness, circulatory disturbances,
sleeplessness and inner agitation. (CGBLH, 270) A
physician must be consulted in cases where symptoms
continue unchanged for longer than six weeks or when
fluid accumulates in the legs. Medical diagnosis is
absolutely necessary when pains occur in the region of
the heart, spreading out to the arms, upper abdomen
or the area around the neck, or in cases of respiratory
distress (shortness of breath). (TGHM, 143; ESCOPM, 99;
WHO2, 77) In 1997, it was noted that in Canada, the
herb carries new drug status and is not approved, as
self-treatment of cardiovascular conditions is deemed
inappropriate. (TCPHP, 257)
Hawthorn preparations may have a potentiating
effect which may necessitate a smaller dosage
of digitalis,(PPP, 446; BSH, 37) though this action
has not been confirmed. (HM, 186) Hawthorn
preparations may act in synergy with beta-blockers
and other hypotensive drugs. Modification of drug
dosage may be required. (PPP, 446; CGBLH, 270;
TCPHP, 257)
Refer to the MediHerb Herb-Drug Interactions chart
(under Hawthorn and Tannin- or OPC-containing
herbs).
Herbal Throat Spray Phytosynergist®
Contraindicated in known allergy to plants of the daisy family, and allergy to clove or eugenol. Not to be used during pregnancy and lactation unless otherwise directed
by a qualified health care professional.
Marshmallow Root
Althaea officinalis root
1
As a mucilage or respiratory demulcent, contraindicated Absorption of other drugs taken simultaneously may
or at least inappropriate in congestive bronchial,
be delayed. (BSH, 9; HM, 245, 247; ESCOPM, 33;
catarrhal and congestive conditions of the mucosa. (PPP, TGHM, 166, 167; WHO2, 9; CGBLH, 321)
169, 211)
Refer to the MediHerb Herb-Drug Interactions chart.
Sage
Salvia officinalis herb
2b, 2d
Leaf and essential oil are contraindicated in pregnancy
and lactation. (CGBLH, 394; TGHM, 198) After prolonged
ingestion of alcohol extracts or of the pure essential
oil, epileptiform convulsions can occur. (HM, 332;
TGHM, 198) Caution is advised with the use of alcoholic
preparations and the pure essential oil because of the
presence of thujone. (ESCOPM, 453; HM, 332; TGHM,
198) Do not exceed the recommended dose, take with
caution if using long term. (CGBLH, 394)
Calendula
Calendula officinalis flower
No information. Inappropriate when there is already prescription of
strong anti-inflammatory medication, (PPP, 148) and
for those with known sensitivity to members of the
Compositae family. (ESCOPM, 59; WHO2, 41; CGBLH,
120) Weak skin sensitization and a case of anaphylactic
shock has been reported from topical use (a gargle).
(CGBLH, 120)
None known. (HM, 332; ESCOPM, 453; TGHM, 198;
BSH, 102; CGBLH, 394)
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
None known. (HM, 45; ESCOPM, 59; TGHM, 100,
319; CGBLH, 120)
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
34
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Echinacea
Echinacea angustifolia root
1
Contraindications, Cautions
and Potential Adverse Reactions
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
Interactions with Drugs
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Myrrh
Commiphora molmol resin
2b, 2d
Clove
Syzygium aromaticum bud essential oil
No information. Oil of clove may be irritating to mucosal tissues. (TGHM, At an oral daily dose of 0.5 mL or above: use
112)
with caution in those taking anticoagulants or
acetominophen. (EOS, 113-114, 131)
At an oral daily dose of 0.5 mL or above: use with
caution in alcoholism, hemophilia, kidney disease, liver
disease, prostate cancer, systemic lupus erythematosus.
(EOS, 113-114, 131)
Contraindicated in pregnancy, excessive uterine bleeding None known. (CGBLH, 335)
and known allergy. Allergic contact dermatitis has been
reported. Not to be ingested for prolonged periods
(> few weeks). (CGBLH, 335)
HiPep
Contraindicated in known allergy to plants of the daisy family. Meadowsweet should be avoided by persons hypersensitive to salicylates. Not to be used during
pregnancy and lactation unless otherwise directed by a qualified health care professional.
Deglycyrrhizinized Licorice
Glycyrrhiza glabra root
No information. Deglycyrrhizinized licorice is usually free of adverse
effects. (BSH, 58; BHC, 146)
Co-administered deglycyrrhizinized licorice increased
the bioavailability of nitrofurantoin.(AEHD3, 77)
Refer to the MediHerb Herb-Drug Interactions chart.
Chamomile
Matricaria recutita flower
Meadowsweet
Filipendula ulmaria herb
1
1
Contraindicated in known allergy to chamomile or
other members of the Compositae family. (CGBLH, 137)
May cause rare contact allergy. (BHC, 155) Allergic
concern based upon case reports. (TCPHP, 301) Highly
concentrated hot tea is noted as emetic. (BSH, 74)
German Standard License requires the following label:
“The infusion should not be used near the eyes.” (BSH,
74) The pollen contained in these infusions appears to
be responsible for the allergic reaction. (CGBLH, 138)
None known. (TGHM, 107; HM, 60; BHC, 155) Avoid
concomitant administration of chamomile during
iron intake. In anemia and cases for which iron
supplementation is required, chamomile should
not be taken simultaneously with meals or iron
supplements. (CGBLH, 137-138)
Contraindicated in cases of hypersensitivity to
salicylates.(ESCOPM, 158)
None known. (TGHM, 169; HM, 254; ESCOPM, 158)
With the experimental anticoagulant effect of this
herb, caution should be used if patients are taking
warfarin, (PPP, 481; CGBLH, 324) although the level
of salicylate derivatives makes interaction with
anticoagulant agents unlikely. (ESCOPM, 158)
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
Refer to the MediHerb Herb-Drug Interactions
chart (under Meadowsweet and Tannin- or OPCcontaining herbs).
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
35
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Horsechestnut Complex
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Butcher’s Broom
Ruscus aculeatus root & rhizome
1
Horsechestnut
Aesculus hippocastanum seed
No information. Contraindicated in known allergy to plants of the
Hippocastanaceae family. (WHO2, 144) Adverse
effects reported to include pruritis, nausea, and gastric
complaints in isolated cases after oral intake. (HM, 203;
ESCOPM, 249; WHO2, 145) Oral use may cause irritation
of the gastric mucous membranes and reflux. Saponins
may cause hemolysis, but this effect is negligible at the
oral doses commonly used. (PPP, 454) Horsechestnut
should not be applied to broken or ulcerated skin. (PPP,
454) Allergic reactions have been reported from topical
use of the active constituent escin. (WHO2, 145)
None known. (HM, 203; PPP, 454; ESCOPM, 249;
CGBLH, 281)
Ginkgo
Ginkgo biloba leaf
2d
None known. (TGHM, 138; WHO1, 163) Caution
should be exercised when prescribing Ginkgo with
warfarin or aspirin. (PPP, 414; HM, 167) (Although
no interactions with substances that inhibit blood
coagulation have been observed in controlled
studies. (ESCOPM, 179)) The effect of plateletaggregation inhibitors may be increased. (HM, 167)
None known. (ESCOPM, 438) In rare cases, gastric
disorders or nausea may occur. (HM, 41; TGHM, 99)
Adverse reactions: headaches, mild gastrointestinal
disturbances, and allergic skin reactions are possible.
(WHO1, 163; PPP, 414; TGHM, 138; HM, 166; AEHD3,
59; BSH, 57; ESCOPM, 179) Contraindicated in
hypersensitivity or intolerance to Ginkgo preparations.
(TGHM, 137; WHO1, 162; ESCOPM, 179) Hematologic
and neurologic concern based on case reports. (TCPHP,
301) Isolated episodes of spontaneous bleeding have
been reported. (CGBLH, 233)
None known. (HM, 41; TGHM, 99; ESCOPM, 438)
Refer to the MediHerb Herb-Drug Interactions chart.
LivCo
®
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional. In anemia and cases where iron
supplementation, do not take simultaneously with meals or iron supplements.
Schisandra
Schisandra chinensis fruit
Rosemary
Rosmarinus officinalis leaf
1
2b
Contraindicated in pregnancy, except to assist childbirth;
in the early stages of cough or rash and in excess heat
patterns. (CGBLH, 405) May be contraindicated in liver
carcinoma. (PPP, 192) Rare side effects of appetite
suppression, stomach upset, and urticaria are reported.
(BSH, 104)
None known. (CGBLH, 405)
Contraindications: pregnancy (PPP, 100) and
hypersensitivity to rosemary leaf and rosemary
preparations, especially those containing carnosol.
(ESCOPM, 430) Caution may be warranted in women
wishing to conceive. (CGBLH, 389)
None known. (HM, 327; TGHM, 197; ESCOPM, 430)
Avoid concomitant administration of rosemary
during iron intake. In anemia and cases for which
iron supplementation is required, rosemary should
not be taken simultaneously with meals or iron
supplements. (CGBLH, 389)
Refer to the MediHerb Herb-Drug Interactions chart.
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
Milk Thistle
Silybum marianum seed
Note: 1
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (PPP, 560; HM, 261; TGHM, 170)
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
36
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Livton® Complex
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional. Contraindicated in closure of the
gallbladder. In anemia and cases where iron supplementation, do not take simultaneously with meals or iron supplements. Use only with professional supervision in
gallstones.
Globe Artichoke
Cynara scolymus leaf
No information. Contraindicated in closure of the gallbladder (PPP, 437) None known. (PPP, 437; TGHM, 85; HM, 11; ESCOPM,
or obstruction of bile duct. (ESCOPM, 119). Precautions 119; CGBLH, 240)
with known allergies to artichoke and similar plants
(Compositae family). The likelihood of allergy is very
low, no cases of allergy reaction after oral intake have
been reported. (TGHM, 84; HM, 11; ESCOPM, 119;
CGBLH, 240) Use only with professional supervision in
cholelithiasis. (PPP, 437; HM, 11; ESCOPM, 119) As with
other members of the Compositae family, contact with
fresh plant can cause contact dermatitis. (PPP, 438) Mild
gastrointestinal disturbances may occur in rare cases;
allergic reactions might occur in sensitized patients.
(ESCOPM, 119)
Dandelion Root
Taraxacum officinale root
None known. (TGHM, 119; HM, 80, 81; ESCOPM,
No information. Contraindicated or at least inappropriate in the
503; CGBLH, 173)
following: (1) obstructed bile ducts, (2) unconjugated
hyperbilirubinemia, (3) acute or severe hepatocellular
disease, (4) septic cholecystitis (where there is risk of
peritonitis), (5) intestinal spasm or ileus, (6) liver cancer
and (7) gall bladder empyema. (PPP, 187; BHC, 73,
76; ESCOPM, 503; BSH, 114) In case of gallstones, first
consult a physician. (HM, 80, 81) May cause superacidic
stomach problems. (BSH, 114)
Milk Thistle
Silybum marianum seed
1
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
None known. (PPP, 560; HM, 261; TGHM, 170)
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
Bupleurum
Bupleurum falcatum root
1
Contraindicated in deficient yin cough, or liver fire
ascending to the head, such as some cases of headache
and hypertension. (CGBLH, 116) Bupleurum has a slight
sedative effect in some patients and may also increase
bowel movements and flatulence (wind). (CAACH, 23;
WHO1, 73, 74; PPP, 317) May cause nausea and reflux
in sensitive patients. (PPP, 317)
The use of alcohol, sedatives and other central
nervous system depressants, in conjunction with
this herb, may cause synergistic sedative effects.
(WHO1, 73)
Fringe Tree
Chionanthus virginicus stem bark
1
The herb is classified as a choleretic and cholagogue. It
is either contraindicated or at least inappropriate in the
following: (1) obstructed bile ducts, (2) unconjugated
hyperbilirubinemia, (3) acute or severe hepatocellular
disease, (4) septic cholecystitis (where there is risk of
peritonitis), (5) intestinal spasm or ileus, and (6) liver
cancer. (PPP, 187)
None known. (CGBLH, 222)
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
37
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Nevaton®
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Do not use this product while taking any prescription
drug(s) without the advice of your prescribing physician. Avoid excessive exposure to UV irradiation (e.g. sunlight, tanning) when using this product.
Schisandra
Schisandra chinensis fruit
1
Contraindicated in pregnancy, except to assist childbirth;
in the early stages of cough or rash and in excess heat
patterns. (CGBLH, 405) May be contraindicated in liver
carcinoma. (PPP, 192) Rare side effects of appetite
suppression, stomach upset, and urticaria are reported.
(BSH, 104)
None known. (CGBLH, 405)
None known. (TGHM, 326; CGBLH, 171)
Refer to the MediHerb Herb-Drug Interactions chart.
Damiana
Turnera diffusa leaf
1
Possible contraindication in patients with extremely
debilitated constitutions. (PPP, 234)
Skullcap
Scutellaria lateriflora herb
1
None known. (CGBLH, 415)
May be contraindicated in depression and insomnia
marked by increasing restlessness during the early
hours of the morning. (PPP, 233) High doses may cause
giddiness, stupor, confusion, twitching, arrhythmias, and
epilepsy. (TCPHP, 218) Reports of toxicity are likely due
to adulteration with germander. (BSH, 105)
St John’s Wort
Hypericum perforatum herb flowering top
2d
Contraindicated in the treatment of serious depression
with psychotic symptoms, suicidal risk or signs and
symptoms that are so severe that they do not allow
the patient’s family or work involvements to continue.
