Vivitas Herbal Diuretic (Tablet) by SunOpta Inc

There is insufficient reliable information available about the effectiveness of buchu.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anxiety. It is unclear if oral celery seed extract is beneficial in patients with anxiety. Details: A small clinical study in Iranian adults with hypertension on standard antihypertensive therapy shows that taking celery seed extract 1.34 grams daily for 4 weeks reduces symptoms of anxiety and depression when compared with placebo (112409). However, it is unclear if these benefits can be extrapolated to patients in geographic locations other than Iran.
• Depression. It is unclear if oral celery seed extract is beneficial in patients with depression. Details: A small clinical study in Iranian adults with hypertension on standard antihypertensive therapy shows that taking celery seed extract 1.34 grams daily for 4 weeks reduces symptoms of anxiety and depression when compared with placebo (112409). However, it is unclear if these benefits can be extrapolated to patients in geographic locations other than Iran.
• Diabetes. It is unclear if oral celery seed extract is beneficial in patients with diabetes. Details: A small clinical study in adults with type 2 diabetes shows that taking celery seed powder 250 mg three times daily for 12 weeks does not improve fasting blood glucose, fasting insulin, insulin resistance, total cholesterol, low-density lipoprotein or high-density lipoprotein cholesterol, triglycerides, or blood pressure when compared with placebo (112411). However, the study may have been inadequately powered to detect a difference between groups.
• Dysmenorrhea. Oral celery seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One clinical trial in female college students shows that taking a specific combination product containing celery seed, saffron, and anise extracts (SCA, Gol Daro Herbal Medicine Laboratory) 500 mg three times daily for 3 days, starting at the beginning of bleeding or pain, reduces severity and duration of pain symptoms associated with menstruation when compared with placebo (17214). It is not clear if these effects are due to celery, other ingredients, or the combination.
• Dyspepsia. Oral celery seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized clinical trial in adults with functional dyspepsia conducted in Iran shows that taking celery seed powder 500 mg daily with bishop's weed 500 mg daily spread over three doses after meals for 4 weeks reduces patient-reported dyspepsia symptom severity when compared with domperidone. Taking celery and bishop's weed also reduces patient-reported symptom frequency when compared to baseline (112410). However, it is unclear if these effects are due to celery, bishop's weed, or the combination, or if results can be extrapolated to patients in geographic locations other than Iran. The interpretation of these results is also limited by the lack of a placebo group.
• Gout. Oral celery has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small, open-label clinical study in patients with gout shows that taking a specific combination product (GoutFigher, Max Biocare) containing celery seed extract 600 mg, devil's claw root extract 300 mg, sour cherry extract 200 mg, and other ingredients twice daily for 45 days reduces pain, joint inflammation, and uric acid levels when compared to baseline (106488). The validity of these findings is limited by the lack of a control group. Additionally, it is unclear if these findings are due to celery, other ingredients, or the combination.
• Headache. Although there has been interest in using oral celery for headache, there is insufficient reliable information about the clinical effects of celery for this purpose.
• Hypertension. It is unclear if oral celery seed extract is beneficial in patients with hypertension. Details: A small clinical study in Iranian adults with hypertension on standard antihypertensive therapy shows that taking celery seed extract 1.34 grams daily for 4 weeks reduces daytime systolic blood pressure by about 12 mmHg compared to less than 1 mmHg with placebo. Celery seed extract also reduces night-time blood pressure, diastolic blood pressure, and mean arterial pressure, but does not impact the heart rate (110755). However, it is unclear if these benefits can be extrapolated to patients in geographic locations other than Iran.
• Impaired glucose tolerance (prediabetes). It is unclear if oral celery leaf extract is beneficial in patients with prediabetes. Details: A small clinical study in elderly patients with prediabetes shows that taking celery leaf extract 250 mg three times daily for 12 days reduces postprandial plasma glucose levels, but not insulin levels, when compared to baseline (99572). Although a control group was included in the study, statistical comparisons between treatment and control groups were not reported.
• Mosquito repellent. It is unclear if topical celery seed extract is beneficial for use as a mosquito repellant. Details: One small clinical study shows that applying gel formulations containing celery seed extract 5% to 25% can repel mosquitos in a dose-dependent manner for up to 4.5 hours. These formulations show similar repellant action when compared with DEET-containing formulations and appear to be superior to commercial repellants without DEET (40988). Celery extract has also been evaluated in combination with other ingredients. Two clinical studies show that application of a specific formulation (G10, E.A.R. Samunpri) containing celery seed extract 5%, along with vanillin, eucalyptus oil, orange oil, and citronella oil, seems to repel mosquitos for up to 4.5 hours comparably to other commercial products, including DEET 25% and Insect Block 28 (41049,41052). It is unclear if these findings are due to celery, other ingredients, or the combination.