(PPP, 549; ESCOPM, 259) Not to be taken after organ
transplants. (ESCOPM, 258) Contraindicated in known
photosensitivity and known allergy to plants of the
Clusiaceae family. (WHO2, 163; CGBLH, 420) May cause
mild stomach discomfort, skin rash, tiredness, fatigue,
headache, sleep disturbances. Photosensitization is
possible after exposure to sunlight and especially in fair
skinned individuals. (BSH, 62; TGHM, 215; HM, 363; PPP,
548; ESCOPM, 259; WHO2, 163) Patients taking higher
doses should avoid excessive exposure to sunlight and
UV radiation. (CGBLH, 420)
Caution advised in very severe debility, especially if
associated with immune or digestive collapse, renal
or hepatic failure, rampant cancer or strong regimes
of chemotherapy. (PPP, 155) Dermatologic and
neurologic concern based upon case reports. (TCPHP,
301) Side effects are rare and mild, and include minor
gastrointestinal irritations, allergic reactions, tiredness
and restlessness. (WHO2, 165) Mild, reversible
elevations of serum liver enzymes noted in HIV-positive
patients. Mania has been noted as a side effect but
has not been conclusively linked to use of the herb.
Avoid use of preparations made from herb harvested
at the onset of full flowering, and avoid dispensing
the sediment from liquid extracts – the resinous
compounds contained therein may cause sensory nerve
hypersensitivity. (CGBLH, 422)
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 215; HM, 363) May potentiate
pharmaceutical MAO-inhibitors. (BSH, 62, 173)
Recommend physician consultation when taken
with MAO inhibitors, SSRIs, and tricyclics (PPP, 549)
Reduced blood levels have been reported with
respect to cyclosporin, indinavir and potentially
other antiretroviral protease and transcriptase
inhibitors, the anticoagulants phenprocoumon and
warfarin, theophylline and digoxin. It remains an
open question whether St John’s wort preparations
also interact with oral contraceptives, particularly
low dose contraceptives (<50 mcg of estrogen).
(ESCOPM, 259) Contraindicated in patients taking
irinotecan. No clinical adverse effects have been
reported for phenytoin or any other anticonvulsant
drug. (CGBLH, 421)
Refer to the MediHerb Herb-Drug Interactions chart
(under St John’s Wort and Tannin- or OPC-containing
herbs).
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
38
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
ProstaCo
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. The National Institute on Aging recommends that men
get regular medical checkups with a thorough prostate exam.
Nettle Root
Urtica dioica root
None known. (TGHM, 217; ESCOPM, 529)
No information. Contraindicated in known allergy to plants of the
Urticaceae family. (WHO2, 337) Commission E advises
that nettle root is useful for the problems associated
with an enlarged prostate. However, they advise that its
use for BPH should occur under professional supervision.
(PPP, 496) Difficulties in micturition require at all times
clarification by a physician; consultation with a physician
is necessary especially in cases blood in the urine
and acute urine retention. (ESCOPM, 529) May cause
mild gastrointestinal trouble and allergic skin reactions
(rarely). (PPP, 496; TGHM, 216; ESCOPM, 529; WHO2,
338)
Saw Palmetto
Serenoa repens fruit
1
Crataeva
Crataeva nurvala stem bark
No information. None known. (CGBLH, 168)
None known. (HM, 338; TGHM, 201; PPP, 530;
Stomach problems or gastrointestinal distress in rare
ESCOPM, 478; CGBLH, 400)
cases. (HM, 338; TGHM, 201; BSH, 107; ESCOPM, 478)
Commission E suggests regular consultation with
a physician when using this herb for treatment of
enlarged prostate. This caution is based on assumption
that this herb treats only symptoms without eliminating
hypertrophic concerns. (BSH, 107) No adverse effects
are expected if used as recommended. (PPP, 524)
None known. (CGBLH, 168)
PulmaCo
Contraindicated in pregnancy and lactation.
Chinese Skullcap
Scutellaria baicalensis root
1
Malabar Nut Tree
Adhatoda vasica leaf
No information. Contraindicated in pregnancy except at birth. Unlikely
that abortifacient doses can be achieved by oral use of
the herb, but it is best to be cautious. (CAACH, 93)
No information.
Grindelia
Grindelia camporum herb
No information. High doses can produce kidney and stomach irritation.
(BSH, 59)
None known. (CGBLH, 224)
Turmeric
Curcuma longa rhizome
2b, 2d
None known. (HM, 382; TGHM, 222; ESCOPM, 108)
High doses (>15 g/day) should not be given to
patients taking antiplatelet or anticoagulant drugs.
(PPP, 578; CGBLH, 436)
Traditionally contraindicated in cold conditions. (CGBLH,
83) Gastric discomfort occurs rarely. (AEHD2, 291)
Contraindicated in obstruction of bile passages; in case
of gallstones, use only after consulting with a physician.
(TGHM, 222; HM, 382; WHO1, 121; PPP, 578; ESCOPM,
107) The herb should not be administered to patients
who suffer from stomach ulcers or hyperacidity. (BSH,
39; HM, 382) Occasional cases of allergic dermatitis
reported. (WHO1, 121; PPP, 578) Care should be
exercised with women wishing to conceive and patients
complaining of hair loss. (CGBLH, 436) Patients applying
topical doses should be cautioned against excessive
exposure to sunlight. (PPP, 578)
None known. (CGBLH, 83)
Refer to the MediHerb Herb-Drug Interactions chart.
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
39
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Ginkgo
Ginkgo biloba leaf
2d
Fennel
Foeniculum vulgare seed essential oil
Contraindications, Cautions
and Potential Adverse Reactions
Adverse reactions: headaches, mild gastrointestinal
disturbances, and allergic skin reactions are possible.
(WHO1, 163; PPP, 414; TGHM, 138; HM, 166; AEHD3,
59; BSH, 57; ESCOPM, 179) Contraindicated in
hypersensitivity or intolerance to Ginkgo preparations.
(TGHM, 137; WHO1, 162; ESCOPM, 179) Hematologic
and neurologic concern based on case reports. (TCPHP,
301) Isolated episodes of spontaneous bleeding have
been reported. (CGBLH, 233)
No information. In rare cases, allergic reactions affecting skin and
respiratory system. (HM, 126; TGHM, 128) Avoid
in those with sensitivity to anethole. Preparations
containing the essential oil should not be used during
pregnancy and lactation. (ESCOPM, 163) High doses
(greater than 0.1–0.6 mL/day) are contraindicated in
pregnancy, infants and toddlers. (TGHM, 128) Very high
doses should be avoided in hepatic disorders. (Normal
recommended daily dosage: 5–20 drops.) (PPP, 382)
Should not be taken at an oral daily dose of 0.5 mL or
above. (EOS, 113-114, 136)
Interactions with Drugs
None known. (TGHM, 138; WHO1, 163) Caution
should be exercised when prescribing Ginkgo with
warfarin or aspirin. (PPP, 414; HM, 167) (Although
no interactions with substances that inhibit blood
coagulation have been observed in controlled
studies. (ESCOPM, 179)) The effect of plateletaggregation inhibitors may be increased. (HM, 167)
Refer to the MediHerb Herb-Drug Interactions chart.
Interaction between fennel oil and drugs in humans
is not known. (TGHM, 128; HM, 126; PPP, 382;
AEDH1,138)
Rehmannia Complex
Contraindicated in individuals with a known hypersensitivity to Feverfew, parthenolide or other members of the daisy family. Not to be used during pregnancy and
lactation unless otherwise directed by a qualified health care professional.
Bupleurum
Bupleurum falcatum root
1
Contraindicated in deficient yin cough, or liver fire
ascending to the head, such as some cases of headache
and hypertension. (CGBLH, 116) Bupleurum has a slight
sedative effect in some patients and may also increase
bowel movements and flatulence (wind). (CAACH, 23;
WHO1, 73, 74; PPP, 317) May cause nausea and reflux
in sensitive patients. (PPP, 317)
Rehmannia
Rehmannia glutinosa root
2d
Contraindicated with diarrhea and indigestion. (BSH, 95) None known. (PPP, 521; CGBLH, 386)
Side effects may include mild diarrhea, abdominal pain,
dizziness, lack of energy, palpitations and edema. (BSH,
95; PPP, 521)
Hemidesmus
Hemidesmus indicus root
4
Although mildly immunosuppressant, there are no
reported side effects. (CAACH, 118)
None known. (CGBLH, 275)
Feverfew
Tanacetum parthenium leaf & stem
2b
Contraindication: pregnancy. Occasional mouth
ulceration and gastric disturbances have been reported,
but the incidence is low. Contact allergy is known but
rare. No major adverse effects with long-term use have
been recorded. (BHC, 97) Contraindicated in those with
known hypersensitivity to either feverfew, parthenolide
or other members of the Compositae family. (PPP, 391;
WHO2, 324; CGBLH, 219)
None known. (ESCOPM, 493; PPP, 391; CGBLH, 219)
In vitro studies suggest that feverfew may inhibit
platelet aggregation (TCPHP, 102), however, results
from clinical trials suggest that normal clotting
mechanisms remain intact. (PPP, 387)
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The use of alcohol, sedatives and other central
nervous system depressants, in conjunction with
this herb, may cause synergistic sedative effects.
(WHO1, 73)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
40
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
ResCo®
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation.
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Mullein
Verbascum thapsus leaf
1
None known. (CGBLH, 333)
None known. (HM, 271; TGHM, 173; CGBLH, 333)
Euphorbia
Euphorbia hirta herb
2d
Large doses may cause nausea and vomiting, and it
may occasionally cause epigastric distress with nausea.
(CGBLH, 199)
None known. (CGBLH, 199)
Grindelia
Grindelia camporum herb
No information. High doses can produce kidney and stomach irritation.
(BSH, 59)
None known. (CGBLH, 224)
Ginger
Zingiber officinale rhizome
2b, 2d
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
Refer to the MediHerb Herb-Drug Interactions chart.
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
41
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Product and Ingredient Name
Class
Fennel
Foeniculum vulgare fruit essential oil
No information. In rare cases, allergic reactions affecting skin and
respiratory system. (HM, 126; TGHM, 128) Avoid
in those with sensitivity to anethole. Preparations
containing the essential oil should not be used during
pregnancy and lactation. (ESCOPM, 163) High doses
(greater than 0.1–0.6 mL/day) are contraindicated in
pregnancy, infants and toddlers. (TGHM, 128) Very high
doses should be avoided in hepatic disorders. (Normal
recommended daily dosage: 5–20 drops.) (PPP, 382)
Should not be taken at an oral daily dose of 0.5 mL or
above. (EOS, 113-114, 136)
Interaction between fennel oil and drugs in humans
is not known. (TGHM, 128; HM, 126; PPP, 382;
AEDH1,138)
Thyme
Thymus vulgaris leaf essential oil
No information. None known for an oral daily dose of 0.5 mL or above.
(EOS, 113-114, 176) Substantial doses should be
avoided in pregnancy. (BSH, 116)
No information.
ResCo Phytosynergist®
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation. Contraindicated in known
allergy to Elecampane.
Mullein
Verbascum thapsus leaf
1
None known. (CGBLH, 333)
None known. (HM, 271; TGHM, 173; CGBLH, 333)
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Elecampane
Inula helenium root
2b, 2c
Occasional allergic reactions may occur. (BHC, 87) Large None known. (CGBLH, 193)
doses causes vomiting, diarrhea, cramps, spasms, and
symptoms of paralysis. (BSH, 64; TGHM, 329) Regulated
in the U.S. as an allowable flavoring agent in alcoholic
beverages only. (BSH, 64) Caution is advised in known
sensitivity to elecampane or to other members of the
Compositae family. (CGBLH, 193)
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
42
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Product and Ingredient Name
Class
Euphorbia
Euphorbia hirta herb
2d
Grindelia
Grindelia camporum herb
No information. High doses can produce kidney and stomach irritation.
(BSH, 59)
None known. (CGBLH, 224)
Ginger
Zingiber officinale rhizome
2b, 2d
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
No information. In rare cases, allergic reactions affecting skin and
respiratory system. (HM, 126; TGHM, 128) Avoid
in those with sensitivity to anethole. Preparations
containing the essential oil should not be used during
pregnancy and lactation. (ESCOPM, 163) High doses
(greater than 0.1–0.6 mL/day) are contraindicated in
pregnancy, infants and toddlers. (TGHM, 128) Very high
doses should be avoided in hepatic disorders. (Normal
recommended daily dosage: 5–20 drops.) (PPP, 382)
Should not be taken at an oral daily dose of 0.5 mL or
above. (EOS, 113-114, 136)
Interaction between fennel oil and drugs in humans
is not known. (TGHM, 128; HM, 126; PPP, 382;
AEDH1,138)
Fennel
Foeniculum vulgare fruit essential oil
Large doses may cause nausea and vomiting, and it
may occasionally cause epigastric distress with nausea.
(CGBLH, 199)
None known. (CGBLH, 199)
Refer to the MediHerb Herb-Drug Interactions chart.
Rhodiola & Ginseng
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Discontinue during an acute infection or fever.
Rhodiola
Rhodiola rosea root
No information. No information.
No information.
Korean Ginseng
Panax ginseng root
2d
May interact with monoamine oxidase inhibitor
phenelzine and also with warfarin, (PPP, 429;
WHO1, 176) although studies are needed to verify
the potential interaction with warfarin and the
underlying mechanism. (ESCOPM, 212) Do not use
with stimulants, including excessive use of caffeine.
(HM, 174; PPP, 429)
Note: Contraindicated for hypertension. (BSH, 81; HM, 174;
CGBLH, 297) Contraindicated with signs of heat, acute
infections, acute asthma, hypertension, excessive
menstruation or nose bleeds. (PPP, 429; CAACH, 41)
Consuming caffeine with ginseng increases the risk
of overstimulation and gastrointestinal upset. (BSH,
81; BHC, 116) Concurrent use with amphetamines
should be avoided. (CGBLH, 297) Higher doses can
overstimulate and aggravate insomnia, irritability,
depression, headache, palpitation, hypertension, and
can cause tremor, euphoria, skin eruptions, menstrual
abnormalities, diminished sexual function and weight
loss. (BSH, 81; CAACH, 40) The use of ginseng is not
associated with serious adverse effects if taken at the
recommended dose level. (ESCOPM, 212) May cause
side effects related to an estrogen-like activity in
women. (CGBLH, 298) May reduce blood glucose levels,
diabetic patients should consult with physician. (WHO1,
176; ESCOPM, 212)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
43
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Saligesic
Contraindicated in known allergy or sensitivity to salicylates. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care
professional.
Willow Bark
Salix purpurea stem bark
1
No relevant information found in reference texts.
[Editor's note: However, use with caution during
lactation as salicylates excreted in breast milk may
cause rashes in babies. (Health care professionals
should be aware of the possibility of Reye's syndrome,
an acute sepsis-like illness encountered exclusively in
children below 15 years of age. The cause is unknown,
although viral agents and drugs, especially salicylates,
have been implicated.)]
None known. (ESCOPM, 446) Interactions like those
encountered with salicylates may arise, however,
there is no definite evidence for this to date. (HM,
410; TGHM, 230)
Refer to the MediHerb Herb-Drug Interactions chart
(under Willow Bark and Tannin- or OPC-containing
herbs).
Silymarin
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. In anemia and cases where iron supplementation is
required, do not take simultaneously with meals or iron supplements.
Milk Thistle
Silybum marianum fruit
Note: 1
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (PPP, 560; HM, 261; TGHM, 170)
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
44
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
St John's Wort 1.8g
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Do not use this product while taking any prescription
drug(s) without the advice of your prescribing physician. Avoid excessive exposure to UV irradiation (e.g. sunlight, tanning) when using this product.
St John's Wort
Hypericum perforatum herb flowering top
Note: 2d
Contraindicated in the treatment of serious depression
with psychotic symptoms, suicidal risk or signs and
symptoms that are so severe that they do not allow
the patient’s family or work involvements to continue.
(PPP, 549; ESCOPM, 259) Not to be taken after organ
transplants. (ESCOPM, 258) Contraindicated in known
photosensitivity and known allergy to plants of the
Clusiaceae family. (WHO2, 163; CGBLH, 420) May cause
mild stomach discomfort, skin rash, tiredness, fatigue,
headache, sleep disturbances. Photosensitization is
possible after exposure to sunlight and especially in fair
skinned individuals. (BSH, 62; TGHM, 215; HM, 363; PPP,
548; ESCOPM, 259; WHO2, 163) Patients taking higher
doses should avoid excessive exposure to sunlight and
UV radiation. (CGBLH, 420)
Caution advised in very severe debility, especially if
associated with immune or digestive collapse, renal
or hepatic failure, rampant cancer or strong regimes
of chemotherapy. (PPP, 155) Dermatologic and
neurologic concern based upon case reports. (TCPHP,
301) Side effects are rare and mild, and include minor
gastrointestinal irritations, allergic reactions, tiredness
and restlessness. (WHO2, 165) Mild, reversible
elevations of serum liver enzymes noted in HIV-positive
patients. Mania has been noted as a side effect but
has not been conclusively linked to use of the herb.
Avoid use of preparations made from herb harvested
at the onset of full flowering, and avoid dispensing
the sediment from liquid extracts – the resinous
compounds contained therein may cause sensory nerve
hypersensitivity. (CGBLH, 422)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 215; HM, 363) May potentiate
pharmaceutical MAO-inhibitors. (BSH, 62, 173)
Recommend physician consultation when taken
with MAO inhibitors, SSRIs, and tricyclics (PPP, 549)
Reduced blood levels have been reported with
respect to cyclosporin, indinavir and potentially
other antiretroviral protease and transcriptase
inhibitors, the anticoagulants phenprocoumon and
warfarin, theophylline and digoxin. It remains an
open question whether St John’s wort preparations
also interact with oral contraceptives, particularly
low dose contraceptives (<50 mcg of estrogen).
(ESCOPM, 259) Contraindicated in patients taking
irinotecan. No clinical adverse effects have been
reported for phenytoin or any other anticonvulsant
drug. (CGBLH, 421)
Refer to the MediHerb Herb-Drug Interactions chart
(under St John’s Wort and Tannin- or OPC-containing
herbs).
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
45
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Thyroid Complex
Contraindicated in pregnancy and lactation. Contraindicated in hyperthyroidism and related cardiac problems.
Bladderwrack
Fucus vesiculosus whole plant
2b, 2c, 2d
Contraindicated in hyperthyroidism, cardiac problems
associated with hyperthyroidism, pregnancy and
lactation. (BHC, 38; CGBLH, 103) Long-term therapeutic
use is not recommended. (BSH, 54) Kelp (species
undefined) has caused transient hyperthyroidism,
raised levels of thyroid stimulating hormone, and in
large doses (as a food – probably not bladderwrack)
has caused subclinical hypothyroidism, Hashimoto's
thyroiditis and rare extrathyroidal effects in susceptible
individuals. (CGBLH, 103) In rare cases allergic reactions
involving serious overall reactions may occur. (TGHM,
315)
Marine organisms, including bladderwrack, naturally
accumulate arsenic. However, this is mainly organically
bound and rapidly excreted. For this reason the World
Health Organization has established a tolerable weekly
intake only for inorganic arsenic which is present in
bladderwrack at considerably lower levels. (AEHD1, 42)
However, isolated cases of adverse effects have been
attributed to arsenic intake from various seaweeds.
(AEHD1, 42)
None known. (HM, 213) May interact with thyroid
replacement therapies (thyroxine). (CGBLH, 103)
Caution indicated if taking iodine-containing drugs.
(AEHD3, 44)
High dosages of alkaloids from Withania exhibit
prolonged hypotensive, bradycardiac and respiratory
stimulant actions, may also have depressant effect on
higher cerebral centers; sedative effects have also been
demonstrated. (CAACH, 138)
None known. (PPP, 601; CGBLH, 73) May potentiate
the effects of barbiturates. (BSH, 124)
Withania (Ashwaganda)
Withania somnifera root
2b, 2d
Bacopa
Bacopa monnieri herb
No information. Containing saponins, this herb is a potential
gastrointestinal irritant. (PPP, 46; CGBLH, 80)
Refer to the MediHerb Herb-Drug Interactions chart.
None known. (CAACH, 101-102; CGBLH, 80)
Tribulus
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Tribulus
Tribulus terrestris herb (aerial parts)
Note: No information. Due to the presence of saponins, this herb may be a
gastrointestinal irritant. (PPP, 46)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
This herb may increase FSH in women, which in turn
increases levels of estrogen. (PPP, 46)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
46
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
UriCo Phytosynergist®
Contraindicated in known allergy to plants of the daisy family. Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood
potassium, pregnancy and lactation. Not to be taken long-term.
Couch Grass
Agropyron repens rhizome
No information. Copious fluid intake and herbal treatment is inadvisable None known. (TGHM, 118; CGBLH, 161)
if edema due to cardiac or renal insufficiency is
present. (TGHM, 118) The use of this diuretic may be
inappropriate and possibly even contraindicated in renal
failure and diabetes. (PPP, 222)
Echinacea
Echinacea angustifolia root
1
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Buchu
Barosma betulina leaf
2b, 2d
Occasional gastrointestinal intolerance and irritation on
empty stomach. (PPP, 311; BHC, 44) Contraindicated in
kidney inflammation. (BSH, 19)
Refer to the MediHerb Herb-Drug Interactions chart.
Refer to the MediHerb Herb-Drug Interactions chart.
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (PPP, 311; BSH, 19; TGHM, 317; CGBLH,
111)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
47
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Valerian Complex
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Valerian
Valeriana officinalis root & rhizome
1
Can aggravate a sensation of tiredness or drowsiness,
particularly in higher doses. (PPP, 587; WHO1, 273)
Overdose can result in blurred vision, erratic heart beat,
headache, nausea, restlessness, visual illusions, even
spasmodic movements. (PPP, 588; BSH, 120) Very
large doses may cause bradycardia and arrhythmias,
and decrease intestinal motility. (WHO1, 274) Canada
allows products containing valerian for use as sleeping
aids and sedatives. (TCPHP, 64) Hepatic and neurologic
concern based upon case reports, although in the case
of alleged hepatotoxicity coingestants were involved.
(TCPHP, 301)
None known. (TGHM, 226; ESCOPM, 540; HM, 397)
May increase the effects of CNS depressants or
alcohol when taken together, (PPP, 587; AEHD3, 172;
WHO1, 273) although human studies indicate that
this is unlikely for alcohol. (CGBLH, 447) The herb
may be expected to have at least an additive effect
with barbiturates, alcohol, benzodiazepines, and
other CNS depressants. (TCPHP, 64)
Refer to the MediHerb Herb-Drug Interactions chart.
Passion Flower
Passiflora incarnata herb
1
Hypersensitivity is possible in very rare cases. May
cause drowsiness. One case of nausea, bradycardia and
ventricular arrhythmia has been reported. (ESCOPM,
4) Herbal sedatives such as passion flower are also
contraindicated in patients with depression and
insomnia marked by increasing restlessness during the
early hours of the morning. (PPP, 233)
None known. (HM, 295; TGHM, 180; CGBLH, 362)
Spiny Jujube
Zizyphus spinosa seed
2b
Based on animal experiments, the herb has
anticonvulsant and hypotensive properties; sedative
effects have been observed. (CAACH, 88) Noted as
uterine stimulant. (BSH, 125)
Zizyphus has synergistic effects with many sedatives
and hypnotics. (CAACH, 88)
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
48
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Vitanox®
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional. Contraindicated in closure of the
gallbladder. Use only with professional supervision in gallstones. In anemia and cases where iron supplementation, do not take simultaneously with meals or iron
supplements.
Rosemary
Rosmarinus officinalis leaf
2b
Contraindications: pregnancy (PPP, 100) and
hypersensitivity to rosemary leaf and rosemary
preparations, especially those containing carnosol.
(ESCOPM, 430) Caution may be warranted in women
wishing to conceive. (CGBLH, 389)
None known. (HM, 327; TGHM, 197; ESCOPM, 430)
Avoid concomitant administration of rosemary
during iron intake. In anemia and cases for which
iron supplementation is required, rosemary should
not be taken simultaneously with meals or iron
supplements. (CGBLH, 389)
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
Green Tea
Camellia sinensis leaf
Class not
defined for
green tea.
Use cautiously in patients with highly inflamed,
ulcerated or damaged gastrointestinal tissue. (PPP, 37)
Tannin-containing herbs may reduce the absorption
of pharmacological substances e.g. metal ions
(iron supplements) and thiamine. Avoid concurrent
consumption. (PPP, 37, 103)
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs
and Tannin- or OPC-containing herbs).
Turmeric
Curcuma longa rhizome
Grape Seed
Vitis vinifera seed
2b, 2d
Contraindicated in obstruction of bile passages; in case
of gallstones, use only after consulting with a physician.
(TGHM, 222; HM, 382; WHO1, 121; PPP, 578; ESCOPM,
107) The herb should not be administered to patients
who suffer from stomach ulcers or hyperacidity. (BSH,
39; HM, 382) Occasional cases of allergic dermatitis
reported. (WHO1, 121; PPP, 578) Care should be
exercised with women wishing to conceive and patients
complaining of hair loss. (CGBLH, 436) Patients applying
topical doses should be cautioned against excessive
exposure to sunlight. (PPP, 578)
No information. No information.
None known. (HM, 382; TGHM, 222; ESCOPM, 108)
High doses (>15 g/day) should not be given to
patients taking antiplatelet or anticoagulant drugs.
(PPP, 578; CGBLH, 436)
Refer to the MediHerb Herb-Drug Interactions chart.
No information.
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
49
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Wild Yam Complex
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional. Discontinue during an acute infection
or fever. Do not use this product while taking any prescription drug(s) without the advice of your prescribing physician. Avoid excessive exposure to UV irradiation (e.g.
sunlight, tanning) when using this product.
Wild Yam
Dioscorea villosa root & rhizome
1
Shatavari
Asparagus racemosus root
No information. None known. (CGBLH, 409)
None known. (CGBLH, 409)
St John's Wort
Hypericum perforatum
herb flowering top
2d
None known. (TGHM, 215; HM, 363) May potentiate
pharmaceutical MAO-inhibitors. (BSH, 62, 173)
Recommend physician consultation when taken
with MAO inhibitors, SSRIs, and tricyclics (PPP, 549)
Reduced blood levels have been reported with
respect to cyclosporin, indinavir and potentially
other antiretroviral protease and transcriptase
inhibitors, the anticoagulants phenprocoumon and
warfarin, theophylline and digoxin. It remains an
open question whether St John’s wort preparations
also interact with oral contraceptives, particularly
low dose contraceptives (<50 mcg of estrogen).