• Osteoarthritis. Oral celery seed has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small, open-label clinical study in patients with mild knee osteoarthritis shows that taking a specific combination product (Tregocel, Max Biocare) providing celery seed 1000 mg, Boswellia serrata resin extract 1000 mg, devil's claw 1000 mg, ginger rhizome 330 mg, and curcumin 180 mg daily for 36 weeks reduces pain, improves functional capacity, and increases walking distance when compared to baseline (106078). The validity of these findings is limited by the lack of a control group. Additionally, it is unclear if these findings are due to celery, other ingredients, or the combination.
• Rheumatoid arthritis (RA). Although there has been interest in using oral celery juice for RA, there is insufficient reliable information about the clinical effects of celery for this purpose.
• Sexual dysfunction. It is unclear if oral celery seed powder is beneficial in females with sexual dysfunction. Details: One small clinical study in females with sexual dysfunction shows that taking celery seed powder 500 mg three times daily for 6 weeks improves sexual dysfunction symptom scores, primarily due to patient-rated improvements in sexual desire, arousal, lubrication, and pain, when compared with placebo (106486).
• Urinary tract infections (UTIs). Although there has been interest in using oral celery juice for UTIs, there is insufficient reliable information about the clinical effects of celery for this purpose. More evidence is needed to rate celery for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bronchitis. Although there has been interest in using inhaled juniper essential oil for bronchitis, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Cancer. Although there has been interest in using oral juniper for cancer, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Diabetes. Although there has been interest in using oral juniper for diabetes, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Dyspepsia. Although there has been interest in using oral juniper for dyspepsia, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Flatulence. Although there has been interest in using oral juniper for flatulence, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Gastroesophageal reflux disease (GERD). Although there has been interest in using oral juniper for GERD, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Kidney stones (nephrolithiasis). Although there has been interest in using oral juniper for nephrolithiasis, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Intestinal parasite infection. Although there has been interest in using oral juniper for intestinal parasite infection, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using topical juniper for RA, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Urinary tract infections (UTIs). Although there has been interest in using oral juniper for UTIs, there is insufficient reliable information about the clinical effects of juniper for this purpose.
• Wound healing. Although there has been interest in using topical juniper for wound healing, there is insufficient reliable information about the clinical effects of juniper for this purpose. More evidence is needed to rate juniper for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Abortion. Although there has been interest in using oral parsley to induce abortion, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Constipation. Although there has been interest in using oral parsley for constipation, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Diabetes. Although there has been interest in using oral parsley for diabetes, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Dry skin. Although there has been interest in using topical parsley for dry skin, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Dyspepsia. Although there has been interest in using oral parsley for dyspepsia, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Hypertension. Although there has been interest in using oral parsley for hypertension, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Insect bite. Although there has been interest in using topical parsley for insect bites, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Kidney stones (nephrolithiasis). Although there has been interest in using oral parsley for kidney stones, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Melasma. It is unclear if topical parsley is beneficial for melasma. Details: A small clinical study in adults with melasma shows that applying a brewed parsley water to the face with a cotton ball on 6 days of each week for 8 weeks is as effective as hydroquinone 4% cream for improving dark spots (96828).
• Nonmelanoma skin cancer. Although there has been interest in using topical parsley to prevent nonmelanoma skin cancer, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Osteoarthritis. Although there has been interest in using oral parsley for osteoarthritis, there is insufficient reliable information about the clinical effects of parsley for this purpose.
• Urinary tract infections (UTIs). Although there has been interest in using oral parsley for UTIs, there is insufficient reliable information about the clinical effects of parsley for this purpose. More evidence is needed to rate parsley for these uses.