(ESCOPM, 259) Contraindicated in patients taking
irinotecan. No clinical adverse effects have been
reported for phenytoin or any other anticonvulsant
drug. (CGBLH, 421)
Large doses produce emesis. (BSH, 42) Oral use may
cause irritation of the gastric mucous membranes and
reflux. (CGBLH, 464) Also classified as choleretic and
cholagogue, the herb is either contraindicated or at
least inappropriate in the following: (1) obstructed bile
ducts, (2) unconjugated hyperbilirubinemia, (3) acute
or severe hepatocellular disease, (4) septic cholecystitis
(where there is risk of peritonitis), (5) intestinal spasm
or ileus, and (6) liver cancer. (PPP, 187)
Contraindicated in the treatment of serious depression
with psychotic symptoms, suicidal risk or signs and
symptoms that are so severe that they do not allow
the patient’s family or work involvements to continue.
(PPP, 549; ESCOPM, 259) Not to be taken after organ
transplants. (ESCOPM, 258) Contraindicated in known
photosensitivity and known allergy to plants of the
Clusiaceae family. (WHO2, 163; CGBLH, 420) May cause
mild stomach discomfort, skin rash, tiredness, fatigue,
headache, sleep disturbances. Photosensitization is
possible after exposure to sunlight and especially in fair
skinned individuals. (BSH, 62; TGHM, 215; HM, 363; PPP,
548; ESCOPM, 259; WHO2, 163) Patients taking higher
doses should avoid excessive exposure to sunlight and
UV radiation. (CGBLH, 420)
Caution advised in very severe debility, especially if
associated with immune or digestive collapse, renal
or hepatic failure, rampant cancer or strong regimes
of chemotherapy. (PPP, 155) Dermatologic and
neurologic concern based upon case reports. (TCPHP,
301) Side effects are rare and mild, and include minor
gastrointestinal irritations, allergic reactions, tiredness
and restlessness. (WHO2, 165) Mild, reversible
elevations of serum liver enzymes noted in HIV-positive
patients. Mania has been noted as a side effect but
has not been conclusively linked to use of the herb.
Avoid use of preparations made from herb harvested
at the onset of full flowering, and avoid dispensing
the sediment from liquid extracts – the resinous
compounds contained therein may cause sensory nerve
hypersensitivity.(CGBLH, 422)
None known. (CGBLH, 464) Consult physician when
patient is being treated with estrogen-promoting
drugs. (PPP, 46, 245) The herb is contraindicated
or at least inappropriate when there is already
prescription of strong anti-inflammatory medication.
(PPP, 149)
Refer to the MediHerb Herb-Drug Interactions chart
(under St John’s Wort and Tannin- or OPC-containing
herbs).
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
50
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Sage
Salvia officinalis herb
2b, 2d
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Leaf and essential oil are contraindicated in pregnancy
and lactation. (CGBLH, 394; TGHM, 198) After prolonged
ingestion of alcohol extracts or of the pure essential
oil, epileptiform convulsions can occur. (HM, 332;
TGHM, 198) Caution is advised with the use of alcoholic
preparations and the pure essential oil because of the
presence of thujone. (ESCOPM, 453; HM, 332; TGHM,
198) Do not exceed the recommended dose, take with
caution if using long term. (CGBLH, 394)
None known. (HM, 332; ESCOPM, 453; TGHM, 198;
BSH, 102; CGBLH, 394)
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
Black Cohosh
Cimicifuga racemosa root
2b, 2c
Contraindicated in pregnancy (except during the last
month to assist with birth), lactation and in women
with estrogen-dependent tumors such as breast cancer.
(PPP, 307; CGBLH, 96) Occasional gastrointestinal
discomfort may occur and large doses may cause
vertigo, headache, nausea, impaired vision, vomiting,
and impaired circulation. An estrogenic effect and
lowering of blood pressure have been recorded. (BSH,
29-30; BHC, 35; HM, 25; PPP, 307-308; ESCOPM, 80;
CGBLH, 96) Canadian regulations do not allow the herb
as a non-medicinal ingredient for oral use products.
(BSH, 30)
None known. (TGHM, 90; HM, 25; PPP, 307; ESCOPM,
80) Black cohosh demonstrated an antiproliferative
effect in vitro when combined with tamoxifen.
Whether this favorable interaction also applies
in vivo has not been established. (CGBLH, 96)
Korean Ginseng
Panax ginseng root
2d
Contraindicated for hypertension. (BSH, 81; HM, 174;
CGBLH, 297) Contraindicated with signs of heat, acute
infections, acute asthma, hypertension, excessive
menstruation or nose bleeds. (PPP, 429; CAACH, 41)
Consuming caffeine with ginseng increases the risk
of overstimulation and gastrointestinal upset. (BSH,
81; BHC, 116) Concurrent use with amphetamines
should be avoided. (CGBLH, 297) Higher doses can
overstimulate and aggravate insomnia, irritability,
depression, headache, palpitation, hypertension, and
can cause tremor, euphoria, skin eruptions, menstrual
abnormalities, diminished sexual function and weight
loss. (BSH, 81; CAACH, 40) The use of ginseng is not
associated with serious adverse effects if taken at the
recommended dose level. (ESCOPM, 212) May cause
side effects related to an estrogen-like activity in
women. (CGBLH, 298) May reduce blood glucose levels,
diabetic patients should consult with physician. (WHO1,
176; ESCOPM, 212)
May interact with monoamine oxidase inhibitor
phenelzine and also with warfarin, (PPP, 429;
WHO1, 176) although studies are needed to verify
the potential interaction with warfarin and the
underlying mechanism. (ESCOPM, 212) Do not use
with stimulants, including excessive use of caffeine.
(HM, 174; PPP, 429)
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
51
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Withania Complex
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation. Discontinue during an acute
infection or fever.
Skullcap
Scutellaria lateriflora herb
1
None known. (CGBLH, 415)
May be contraindicated in depression and insomnia
marked by increasing restlessness during the early
hours of the morning. (PPP, 233) High doses may cause
giddiness, stupor, confusion, twitching, arrhythmias, and
epilepsy. (TCPHP, 218) Reports of toxicity are likely due
to adulteration with germander. (BSH, 105)
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Withania (Ashwaganda)
Withania somnifera root
2b, 2d
High dosages of alkaloids from Withania exhibit
prolonged hypotensive, bradycardiac and respiratory
stimulant actions, may also have depressant effect on
higher cerebral centers; sedative effects have also been
demonstrated. (CAACH, 138)
None known. (PPP, 601; CGBLH, 73) May potentiate
the effects of barbiturates. (BSH, 124)
Continues on next page
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
52
Contraindications and Cautions
Tablets, Capsules & Phytosynergist® Liquid Complexes
Product and Ingredient Name
Class
Korean Ginseng
Panax ginseng root
2d
Contraindications, Cautions
and Potential Adverse Reactions
Contraindicated for hypertension. (BSH, 81; HM, 174;
CGBLH, 297) Contraindicated with signs of heat, acute
infections, acute asthma, hypertension, excessive
menstruation or nose bleeds. (PPP, 429; CAACH, 41)
Consuming caffeine with ginseng increases the risk
of overstimulation and gastrointestinal upset. (BSH,
81; BHC, 116) Concurrent use with amphetamines
should be avoided. (CGBLH, 297) Higher doses can
overstimulate and aggravate insomnia, irritability,
depression, headache, palpitation, hypertension, and
can cause tremor, euphoria, skin eruptions, menstrual
abnormalities, diminished sexual function and weight
loss. (BSH, 81; CAACH, 40) The use of ginseng is not
associated with serious adverse effects if taken at the
recommended dose level. (ESCOPM, 212) May cause
side effects related to an estrogen-like activity in
women. (CGBLH, 298) May reduce blood glucose levels,
diabetic patients should consult with physician. (WHO1,
176; ESCOPM, 212)
Interactions with Drugs
May interact with monoamine oxidase inhibitor
phenelzine and also with warfarin, (PPP, 429;
WHO1, 176) although studies are needed to verify
the potential interaction with warfarin and the
underlying mechanism. (ESCOPM, 212) Do not use
with stimulants, including excessive use of caffeine.
(HM, 174; PPP, 429)
Refer to the MediHerb Herb-Drug Interactions chart.
Wormwood Complex
Contraindicated in pregnancy and lactation.
Stemona
Stemona sessilifolia root
No information. No information.
No information.
Black Walnut
Juglans nigra green hulls
2d
Prolonged use is not advised due to the presence of
significant quantities of juglone, a known mutagen
in animals. Carcinogenic effects associated with the
chronic external use of Juglans regia have been
observed, but are inconclusive in regard to Juglans
nigra. (BSH, 65; TGHM, 381)
None known. (TGHM, 227; HM, 402)
Wormwood
Artemisia absinthium herb
2b, 2c, 2d
None known. (BSH, 15; TGHM, 233; ESCOPM, 4;
Contraindications: gastric and duodenal ulcers,
pregnancy, lactation, hyperacidity, known sensitivity to CGBLH, 469)
wormwood or other members of the Compositae family.
(ESCOPM, 4; CGBLH, 469) The toxicological risk from use
of conventional wormwood preparations is considered
to be very low. (ESCOPM, 4) The recommended dosage
range must not be exceeded. (CGBLH, 469) As a bitter,
this herb is contraindicated or at least inappropriate in
duodenal ulceration and conditions involving dry cough
and some kidney diseases. (PPP, 173) Wormwood
contains approximately 1.5–1.7% essential oil which
contains a neurotoxin called thujone. In toxic doses,
thujone acts as a convulsant poison. Therefore, the pure
essential oil must not be used. (TGHM, 233; BSH, 158)
Regulatory restrictions require finished food products to
be thujone-free in the U.S. and other countries. (BSH,
15) Toxicological concern not indicated, except in long
term use. (BSH, 15)
Clove
Syzygium aromaticum bud essential oil
No information. Oil of clove may be irritating to mucosal tissues. (TGHM, At an oral daily dose of 0.5 mL or above: use
with caution in those taking anticoagulants or
112)
acetominophen. (EOS, 113-114, 131)
At an oral daily dose of 0.5 mL or above: use with
caution in alcoholism, hemophilia, kidney disease, liver
disease, prostate cancer, systemic lupus erythematosus.
(EOS, 113-114, 131)
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
53
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Albizia 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Albizia
Albizia lebbek bark
No information. None known. (CAACH, 94) Since the herb contains
saponins, it may be a gastrointestinal irritant. It may
also be contraindicated or at least inappropriate in
topical application to open wounds, patients with celiac
disease, and some upper digestive irritations. (PPP, 46,
170)
None known. (CAACH, 95; CGBLH, 59)
Ashwaganda 1:1 Standardized
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Ashwaganda
Withania somnifera root
2b, 2d
High dosages of alkaloids from Withania exhibit
prolonged hypotensive, bradycardiac and respiratory
stimulant actions, may also have depressant effect on
higher cerebral centers; sedative effects have also been
demonstrated. (CAACH, 138)
None known. (PPP, 601; CGBLH, 73) May potentiate
the effects of barbiturates. (BSH, 124)
Astragalus 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Discontinue during an acute infection or fever.
Astragalus
Astragalus membranaceus root
1
Contraindications: not advisable in acute infections. (PPP, None known. (PPP, 277; WHO1, 56; BSH, 17; CGBLH,
277; CAACH, 19; CGBLH, 77)
77)
Bacopa 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Bacopa
Bacopa monnieri herb
No information. Containing saponins, this herb is a potential
gastrointestinal irritant. (PPP, 46; CGBLH, 80)
None known. (CAACH, 101-102; CGBLH, 80)
Bilberry 1:1
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Bilberry
Vaccinium myrtillus fruit
1
Very high doses should be used cautiously in patients
with hemorrhagic disorders and in those taking warfarin
or antiplatelet drugs. (PPP, 301) Mild side effects
affecting the gastrointestinal, cutaneous and nervous
systems observed in a small percentage of patients.
(CGBLH, 93)
None known. (HM, 18; TGHM, 88; ESCOPM, 346)
Possible interaction with warfarin and antiplatelet
drugs in very high doses. (PPP, 301)
Refer to the MediHerb Herb-Drug Interactions chart.
Black Cohosh 1:2 Quantified Activity
Contraindicated in pregnancy, lactation, and in women with estrogen-dependent tumors such as breast cancer. Caution in patients with liver problems, who frequently
use alcohol or take any medications.
Black Cohosh
Cimicifuga racemosa root
Note: 2b, 2c
Contraindicated in pregnancy (except during the last
month to assist with birth), lactation and in women
with estrogen-dependent tumors such as breast cancer.
(PPP, 307; CGBLH, 96) Occasional gastrointestinal
discomfort may occur and large doses may cause
vertigo, headache, nausea, impaired vision, vomiting,
and impaired circulation. An estrogenic effect and
lowering of blood pressure have been recorded. (BSH,
29-30; BHC, 35; HM, 25; PPP, 307-308; ESCOPM, 80;
CGBLH, 96) Canadian regulations do not allow the herb
as a non-medicinal ingredient for oral use products.
(BSH, 30)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 90; HM, 25; PPP, 307; ESCOPM,
80) Black cohosh demonstrated an antiproliferative
effect in vitro when combined with tamoxifen.
Whether this favorable interaction also applies
in vivo has not been established. (CGBLH, 96)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
54
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Black Walnut Hulls 1:10
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Black Walnut
Juglans nigra hulls
2d
Prolonged use is not advised due to the presence of
significant quantities of juglone, a known mutagen
in animals. Carcinogenic effects associated with the
chronic external use of Juglans regia have been
observed, but are inconclusive in regard to Juglans
nigra. (BSH, 65; TGHM, 381)
None known. (TGHM, 227; HM, 402)
Bladderwrack 1:1
Contraindicated in pregnancy and lactation. Contraindicated in hyperthyroidism and cardiac problems.
Bladderwrack
Fucus vesiculosus herb
2b, 2c, 2d
Contraindicated in hyperthyroidism, cardiac problems
associated with hyperthyroidism, pregnancy and
lactation. (BHC, 38; CGBLH, 103) Long-term therapeutic
use is not recommended. (BSH, 54) Kelp (species
undefined) has caused transient hyperthyroidism,
raised levels of thyroid stimulating hormone, and in
large doses (as a food – probably not bladderwrack)
has caused subclinical hypothyroidism, Hashimoto’s
thyroiditis and rare extrathyroidal effects in susceptible
individuals. (CGBLH, 103) In rare cases allergic reactions
involving serious overall reactions may occur. (TGHM,
315)
Marine organisms, including bladderwrack, naturally
accumulate arsenic. However, this is mainly organically
bound and rapidly excreted. For this reason the World
Health Organization has established a tolerable weekly
intake only for inorganic arsenic which is present in
bladderwrack at considerably lower levels. (AEHD1, 42)
However, isolated cases of adverse effects have been
attributed to arsenic intake from various seaweeds.
(AEHD1, 42)
None known. (HM, 213) May interact with thyroid
replacement therapies (thyroxine). (CGBLH, 103)
Caution indicated if taking iodine-containing drugs.
(AEHD3, 44)
Refer to the MediHerb Herb-Drug Interactions chart.
Bugleweed 1:2
Contraindicated in pregnancy and lactation. Contraindicated in hypothyroidism and enlargement of the thyroid without functional disorder.
Bugleweed
Lycopus spp. herb
2b, 2c, 2d
Contraindicated in thyroid hypofunction, enlargement
of the thyroid without functional disorders, (TGHM, 99;
BSH, 72) pregnancy and lactation. (AEHD2, 248; CGBLH,
113) Adverse reactions occurring occasionally include
undesired thyroidal effects (including enlarged thyroid)
and headache. (AEHD2, 248)
None known. (TGHM, 99) Do not take with thyroid
medications. (BSH, 72; TGHM, 99) Administration of
the herb interferes with diagnostic procedures using
radioactive isotopes. (TGHM, 99; AEHD2, 248; CGBLH,
113)
Refer to the MediHerb Herb-Drug Interactions chart.
Bupleurum 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Bupleurum
Bupleurum falcatum root
Note: 1
Contraindicated in deficient yin cough, or liver fire
ascending to the head, such as some cases of headache
and hypertension. (CGBLH, 116) Bupleurum has a slight
sedative effect in some patients and may also increase
bowel movements and flatulence (wind). (CAACH, 23;
WHO1, 73, 74; PPP, 317) May cause nausea and reflux
in sensitive patients. (PPP, 317)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The use of alcohol, sedatives and other central
nervous system depressants, in conjunction with
this herb, may cause synergistic sedative effects.
(WHO1, 73)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
55
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Burdock 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Burdock
Arctium lappa root
1
None known. (BHC, 46; TGHM, 318)
None known. (CGBLH, 118)
Calendula 1:2
Contraindicated in known allergy to plants of the daisy family. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care
professional.
Calendula
Calendula officinalis flower
No information. Inappropriate when there is already prescription of
strong anti-inflammatory medication, (PPP, 148) and
for those with known sensitivity to members of the
Compositae family. (ESCOPM, 59; WHO2, 41; CGBLH,
120) Weak skin sensitization and a case of anaphylactic
shock has been reported from topical use (a gargle).
(CGBLH, 120)
None known. (HM, 45; ESCOPM, 59; TGHM, 100,
319; CGBLH, 120)
Californian Poppy 1:2
Contraindicated in pregnancy and lactation.
Californian Poppy
Eschscholtzia californica herb
2b, 2d
This herb should be restricted in its application to
experienced and well-trained practitioners. (PPP, 232)
There is a theoretically increased risk of neurotoxicity
and other adverse effects (although no known
incidence). (PPP, 233) The following cases should be
approached with caution: (1) concurrent prescription
of powerful analgesics, (2) pain in children, (3)
neurological disease, (4) depression and psychosis, (5)
liver and kidney disease, and (6) history of allergic or
anaphylactic reactions. (PPP, 232)
None known. (CGBLH, 124) May potentiate
pharmaceutical MAO-inhibitors. (BSH, 49)
Cat’s Claw 1:2 Quantified Activity
Contraindicated in pregnancy and lactation.
Cat’s Claw
Uncaria tomentosa inner bark
4
None known. (CGBLH, 131)
Contraindicated in patients undergoing skin grafts and
organ transplants; hemophiliacs prescribed fresh blood
plasma; simultaneous administration of certain vaccines,
hormone therapies, thymus extracts, and insulin and
children under three years of age. (BSH, 119) Use
with caution in pregnancy and lactation. Diarrhea and
indigestion have been reported in several patients.
(CGBLH, 131)
Celery Seed 1:2 Quantified Activity
Contraindicated in kidney disorders. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Celery Seed
Apium graveolens fruit
Note: 2b, 2d
None known. (CGBLH, 134)
Apium graveolens can cause rare allergic reactions,
even ending in anaphylactic shock (‘celery-carrotmugwort’ allergic reaction). (TGHM, 320; BHC, 57)
Refer to the MediHerb Herb-Drug Interactions chart.
Can contain phototoxic furanocoumarins. (TGHM, 320)
The BHC recommends that celery is contraindicated in
kidney disorders and pregnancy, (BHC, 57) although
no evidence has been found for the contraindication in
pregnancy. (CGBLH, 134) As a diuretic, inappropriate and
possibly contraindicated in renal failure and diabetes.
(PPP, 222; BSH, 11)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
56
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Chamomile High Grade 1:2 Quantified Activity
Contraindicated in known allergy to plants of the daisy family. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care
professional.
Chamomile
Matricaria recutita flower
1
Contraindicated in known allergy to chamomile or
other members of the Compositae family. (CGBLH, 137)
May cause rare contact allergy. (BHC, 155) Allergic
concern based upon case reports. (TCPHP, 301) Highly
concentrated hot tea is noted as emetic. (BSH, 74)
German Standard License requires the following label:
“The infusion should not be used near the eyes.” (BSH,
74) The pollen contained in these infusions appears to
be responsible for the allergic reaction. (CGBLH, 138)
None known. (TGHM, 107; HM, 60; BHC, 155) Avoid
concomitant administration of chamomile during
iron intake. In anemia and cases for which iron
supplementation is required, chamomile should
not be taken simultaneously with meals or iron
supplements. (CGBLH, 137-138)
Refer to the MediHerb Herb-Drug Interactions chart
(under Polyphenolic- or Flavonoid-containing herbs).
Chaste Tree 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Chaste Tree
Vitex agnus-castus fruit
2b, 2d
Contraindicated in conjunction with progesterone drugs,
the contraceptive pill, or HRT. (PPP, 332; BSH, 123;
ESCOPM, 9) The herb may aggravate pure spasmodic
dysmenorrhea not associated with PMS. (PPP, 332) Rare
occurrences of itching, urticaria and headache have
been reported. (PPP, 333; BSH, 123; HM, 63; TGHM,
108; ESCOPM, 9; CGBLH, 142) Should be used cautiously
during pregnancy and only in the early stages for
treating insufficient corpus luteal function. (CGBLH, 142)
May interact antagonistically with dopamine
receptor antagonists, progesterone drugs,
contraceptive pill or HRT. (PPP, 332; HM, 63; TGHM,
108; CGBLH, 142)
Chinese Skullcap 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Chinese Skullcap
Scutellaria baicalensis root
1
Traditionally contraindicated in cold conditions. (CGBLH,
83) Gastric discomfort occurs rarely. (AEHD2, 291)
None known. (CGBLH, 83)
Cinnamon Quills 1:2
Contraindicated in pregnancy and lactation. Contraindicated in known allergy to cinnamon and Peruvian balsam.
Cinnamon
Cinnamomum cassia stem bark
2b, 2d
As an aromatic, the herb may be contraindicated or
inappropriate in gastroesophageal reflux. (PPP, 171,
211) Allergic reactions of the skin and mucosa have
been reported. (WHO1, 102; HM, 66; TGHM, 110;
BSH, 31) The herb is contraindicated in pregnancy,
cases of stomach or duodenal ulcers, and in patients
with an allergy to cinnamon, cinnamon bark oil,
cinnamaldehyde or Peruvian balsam. (WHO1, 101;
HM, 66; TGHM, 110; ESCOPM, 93) Cinnamon does not
present any special risk in pregnancy, but prolonged
use of the essential oil should be restricted during
pregnancy. (AEHD1, 111)
None known. (HM, 66; TGHM, 110; ESCOPM, 93;
CGBLH, 149)
Cleavers 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Cleavers
Galium aparine herb
Note: 1
This herb may be provocative to skin disease, and care
needs to be taken to reduce the prospects for major
exacerbations. (PPP, 254)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (BHC, 61; CGBLH, 152)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
57
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Coleus 1:1 Quantified Activity
Contraindicated in hypotension. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Coleus
Coleus forskohlii root
No information. Contraindicated in hypotension. (CAACH, 106) Use
cautiously in peptic ulcer. (CGBLH, 156)
Forskolin has the ability to potentiate many
drugs. Use cautiously in patients taking prescribed
medication, especially hypotensive and antiplatelet
drugs. (CAACH, 106; CGBLH, 156)
Refer to the MediHerb Herb-Drug Interactions chart.
Corn Silk 1:1
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Corn Silk
Zea mays styles & stigma
1
May be inappropriate and possibly even contraindicated None known. (CGBLH, 160)
with renal failure and diabetes. (PPP, 222) Regulated
in the U.S. as an allowable ingredient in certain listed
foods. (BSH, 125)
Cramp Bark 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Cramp Bark
Viburnum opulus bark
No information. Nausea and vomiting may occur with large doses.
None known. (CGBLH, 164)
(CGBLH, 100) Canadian regulations do not allow cramp
bark as a non-medicinal ingredient for oral use products.
(BSH, 122)
Damiana 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Damiana
Turnera diffusa leaf
1
Possible contraindication in patients with extremely
debilitated constitutions. (PPP, 234)
None known. (TGHM, 326; CGBLH, 171)
Dandelion Leaves 1:1
Contraindicated in closure of the gallbladder. Use only with professional supervision in gallstones. Not to be used during pregnancy and lactation unless otherwise
directed by a qualified health care professional.
Dandelion
Taraxacum officinale leaf
2d
None known. (TGHM, 119; HM, 80, 81; ESCOPM,
Contraindicated with occlusion of the bile ducts,
500; CGBLH, 173)
gallbladder empyema (including cholecystitis), and
obstructive ileus. (ESCOPM, 499-500; BSH, 114; HM, 80;
TGHM, 120; CGBLH, 173) Due to the bitter substances
within this herb, it may also cause gastric hyperacidity
and increased ulcer pain. (TGHM, 120; BSH, 114) Contact
allergies caused by sesquiterpene lactones in the latex
have been rarely observed. (HM, 80; TGHM, 119)
Dandelion Root 1:2
Contraindicated in closure of the gallbladder. Use only with professional supervision in gallstones. Not to be used during pregnancy and lactation unless otherwise
directed by a qualified health care professional.
Dandelion
Taraxacum officinale root
Note: None known. (TGHM, 119; HM, 80, 81; ESCOPM,
No information. Contraindicated or at least inappropriate in the
503; CGBLH, 173)
following: (1) obstructed bile ducts, (2) unconjugated
hyperbilirubinemia, (3) acute or severe hepatocellular
disease, (4) septic cholecystitis (where there is risk of
peritonitis), (5) intestinal spasm or ileus, (6) liver cancer
and (7) gall bladder empyema. (PPP, 187; BHC, 73,
76; ESCOPM, 503; BSH, 114) In case of gallstones, first
consult a physician. (HM, 80, 81) May cause superacidic
stomach problems. (BSH, 114)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
58
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Dong Quai 1:2
Contraindicated in the first trimester of pregnancy, especially in higher doses. Do not use in severe menorrhagia. Not to be used during pregnancy and lactation unless
otherwise directed by a qualified health care professional.
Dong Quai
Angelica polymorpha (Angelica sinensis) root
2b
Contraindicated in bleeding or very heavy menstruation,
first trimester of pregnancy, tendency to spontaneous
abortion, acute viral infections such as colds or
influenza. (CAACH, 5-6; BSH, 11; PPP, 352; CGBLH,
182) Also contraindicated in diarrhea caused by weak
digestion and in hemorrhagic disease. (PPP, 352)
Headache may occur in sensitive individuals. (WHO2,
32) Cardiovascular side effects include excessive
bleeding. (TCPHP, 290) A case of gynecomastia in a
male has been reported. (CGBLH, 182) Dong quai has
two furanocoumarins (psoralen and bergapten), which
are photoreactive and have the potential to cause
severe photodermatitis. These furanocoumarins are also
photocarcinogenic. However, the risk of phototoxicity
in humans from ingestion of dong quai has not been
characterized. (TCPHP, 290-291)
Based on animal studies, caution is advised
for patients receiving chronic treatment with
anticoagulant drugs such as Coumadin (warfarin).
(PPP, 352)
Refer to the MediHerb Herb-Drug Interactions chart.