(Read more about PARSLEY)

POSSIBLY INEFFECTIVE

• Urinary tract infections (UTIs). Clinical research does not support the use of oral uva ursi for treatment of UTIs. For prevention of UTIs, oral uva ursi has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large clinical study in females with uncomplicated UTI shows that taking uva ursi tablets providing 210 mg arbutin orally three times daily for 5 days is less effective than a single dose of fosfomycin 3 grams for reducing UTI symptom burden and the number of rescue antibiotic courses. Rescue antibiotics were needed in 44% of patients receiving uva ursi, compared with 23% of those receiving fosfomycin. On day 4, the percentage of patients with symptom resolution was 49% with uva ursi, compared to 65% with fosfomycin. Pyelonephritis occurred in 8 patients on uva ursi and 2 patients on fosfomycin (109535). Also, a large clinical study in females experiencing symptoms of a UTI shows that taking uva ursi extract 1200 mg three times daily for 3-5 days does not improve symptoms or reduce the need for antibiotics when compared with placebo (101815). Uva ursi has also been evaluated for the prevention of UTIs. One small clinical study in females with recurrent UTI shows that taking a specific combination product containing uva ursi and dandelion (UVA-E, Medic Herb AB) 3 tablets three times daily for one month reduces the recurrence rate of UTIs when compared with placebo (1932). It is not clear if this effect is due to uva ursi, dandelion, or the combination.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Benign prostatic hyperplasia (BPH). Although there is interest in using oral uva ursi for BPH, there is insufficient reliable information about the clinical effects of uva ursi for this condition.
• Bronchitis. Although there is interest in using oral uva ursi for bronchitis, there is insufficient reliable information about the clinical effects of uva ursi for this condition. More evidence is needed to rate uva ursi for these uses.

(Read more about UVA URSI)

LIKELY SAFE ...when the leaf is used in amounts commonly found in foods. Buchu has Generally Recognized As Safe status (GRAS) for use in foods in the US (4912).

POSSIBLY SAFE ...when the leaf is used orally and appropriately in medicinal amounts (2,12).

POSSIBLY UNSAFE ...when excessive amounts of buchu leaf are taken orally or when the oil is ingested. Buchu contains pulegone, a known hepatotoxin (4). Pulegone is a major component of the oil. It is more abundant in buchu products that come from Agathosma crenulata (93681).

PREGNANCY: LIKELY UNSAFE
when used in medicinal amounts; buchu is reported to be an abortifacient (4).

LACTATION: POSSIBLY SAFE
when used in food amounts. There is insufficient reliable information available about the safety of using larger amounts; avoid using.

(Read more about BUCHU)

LIKELY SAFE ...when celery stems are consumed as food. ...when celery oil or seeds are consumed in amounts commonly found in foods. Celery seed has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when celery seed is used orally and appropriately in medicinal amounts, short-term (12). Celery seed powder has been safely used at doses up to 1500 mg daily for up to 6 weeks and 750 mg daily for up to 12 weeks. Celery seed extract has been safely used at doses up to 1340 mg daily for up to 4 weeks (106486,110755,112409,112411). ...when celery seed extract is used topically and appropriately, short-term (40988,41049,41052).

PREGNANCY: LIKELY UNSAFE
when celery oil or seeds are used orally in larger amounts; celery might have uterine stimulant or abortifacient effects (4,19,19104).

LACTATION:
There is insufficient reliable information available about the safety of medicinal amounts of celery during lactation; avoid using.

(Read more about CELERY)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Juniper, juniper berry, and juniper extract have Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used topically on limited areas of skin (12230). ...when the oil is used by inhalation and appropriately as aromatherapy (7107). There is insufficient reliable information available about the safety of juniper when used orally in doses of less than 10 grams of berries or 100 mg of oil daily, short-term. Juniper oil and berry have a long history of traditional use (12,103759).

LIKELY UNSAFE ...when used orally in excessive amounts or long-term. Use of daily doses greater than 10 grams of juniper berries (about 60 berries) or 100 mg of juniper essential oil, or prolonged oral use longer than 4 weeks, have been reported to increase the risk of severe adverse effects such as convulsions or kidney damage (8,19,103759).

PREGNANCY: UNSAFE
when used orally. Juniper can increase uterine tone, interfere with fertility and implantation, and cause abortion (4,19).

LACTATION:
Insufficient reliable information available; avoid using.

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LIKELY SAFE ...when used orally in amounts commonly found in foods. Parsley has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term (12,13173).

LIKELY UNSAFE ...when used orally in very large doses e., 200 grams). Parsley oil contains significant amounts of the potentially toxic constituents, apiole and myristicin (11). Apiole can cause blood dyscrasias, kidney toxicity, and liver toxicity; myristicin can cause giddiness and hallucinations (4). ...when parsley seed oil is used topically. Applying parsley seed oil to the skin can cause photodermatitis upon sun exposure (4). There is insufficient reliable information available about the safety of the topical use of parsley leaf and root.

PREGNANCY: LIKELY UNSAFE
when used orally in medicinal amounts. Parsley has been used orally as an abortifacient and to stimulate menstrual flow (4,12,515,19104,92873). Population evidence suggests that maternal intake of An-Tai-Yin, an herbal combination product containing parsley and dong quai, during the first trimester increases the risk of congenital malformations of the musculoskeletal system, connective tissue, and eyes (15129).