Echinacea Premium Blend 1:2 Quantified Activity
Contraindicated in known allergy to plants of the daisy family. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care
professional.
Echinacea
Echinacea purpurea root
Echinacea
Echinacea angustifolia root
Note: 1
1
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
Commission E cautioned that Echinacea pallida
root and E. angustifolia herb and root should not
be used in systemic diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV
infections, and other autoimmune diseases (based
on theoretical considerations and not on any reports
of adverse findings). Other authoritative sources do
not support these restrictions. (HM, 94; TGHM, 121,
328; PPP, 359-360) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (HM, 95; PPP, 360) Caution is advised
for transplant patients taking immunosuppressive
drugs, short-term therapy only is suggested. (PPP,
360; CGBLH, 185)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
Refer to the MediHerb Herb-Drug Interactions chart.
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
59
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Echinacea Purpurea 1:2 Quantified Activity
Contraindicated in known allergy to plants of the daisy family. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care
professional.
Echinacea
Echinacea purpurea root
1
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Echinacea Purpurea 1:3 Glycetract
Contraindicated in known allergy to plants of the daisy family. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care
professional.
Echinacea
Echinacea purpurea root
1
Commission E cautioned that Echinacea pallida root
should not be used in systemic diseases such as
tuberculosis, leukosis, collagenosis, multiple sclerosis,
AIDS, HIV infections, and other autoimmune diseases
(based on theoretical considerations and not on any
reports of adverse findings). Other authoritative sources
do not support these restrictions. (TGHM, 121; PPP,
359-360) Should not be administered to patients with
known allergy to any plant of Asteraceae (Compositae).
(ESCOPM, 137) Allergic reactions, mainly contact
dermatitis, may occur rarely in susceptible patients from
Echinacea aerial parts. The likelihood of Echinacea root
preparations causing allergy is very low. (CGBLH, 185)
None known. (ESCOPM, 137; PPP, 360) Caution
is advised for transplant patients taking
immunosuppressive drugs, short-term therapy only
is suggested. (PPP, 360; CGBLH, 185)
Refer to the MediHerb Herb-Drug Interactions chart.
Eleuthero 1:2 Standardized
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Discontinue during an acute infection or fever.
Eleuthero
Eleutherococcus senticosus root
Note: 1
Contraindicated in acute phase of infections, (PPP, 142,
539) pregnancy, lactation and in cases of known allergy
to plants of the Araliaceae family. (WHO2, 91)
Commission E noted a contraindication for hypertension.
(HM, 107; PPP, 539; TGHM, 125) Two clinical studies
recommend that Eleutherococcus not be administered
to patients with high blood pressure (HM, 107; TGHM,
62; BSH, 45), although a causal relationship to the use
of Eleutherococcus could not be established. (ESCOPM,
142) Caution is advised in cardiovascular disorders.
(CGBLH, 195)
Insomnia, palpitations, tachycardia and hypertension
have been rarely observed in association with clinical
studies. (BSH, 45; CGBLH, 195)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (HM, 108; TGHM, 125; PPP, 539;
ESCOPM, 143) Reports that the herb may increase
serum digoxin levels, but not conclusive (PPP,
539) and the identity of the plant material as
Eleutherococcus was not established. (WHO2, 91)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
60
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Eyebright 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Eyebright
Euphrasia officinalis herb
1
No contraindications noted. (PPP, 376; CGBLH, 203)
None known. (TGHM, 330; PPP, 376; CGBLH, 202)
Garlic 1:1
Contraindicated in known allergy to Garlic. Contraindicated in lactation. Not to be used during pregnancy unless otherwise directed by a qualified health care
professional.
Garlic
Allium sativum bulb
2c
Contraindication with gastrointestinal disturbance; in
rare instances, there may be changes to the flora of
the intestine, or allergic reactions. (TGHM, 134; HM,
145; BSH, 6; BHC, 106) Fresh garlic, extracts or oil may
also cause heartburn, nausea, vomiting, and diarrhea if
taken on an empty stomach. (WHO1, 26)
Garlic intake should be discontinued 10 days before
surgery. (PPP, 200)
May increase the risk of postoperative bleeding.
(WHO1, 25; ESCOPM, 15; AEHD3, 229) Contact allergy
is noted. (AEHD1, 74; WHO1, 26) Hematologic concern
based upon in vitro data and case reports for garlic and
garlic oil. [Editor’s note: the results of case reports are
conflicting.] (TCPHP, 110, 111, 301)
None known. (TGHM, 134) Garlic’s antiplatelet effect
might be dangerous in patients taking warfarin
or antiplatelet agents such as aspirin, ticlopidine,
clopidogrel, or dipyridamole. (TCPHP, 118; HM, 115;
WHO1, 25) An interaction has been observed in two
patients taking warfarin. (ESCOPM, 15)
Refer to the MediHerb Herb-Drug Interactions chart.
Ginger 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Ginger
Zingiber officinale rhizome
2b, 2d
Contraindicated with gallstones; consult a physician
first. (HM, 156; BSH, 125; TGHM, 136) May increase
the chance of bleeding. (PPP, 401) A daily dose of 2 g
of dried ginger should not be exceeded in pregnancy.
Use with caution in cases of peptic ulceration,
gastroesophageal reflux, or other gastric diseases.
At doses approaching or greater than the maximum
recommended dose, an increase in gastric secretory
activity leading to heartburn is possible. (CGBLH, 227)
Overdose may lead to a blood-thinning effect and
an increase in gastric secretory activity leading to
heartburn. (PPP, 401; ESCOPM, 548) Topical application
may cause contact dermatitis in sensitive patients. (PPP,
401)
None known. (HM, 156; TGHM, 136) May increase
the absorption of pharmaceutical drugs. (PPP, 401)
Caution indicated for daily doses of (dried) ginger
in excess of 4 g with patients taking blood-thinning
drugs such as warfarin, or aspirin or who have
increased risk of hemorrhage. (PPP, 401; TCPHP, 129;
CAACH, 106; CGBLH, 227) May enhance absorption
of sulphaguanidine. (ESCOPM, 548)
Refer to the MediHerb Herb-Drug Interactions chart.
Ginkgo 2:1 Standardized
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Ginkgo
Ginkgo biloba leaf
Note: 2d
Adverse reactions: headaches, mild gastrointestinal
disturbances, and allergic skin reactions are possible.
(WHO1, 163; PPP, 414; TGHM, 138; HM, 166; AEHD3,
59; BSH, 57; ESCOPM, 179) Contraindicated in
hypersensitivity or intolerance to Ginkgo preparations.
(TGHM, 137; WHO1, 162; ESCOPM, 179) Hematologic
and neurologic concern based on case reports. (TCPHP,
301) Isolated episodes of spontaneous bleeding have
been reported. (CGBLH, 233)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 138; WHO1, 163) Caution
should be exercised when prescribing Ginkgo with
warfarin or aspirin. (PPP, 414; HM, 167) (Although
no interactions with substances that inhibit blood
coagulation have been observed in controlled
studies. (ESCOPM, 179)) The effect of plateletaggregation inhibitors may be increased. (HM, 167)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
61
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Globe Artichoke 1:2
Contraindicated in closure of the gallbladder. Use only with professional supervision in gallstones. Not to be used during pregnancy and lactation unless otherwise
directed by a qualified health care professional.
Globe Artichoke
Cynara scolymus leaf
No information. Contraindicated in closure of the gallbladder (PPP, 437) None known. (PPP, 437; TGHM, 85; HM, 11; ESCOPM,
or obstruction of bile duct. (ESCOPM, 119). Precautions 119; CGBLH, 240)
with known allergies to artichoke and similar plants
(Compositae family). The likelihood of allergy is very
low, no cases of allergy reaction after oral intake have
been reported. (TGHM, 84; HM, 11; ESCOPM, 119;
CGBLH, 240) Use only with professional supervision in
cholelithiasis. (PPP, 437; HM, 11; ESCOPM, 119) As with
other members of the Compositae family, contact with
fresh plant can cause contact dermatitis. (PPP, 438) Mild
gastrointestinal disturbances may occur in rare cases;
allergic reactions might occur in sensitized patients.
(ESCOPM, 119)
Golden Seal 1:3 Quantified Activity
Contraindicated in pregnancy and lactation. Contraindicated in patients with high blood pressure.
Golden Seal
Hydrastis canadensis root & rhizome
2b
Contraindicated in hypertensive conditions, pregnancy
Berberine, an alkaloid constituent of this herb, may
and jaundiced neonates (PPP, 294; CGBLH, 250) Fresh
reinforce the effects of other drugs which displace
plant may cause irritation to the mucosa. (BSH, 62)
the protein binding of bilirubin. (PPP, 295)
Canadian regulations do not allow golden seal as a nonmedicinal ingredient for oral use products. (BSH, 62)
Gotu Kola 1:1 Standardized
Contraindicated in known allergy to Gotu Kola. Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Gotu Kola
Centella asiatica herb
1
None known. (WHO1, 83; CGBLH, 254)
Canadian regulations do not allow the herb as a nonmedicinal ingredient for oral use products. (BSH, 26)
Allergic contact dermatitis has been associated with
topical application, but it is a low risk. Further testing
revealed that these reactions may be due to other
ingredients in the preparations. (WHO1, 83; CGBLH, 255)
Contraindicated in known allergy and allergy to plants
of the Umbelliferae (carrot) family. (WHO1, 82; CGBLH,
254)
Gymnema 1:1
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Gymnema
Gymnema sylvestre leaf
No information. Since it contains saponins, this herb may be a
gastrointestinal irritant. (PPP, 46)
None known. (CGBLH, 267) [Editor’s note: Particular
care should be exercised where the patient is taking
insulin or oral hypoglycemic drugs.]
Refer to the MediHerb Herb-Drug Interactions chart
(under Hypoglycemic herbs).
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
62
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Hawthorn Berries 1:2 Quantified Activity
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Hawthorn
Crataegus monogyna fruit
1
A physician must be consulted in cases where
symptoms continue unchanged for longer than six
weeks or when fluid accumulates in the legs. Medical
diagnosis is absolutely necessary when pains occur
in the region of the heart, spreading out to the arms,
upper abdomen or the area around the neck, or in
cases of respiratory distress (shortness of breath).
(TGHM, 143; ESCOPM, 99; WHO2, 77) In 1997, it was
noted that in Canada, the herb carries new drug status
and is not approved, as self-treatment of cardiovascular
conditions is deemed inappropriate. (TCPHP, 257)
Hawthorn preparations may have a potentiating
effect which may necessitate a smaller dosage
of digitalis,(PPP, 446; BSH, 37) though this action
has not been confirmed. (HM, 186) Hawthorn
preparations may act in synergy with beta-blockers
and other hypotensive drugs. Modification of drug
dosage may be required. (PPP, 446; CGBLH, 270;
TCPHP, 257)
Refer to the MediHerb Herb-Drug Interactions chart
(under Hawthorn and Tannin- or OPC-containing
herbs).
Horsechestnut 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. May cause gastric upset in some patients. Do not apply
to broken or ulcerated skin.
Horsechestnut
Aesculus hippocastanum seed
No information. Contraindicated in known allergy to plants of the
Hippocastanaceae family. (WHO2, 144) Adverse
effects reported to include pruritis, nausea, and gastric
complaints in isolated cases after oral intake. (HM, 203;
ESCOPM, 249; WHO2, 145) Oral use may cause irritation
of the gastric mucous membranes and reflux. Saponins
may cause hemolysis, but this effect is negligible at the
oral doses commonly used. (PPP, 454) Horsechestnut
should not be applied to broken or ulcerated skin. (PPP,
454) Allergic reactions have been reported from topical
use of the active constituent escin. (WHO2, 145)
None known. (HM, 203; PPP, 454; ESCOPM, 249;
CGBLH, 281)
Horsetail 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Horsetail
Equisetum arvense herb
Note: 2d
Contraindicated in cardiac or renal dysfunction. (BSH,
47; BHC, 93) Products sold in Canada are required to be
certified as free from any thiaminase-like effect. (BSH,
47) Powdered herb not recommended for children
or prolonged use. (BSH, 48) Toxicity is reported to be
similar to nicotine poisoning in children who chewed
the stem. (BSH, 48) Classified as an herbal diuretic,
may be inappropriate or possibly even contraindicated
in renal failure and diabetes. (PPP, 222) No irrigation
therapy (copious fluid intake) in case of edema due to
impaired heart and kidney function. (TGHM, 151; HM,
209)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 151; HM, 210; CGBLH, 285)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
63
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Korean Ginseng 1:2 Standardized
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Discontinue during an acute infection or fever.
Korean Ginseng
Panax ginseng main root
2d
Contraindicated for hypertension. (BSH, 81; HM, 174;
CGBLH, 297) Contraindicated with signs of heat, acute
infections, acute asthma, hypertension, excessive
menstruation or nose bleeds. (PPP, 429; CAACH, 41)
Consuming caffeine with ginseng increases the risk
of overstimulation and gastrointestinal upset. (BSH,
81; BHC, 116) Concurrent use with amphetamines
should be avoided. (CGBLH, 297) Higher doses can
overstimulate and aggravate insomnia, irritability,
depression, headache, palpitation, hypertension, and
can cause tremor, euphoria, skin eruptions, menstrual
abnormalities, diminished sexual function and weight
loss. (BSH, 81; CAACH, 40) The use of ginseng is not
associated with serious adverse effects if taken at the
recommended dose level. (ESCOPM, 212) May cause
side effects related to an estrogen-like activity in
women. (CGBLH, 298) May reduce blood glucose levels,
diabetic patients should consult with physician. (WHO1,
176; ESCOPM, 212)
May interact with monoamine oxidase inhibitor
phenelzine and also with warfarin, (PPP, 429;
WHO1, 176) although studies are needed to verify
the potential interaction with warfarin and the
underlying mechanism. (ESCOPM, 212) Do not use
with stimulants, including excessive use of caffeine.
(HM, 174; PPP, 429)
Refer to the MediHerb Herb-Drug Interactions chart.
Licorice 1:1
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation.
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Note: The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
64
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Licorice High Grade 1:1 Quantified Activity
Contraindicated in high blood pressure, edema (water retention), congestive heart failure, low blood potassium, pregnancy and lactation.
Licorice
Glycyrrhiza glabra root
2b, 2c, 2d
It is recommended that patients with cardiovascular
or renal disease use licorice only under care of health
care professional. (TCPHP, 232; PPP, 474) Patients prone
to potassium deficiency are also advised not to use
licorice. (TCPHP, 232; TGHM, 161) Treatment not to
exceed six weeks. (TCPHP, 232; BSH, 58; TGHM, 162)
Contraindications: hypertension, cholestatic liver
disorders, inflammatory liver disorders, liver cirrhosis,
hypertonia, hypokalemia, severe obesity and severe
kidney insufficiency (HM, 236; BSH, 58; BHC, 146;
TGHM, 161; WHO1, 190; AEHD3, 72; ESCOPM, 298)
pregnancy and lactation (ESCOPM, 298). In the case
of pregnancy doses up to 3 g per day are likely to be
safe. (PPP, 474) Also contraindicated if there is edema
or congestive heart failure. (PPP, 474) Caution is advised
with elderly patients. (CGBLH, 312)
Ingestion of an excessive amount can lead to severe
hypertension, cardiac arrhythmias, cardiomyopathy,
cardiac arrest, pseudoaldosteronism, myopathy,
pulmonary and generalized edema. (AEHD3, 73; BSH,
58; BHC, 146; AEHD3, 72; CGBLH, 313)
Should not be taken concurrently with corticosteroid
treatment. (WHO1, 190; AEHD3, 77) May
decrease plasma clearance and increase the
AUC of prednisolone. Licorice may potentiate the
activity of prednisolone and other corticosteroid
drugs. (ESCOPM, 298; CGBLH, 313) Concurrent
use of furosemide may potentiate development
of acute renal failure. (AEHD3, 77) Potassium loss
due to other drugs, e.g. thiazide diuretics, can be
increased. With potassium loss, sensitivity to digitalis
glycosides increases. (HM, 237; TGHM, 161; WHO1,
190) Excessive use of licorice may interact with
antiarrhythmic drugs or with drugs which induce
reversion to sinus rhythm (e.g. quinidine). (ESCOPM,
298) Should not be administered in conjunction
with spironolactone or amiloride. (WHO1, 190)
Insulin may be synergistic with glycyrrhizin in
causing electrolyte disturbances and suppression
of renin and aldosterone. (AEHD3, 77) There is
a slight chance that licorice may counteract the
contraceptive pill, on the basis of the constituent
glycyrrhizin. (CGBLH, 312)
Refer to the MediHerb Herb-Drug Interactions chart.
Marshmallow Root 1:5 Glycetract
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Marshmallow
Althaea officinalis root
1
As a mucilage or respiratory demulcent, contraindicated Absorption of other drugs taken simultaneously may
or at least inappropriate in congestive bronchial,
be delayed. (BSH, 9; HM, 245, 247; ESCOPM, 33;
catarrhal and congestive conditions of the mucosa. (PPP, TGHM, 166, 167; WHO2, 9; CGBLH, 321)
169, 211)
Refer to the MediHerb Herb-Drug Interactions chart.
Milk Thistle 1:1 Quantified Activity
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. In anemia and cases where iron supplementation is
required, do not take simultaneously with meals or iron supplements.
Milk Thistle
Silybum marianum seed
1
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
None known. (PPP, 560; HM, 261; TGHM, 170)
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
Milk Thistle 1:1 Glycetract Quantified Activity
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. In anemia and cases where iron supplementation is
required, do not take simultaneously with meals or iron supplements.
Milk Thistle
Silybum marianum seed
Note: 1
Contraindicated in cases of known allergy to plants of
the Asteraceae (Compositae) family. (WHO2, 310) Side
effect: a mild laxative effect and mild gastrointestinal
complaints have been observed in occasional instances
from the standardized preparation. (HM, 260; TGHM,
170; WHO2, 310; CGBLH, 326)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (PPP, 560; HM, 261; TGHM, 170)
Refer to the MediHerb Herb-Drug Interactions chart
(under Milk Thistle and Polyphenolic- or Flavonoidcontaining herbs).
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
65
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Mistletoe 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Mistletoe
Viscum album herb
2d
Canadian regulations do not allow European mistletoe
in foods. (BSH, 123)
None known. (TGHM, 172; CGBLH, 329)
Motherwort 1:2
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional.
Motherwort
Leonurus cardiaca herb
2b
Best avoided in early pregnancy. (CGBLH, 331) Excess
dosage may cause diarrhea, uterine bleeding, and
stomach irritation. (BSH, 69)
None known. (TGHM, 172; HM, 268; CGBLH, 331)
Nettle Leaf 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Nettle
Urtica dioica leaf
1
Contraindication: patients who are allergic to nettle
stings should not apply the fresh or unprocessed
dried leaves topically. (PPP, 496) Irrigation therapy
(copious fluid intake) is not advised if edema exists
due to impaired heart or kidney function. (TGHM, 216)
Occasional (rare) allergic reactions have been observed.
(BHC, 166)
None known. (TGHM, 216; ESCOPM, 522; CGBLH,
343)
Nettle Root 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. The National Institute on Aging recommends that men
get regular medical checkups with a thorough prostate exam.
Nettle
Urtica dioica root
None known. (TGHM, 217; ESCOPM, 529)
No information. Contraindicated in known allergy to plants of the
Urticaceae family. (WHO2, 337) Commission E advises
that nettle root is useful for the problems associated
with an enlarged prostate. However, they advise that its
use for BPH should occur under professional supervision.
(PPP, 496) Difficulties in micturition require at all times
clarification by a physician; consultation with a physician
is necessary especially in cases blood in the urine
and acute urine retention. (ESCOPM, 529) May cause
mild gastrointestinal trouble and allergic skin reactions
(rarely). (PPP, 496; TGHM, 216; ESCOPM, 529; WHO2,
338)
Oats Seed 1:1
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Oats
Avena sativa seed
Note: 1
Risks of adverse effects only in those patients with
extremely debilitated constitutions. (PPP, 234)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (HM 282; TGHM, 176; BSH, 18; CGBLH,
349)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
66
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Oregon Grape 1:2
Contraindicated in pregnancy and lactation.
Oregon Grape
Berberis aquifolium (Mahonia aquifolium) root
2b
Berberine, an alkaloid constituent of this herb, may
Canadian regulations require bilingual label warning
potentiate other drugs which displace the protein
against use in pregnancy and is an unacceptable nonbinding of bilirubin. (PPP, 295)
medicinal ingredient in oral use products. (BSH, 73)
Contraindicated in pregnancy, and jaundiced neonates.
(CGBLH, 80) This herb is classified as a choleretic and
cholagogue. It is either contraindicated or at least
inappropriate in the following: (1) obstructed bile ducts,
(2) unconjugated hyperbilirubinemia, (3) acute or
severe hepatocellular disease, (4) septic cholecystitis
(where there is risk of peritonitis), (5) intestinal spasm
or ileus, and (6) liver cancer. (PPP, 187) As an alterative,
this herb may be provocative to skin disease, and
care needs to be taken to reduce the prospects of
exacerbations. (PPP, 254)
Pau d’Arco 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Contraindicated in patients taking anticoagulant drugs.
Pau d’Arco
Tabebuia avellanedae bark
1
Contraindicated with anticoagulants. (PPP, 504) Adverse
effects are not expected when consumed with the
recommended dosage. (PPP, 500) Caution is advised in
pregnancy. (CGBLH, 366)
Patients on anticoagulant therapy should not be
prescribed pau d’arco due to the warfarin-like action
of naphthoquinones at high doses. (PPP, 504)
Refer to the MediHerb Herb-Drug Interactions chart.
Poke Root 1:5
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Contraindicated in lymphocytic leukemia and
gastrointestinal irritation.
Poke Root
Phytolacca decandra root
3
None known. (PPP, 517) Concurrent use with
Contraindications: pregnancy, lactation, lymphocytic
immunosuppressive drugs should be avoided.
leukemia and gastrointestinal irritation. (PPP, 517;
CGBLH, 376) Toxic effects from large doses may include (CGBLH, 376)
nausea, vomiting, profuse sweating and salivation.
(PPP, 517; AEHD2, 255-256) Accurate measurement
of dried plant tincture volumes is vital to ensure that
the safe dosage is not exceeded. (CGBLH, 376) Topical
application of herb should be restricted to dried plant
tinctures and the eyes should be avoided. (PPP, 517;
CGBLH, 376) Possible cardiovascular effects: muscle
weakness and spasms; possible neurological effects:
headache, dizziness, tremor, confusion, and dyspnea,
and diarrhea have been reported. (TCPHP, 239) Canadian
regulations do not allow poke root in foods. (BSH, 85)
Several case reports indicate contraindication with
cardiac conditions. (AEHD2, 257; PPP, 516)
Red Clover 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Red Clover
Trifolium pratense flower
Note: 2b
May be provocative to skin disease. Care needs to be
taken to reduce the prospects for major exacerbations.
(PPP, 255)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (CGBLH, 384)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
67
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Rehmannia 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Rehmannia
Rehmannia glutinosa root
2d
Contraindicated with diarrhea and indigestion. (BSH, 95) None known. (PPP, 521; CGBLH, 386)
Side effects may include mild diarrhea, abdominal pain,
dizziness, lack of energy, palpitations and edema. (BSH,
95; PPP, 521)
Sage 1:2 Quantified Activity
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional.
Sage
Salvia officinalis herb
2b, 2d
Leaf and essential oil are contraindicated in pregnancy
and lactation. (CGBLH, 394; TGHM, 198) After prolonged
ingestion of alcohol extracts or of the pure essential
oil, epileptiform convulsions can occur. (HM, 332;
TGHM, 198) Caution is advised with the use of alcoholic
preparations and the pure essential oil because of the
presence of thujone. (ESCOPM, 453; HM, 332; TGHM,
198) Do not exceed the recommended dose, take with
caution if using long term. (CGBLH, 394)
None known. (HM, 332; ESCOPM, 453; TGHM, 198;
BSH, 102; CGBLH, 394)
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
Sarsaparilla 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Sarsaparilla
Smilax ornata root & rhizome
1
Risks: taking the herb may lead to gastric irritation and
temporary kidney impairment (diuresis). The absorption
of simultaneously administered substances may be
increased. The elimination of other substances (e.g.,
hypnotics) is accelerated. This can cause an uncontrolled
condition of increased or decreased action of herbs
taken simultaneously. (TGHM, 372) These concerns are
theoretical, and not established by animal studies or
case reports. (CGBLH, 397)
Commission E advises of potential drug interactions
with hypnotics, digitalis glycosides, and bismuth.
However, no other reference substantiates these
concerns. (BSH, 108) Such concerns would be
alleviated by not taking sarsaparilla simultaneously
with drug medication. (CGBLH, 397)
Saw Palmetto 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. The National Institute on Aging recommends that men
get regular medical checkups with a thorough prostate exam.
Saw Palmetto
Serenoa repens fruit
1
None known. (HM, 338; TGHM, 201; PPP, 530;
Stomach problems or gastrointestinal distress in rare
ESCOPM, 478; CGBLH, 400)
cases. (HM, 338;TGHM, 201; BSH, 107; ESCOPM, 478)
Commission E suggests regular consultation with
a physician when using this herb for treatment of
enlarged prostate. This caution is based on assumption
that this herb treats only symptoms without eliminating
hypertrophic concerns. (BSH, 107) No adverse effects
are expected if used as recommended. (PPP, 524)
Schisandra 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Schisandra
Schisandra chinensis fruit
Note: 1
Contraindicated in pregnancy, except to assist childbirth;
in the early stages of cough or rash and in excess heat
patterns. (CGBLH, 405) May be contraindicated in liver
carcinoma. (PPP, 192) Rare side effects of appetite
suppression, stomach upset, and urticaria are reported.
(BSH, 104)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (CGBLH, 405)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
68
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Skullcap 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Skullcap
Scutellaria lateriflora herb
1
None known. (CGBLH, 415)
May be contraindicated in depression and insomnia
marked by increasing restlessness during the early
hours of the morning. (PPP, 233) High doses may cause
giddiness, stupor, confusion, twitching, arrhythmias, and
epilepsy. (TCPHP, 218) Reports of toxicity are likely due
to adulteration with germander. (BSH, 105)
St John’s Wort 1:2 Quantified Activity
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Do not use this product while taking any prescription
drug(s) without the advice of your prescribing physician. Avoid excessive exposure to UV irradiation (e.g. sunlight, tanning) when using this product.
St John’s Wort
2d
Hypericum perforatum flowering herb
Note: Contraindicated in the treatment of serious depression
with psychotic symptoms, suicidal risk or signs and
symptoms that are so severe that they do not allow
the patient’s family or work involvements to continue.
(PPP, 549; ESCOPM, 259) Not to be taken after organ
transplants. (ESCOPM, 258) Contraindicated in known
photosensitivity and known allergy to plants of the
Clusiaceae family. (WHO2, 163; CGBLH, 420) May cause
mild stomach discomfort, skin rash, tiredness, fatigue,
headache, sleep disturbances. Photosensitization is
possible after exposure to sunlight and especially in fair
skinned individuals. (BSH, 62; TGHM, 215; HM, 363; PPP,
548; ESCOPM, 259; WHO2, 163) Patients taking higher
doses should avoid excessive exposure to sunlight and
UV radiation. (CGBLH, 420)
Caution advised in very severe debility, especially if
associated with immune or digestive collapse, renal
or hepatic failure, rampant cancer or strong regimes
of chemotherapy. (PPP, 155) Dermatologic and
neurologic concern based upon case reports. (TCPHP,
301) Side effects are rare and mild, and include minor
gastrointestinal irritations, allergic reactions, tiredness
and restlessness. (WHO2, 165) Mild, reversible
elevations of serum liver enzymes noted in HIV-positive
patients. Mania has been noted as a side effect but
has not been conclusively linked to use of the herb.
Avoid use of preparations made from herb harvested
at the onset of full flowering, and avoid dispensing
the sediment from liquid extracts – the resinous
compounds contained therein may cause sensory nerve
hypersensitivity. (CGBLH, 422)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (TGHM, 215; HM, 363) May potentiate
pharmaceutical MAO-inhibitors. (BSH, 62, 173)
Recommend physician consultation when taken
with MAO inhibitors, SSRIs, and tricyclics (PPP, 549)
Reduced blood levels have been reported with
respect to cyclosporin, indinavir and potentially
other antiretroviral protease and transcriptase
inhibitors, the anticoagulants phenprocoumon and
warfarin, theophylline and digoxin. It remains an
open question whether St John’s wort preparations
also interact with oral contraceptives, particularly
low dose contraceptives (<50 mcg of estrogen).
(ESCOPM, 259) Contraindicated in patients taking
irinotecan. No clinical adverse effects have been
reported for phenytoin or any other anticonvulsant
drug. (CGBLH, 421)
Refer to the MediHerb Herb-Drug Interactions chart
(under St John’s Wort and Tannin- or OPC-containing
herbs).
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
69
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
St John’s Wort High Grade 1:2 Quantified Activity
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional. Do not use this product while taking any prescription
drug(s) without the advice of your prescribing physician. Avoid excessive exposure to UV irradiation (e.g. sunlight, tanning) when using this product.
St John’s Wort
2d
Hypericum perforatum flowering herb
Contraindicated in the treatment of serious depression
with psychotic symptoms, suicidal risk or signs and
symptoms that are so severe that they do not allow
the patient’s family or work involvements to continue.
(PPP, 549; ESCOPM, 259) Not to be taken after organ
transplants. (ESCOPM, 258) Contraindicated in known
photosensitivity and known allergy to plants of the
Clusiaceae family. (WHO2, 163; CGBLH, 420) May cause
mild stomach discomfort, skin rash, tiredness, fatigue,
headache, sleep disturbances. Photosensitization is
possible after exposure to sunlight and especially in fair
skinned individuals. (BSH, 62; TGHM, 215; HM, 363; PPP,
548; ESCOPM, 259; WHO2, 163) Patients taking higher
doses should avoid excessive exposure to sunlight and
UV radiation. (CGBLH, 420)
Caution advised in very severe debility, especially if
associated with immune or digestive collapse, renal
or hepatic failure, rampant cancer or strong regimes
of chemotherapy. (PPP, 155) Dermatologic and
neurologic concern based upon case reports. (TCPHP,
301) Side effects are rare and mild, and include minor
gastrointestinal irritations, allergic reactions, tiredness
and restlessness. (WHO2, 165) Mild, reversible
elevations of serum liver enzymes noted in HIV-positive
patients. Mania has been noted as a side effect but
has not been conclusively linked to use of the herb.
Avoid use of preparations made from herb harvested
at the onset of full flowering, and avoid dispensing
the sediment from liquid extracts – the resinous
compounds contained therein may cause sensory nerve
hypersensitivity. (CGBLH, 422)
None known. (TGHM, 215; HM, 363) May potentiate
pharmaceutical MAO-inhibitors. (BSH, 62, 173)
Recommend physician consultation when taken
with MAO inhibitors, SSRIs, and tricyclics (PPP, 549)
Reduced blood levels have been reported with
respect to cyclosporin, indinavir and potentially
other antiretroviral protease and transcriptase
inhibitors, the anticoagulants phenprocoumon and
warfarin, theophylline and digoxin. It remains an
open question whether St John’s wort preparations
also interact with oral contraceptives, particularly
low dose contraceptives (<50 mcg of estrogen).
(ESCOPM, 259) Contraindicated in patients taking
irinotecan. No clinical adverse effects have been
reported for phenytoin or any other anticonvulsant
drug. (CGBLH, 421)
Refer to the MediHerb Herb-Drug Interactions chart
(under St John’s Wort and Tannin- or OPC-containing
herbs).
Tienchi Ginseng 1:2
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional.
Tienchi Ginseng
Panax notoginseng root
2b
Contraindicated in pregnancy. (CAACH,45; CGBLH, 433)
None known. (BSH, 82; CGBLH, 433)
Turmeric 1:1
Contraindicated in pregnancy. Contraindicated during lactation unless otherwise directed by a qualified health care professional. Contraindicated in closure of the
gallbladder. Use only with professional supervision in gallstones.
Turmeric
Curcuma longa rhizome
Note: 2b, 2d
Contraindicated in obstruction of bile passages; in case
of gallstones, use only after consulting with a physician.
(TGHM, 222; HM, 382; WHO1, 121; PPP, 578; ESCOPM,
107) The herb should not be administered to patients
who suffer from stomach ulcers or hyperacidity. (BSH,
39; HM, 382) Occasional cases of allergic dermatitis
reported. (WHO1, 121; PPP, 578) Care should be
exercised with women wishing to conceive and patients
complaining of hair loss. (CGBLH, 436) Patients applying
topical doses should be cautioned against excessive
exposure to sunlight. (PPP, 578)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (HM, 382; TGHM, 222; ESCOPM, 108)
High doses (>15 g/day) should not be given to
patients taking antiplatelet or anticoagulant drugs.
(PPP, 578; CGBLH, 436)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
70
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Uva Ursi 1:2
Contraindicated in pregnancy and lactation. Not suitable for prolonged use.
Uva Ursi
Arctostaphylos uva-ursi leaf
2b, 2d
Large doses may cause nausea and vomiting. (HM, 391;
BHC, 212) May also cause cramping and constipation,
due to high tannin content. Not suitable for longterm use. (PPP, 284; ESCOPM, 536; CGBLH, 444)
Contraindications: kidney disorders, renal failure, which
may be theoretical, and pregnancy. (BHC, 212; PPP, 223,
284; BSH, 13; ESCOPM, 536-537)
Should not be given with treatments that will
lead to the production of acidic urine (leading to a
reduction of antibacterial effect). The high tannin
content could interfere with the absorption of some
nutrients. (CGBLH, 444)
Refer to the MediHerb Herb-Drug Interactions chart
(under Tannin- or OPC-containing herbs).
Valerian 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Valerian
Valeriana officinalis root
1
Can aggravate a sensation of tiredness or drowsiness,
particularly in higher doses. (PPP, 587; WHO1, 273)
Overdose can result in blurred vision, erratic heart beat,
headache, nausea, restlessness, visual illusions, even
spasmodic movements. (PPP, 588; BSH, 120) Very
large doses may cause bradycardia and arrhythmias,
and decrease intestinal motility. (WHO1, 274) Canada
allows products containing valerian for use as sleeping
aids and sedatives. (TCPHP, 64) Hepatic and neurologic
concern based upon case reports, although in the case
of alleged hepatotoxicity coingestants were involved.
(TCPHP, 301)
None known. (TGHM, 226; ESCOPM, 540; HM, 397)
May increase the effects of CNS depressants or
alcohol when taken together, (PPP, 587; AEHD3, 172;
WHO1, 273) although human studies indicate that
this is unlikely for alcohol. (CGBLH, 447) The herb
may be expected to have at least an additive effect
with barbiturates, alcohol, benzodiazepines, and
other CNS depressants. (TCPHP, 64)
Refer to the MediHerb Herb-Drug Interactions chart.
White Peony 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
White Peony
Paeonia lactiflora root
1
Consult with a physician when patient has breast cancer
condition. (PPP, 244) The herb reduces testosterone
production from ovaries but not from adrenal glands.
(CAACH, 31)
None known. (CGBLH, 458) Should not be combined
with Fritillaria verticillata, Cuscuta japonica and
Rheum officinale. (WHO1, 199) Caution should
be exercised when used with estrogenic drugs or
anticoagulant drugs. (PPP, 244; CGBLH, 458)
Wild Yam 1:2 Quantified Activity
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Wild Yam
Dioscorea villosa root & rhizome
Note: 1
Large doses produce emesis. (BSH, 42) Oral use may
cause irritation of the gastric mucous membranes and
reflux. (CGBLH, 464) Also classified as choleretic and
cholagogue, the herb is either contraindicated or at
least inappropriate in the following: (1) obstructed bile
ducts, (2) unconjugated hyperbilirubinemia, (3) acute
or severe hepatocellular disease, (4) septic cholecystitis
(where there is risk of peritonitis), (5) intestinal spasm
or ileus, and (6) liver cancer. (PPP, 187)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (CGBLH, 464) Consult physician when
patient is being treated with estrogen-promoting
drugs. (PPP, 46, 245) The herb is contraindicated
or at least inappropriate when there is already
prescription of strong anti-inflammatory medication.
(PPP, 149)
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
71
Contraindications and Cautions
Liquid Extracts
Product and Ingredient Name
Class
Contraindications, Cautions
and Potential Adverse Reactions
Interactions with Drugs
Wormwood 1:5
Contraindicated in pregnancy and lactation.
Wormwood
Artemisia absinthium herb
2b, 2c, 2d
None known. (BSH, 15; TGHM, 233; ESCOPM, 4;
Contraindications: gastric and duodenal ulcers,
pregnancy, lactation, hyperacidity, known sensitivity to CGBLH, 469)
wormwood or other members of the Compositae family.
(ESCOPM, 4; CGBLH, 469) The toxicological risk from use
of conventional wormwood preparations is considered
to be very low. (ESCOPM, 4) The recommended dosage
range must not be exceeded. (CGBLH, 469) As a bitter,
this herb is contraindicated or at least inappropriate in
duodenal ulceration and conditions involving dry cough
and some kidney diseases. (PPP, 173) Wormwood
contains approximately 1.5–1.7% essential oil which
contains a neurotoxin called thujone. In toxic doses,
thujone acts as a convulsant poison. Therefore, the pure
essential oil must not be used. (TGHM, 233; BSH, 158)
Regulatory restrictions require finished food products to
be thujone-free in the U.S. and other countries. (BSH,
15) Toxicological concern not indicated, except in long
term use. (BSH, 15)
Yellow Dock 1:2
Not to be used during pregnancy and lactation unless otherwise directed by a qualified health care professional.
Yellow Dock
Rumex crispus root
Note: 2d
Use with caution in pregnancy. (CGBLH, 474)
Contraindicated or at least inappropriate in constipation
associated with bowel irritability, bowel disease,
diarrhea. (PPP, 173) Individuals with a history of kidney
stones should use cautiously. (BSH, 100)
The information presented herein has not been confirmed or agreed to by MediHerb or Standard Process. Some information
is based on in vitro data and case reports that have not been substantiated by clinical studies. This compilation of information
and references is presented for the convenience of practitioners who are encouraged to review the source literature.
Sources: AEHD1 = Adverse Effects of Herbal Drugs Vol. 1, AEHD2 = Adverse Effects of Herbal Drugs Vol. 2, AEHD3 = Adverse Effects of
Herbal Drugs Vol. 3, BHC = British Herbal Compendium, BSH = Botanical Safety Handbook, CAACH = Clinical Applications of
Ayurvedic and Chinese Herbs, CGBLH = Clinical Guide to Blending Liquid Herbs, EOS = Essential Oil Safety: A Guide for Health
Care Professionals, ESCOPM = European Scientific Cooperative on Phytotherapy Monographs, HM = Herbal Medicine, PPP = Principles and Practice of Phytotherapy, TGHM = Therapeutic Guide to Herbal Medicines, TCPHP = Toxicology and Clinical
Pharmacology of Herbal Products, WHO1 = World Health Organization Monographs on Selected Medicinal Plants, Volume 1,
WHO2 = World Health Organization Monographs on Selected Medicinal Plants, Volume 2
None known. (CGBLH, 474)
Refer to the MediHerb Herb-Drug Interactions chart.
The herb classification found in the Botanical Safety Handbook are defined:
Class 1 = Herbs that can be safely consumed when used appropriately.
Class 2 = Herbs for which the following use restrictions apply: (2a) for external use only; (2b) not to be used during pregnancy; (2c) not to be used while nursing; (2d) other specific use restrictions as noted.
Class 3 = Herbs for which significant data exist to recommend the following labeling: “To be used only under the supervision of
an expert qualified in the appropriate use of this substance.” Labeling must include proper use information: dosage,
contraindications, potential adverse effects and drug interactions, and any other relevant information related to the safe use of
this substance.
Class 4 = Herbs for which insufficient data are available for classification.
72