LACTATION:
Insufficient reliable information available; avoid using.

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POSSIBLY SAFE ...when used orally and appropriately, short-term. Uva ursi has been used with apparent safety in doses of up to 3600 mg daily for 3-5 days (101815).

POSSIBLY UNSAFE ...when used orally long-term or in high doses. There is concern about the safety of long-term or high-dose use because of the hydroquinone content of uva ursi. Hydroquinone is thought to have mutagenic and carcinogenic effects (7). At high doses (around 20 grams of dried herb) it can cause convulsions, cyanosis, delirium, shortness of breath, and collapse. At very high doses (30 grams of dried herb or more) it can be fatal (4).

CHILDREN: POSSIBLY UNSAFE
when used orally by children. Uva ursi contains hydroquinone and high tannin levels, which can cause severe liver problems in children (4,18); avoid using.

PREGNANCY: LIKELY UNSAFE
when used orally. Uva ursi can have oxytocic effects, increasing the speed of labor (4,7,19); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about UVA URSI)

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ACETAMINOPHEN (Tylenol, others) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery juice might increase the effects and side effects of acetaminophen.  Details Animal research suggests that concomitant use of celery juice plus acetaminophen prolongs the effects of acetaminophen. This effect has been attributed to a decrease in hepatic cytochrome P450 activity (25362). However, other animal research shows that pretreatment with celery root extract protects against acetaminophen-induced acute liver failure (106487). These effects have not been reported in humans.

AMINOPYRINE Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery juice might increase the effects and side effects of aminopyrine.  Details Animal research suggests that concomitant use of celery juice plus aminopyrine prolongs the effects of aminopyrine. This effect has been attributed to a decrease in hepatic cytochrome P450 activity (25362). This effect has not been reported in humans.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery root might increase the risk of bleeding when taken with anticoagulant/antiplatelet drugs.  Details Celery root contains the constituents falcarinol and falcarindiol. Laboratory research suggests that these constituents can inhibit platelet aggregation (6048,40991). This effect has not been reported in humans.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Theoretically, celery seed extract might have additive effects with antihypertensive drugs.  Details Clinical research suggests that taking celery seed extract may reduce daytime systolic blood pressure by about 12 mmHg compared to less than 1 mmHg with placebo (110755).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery might increase levels of drugs metabolized by CYP1A2.  Details In vitro and animal research suggests that constituents of celery can inhibit CYP1A2 (68176). This effect has not been reported in humans.

LEVOTHYROXINE (Synthroid, others) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery seed might decrease the effects of levothyroxine.  Details Several cases of hypothyroidism with low T4 levels have been reported in people who were previously stabilized on levothyroxine and then started taking celery seed tablets. They presented with symptoms such as lethargy, bloating, and dry skin, and recovered when celery seed was stopped (10646). However, celery stem and leaf has been associated with case reports of hyperthyroidism in patients with no pre-existing thyroid disorders (102912,102914).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, celery might reduce excretion and increase levels of lithium due to potential diuretic effects.  Details Celery is thought to have diuretic properties (4,6). However, this effect has not been confirmed in humans.

PHOTOSENSITIZING DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery might increase the risk of photosensitivity reactions when taken with photosensitizing drugs.  Details Laboratory research shows that celery contains photosensitizing agents such as phenols and psoralens (6178,40894,40917,41073,41121).

VENLAFAXINE (Effexor) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, celery root extract might increase blood levels of venlafaxine.  Details There is one case report of a patient who experienced medication-induced bipolar disorder after beginning to take celery root extract 1000 mg daily along with venlafaxine 75 mg and St. John's wort 600 mg daily. Symptoms included confusion, speech abnormalities, manic affect, and visual hallucinations. The plasma level of venlafaxine was 476.8 ng/mL (normal range 195-400 ng/mL). It is theorized that celery root increased venlafaxine levels by inhibiting cytochrome P450 2D6 (92854).

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking juniper berry with antidiabetes medications might cause additive hypoglycemia.  Details Animal research shows that juniper berry can lower blood glucose (4,10580,14907).

DIURETIC DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, juniper berry might increase the risk of adverse effects from diuretic drugs.  Details Juniper berry is thought to have mild diuretic effects (4,512).

LITHIUM Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, juniper berry might reduce lithium excretion and increase serum levels of lithium.  Details Juniper berry is thought to have mild diuretic effects (4,512).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, parsley might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.  Details Animal research suggests that parsley has antiplatelet effects (68209).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, parsley might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research suggests that parsley might decrease blood glucose (13174,68131,68153,68162). Monitor blood glucose levels closely. Dose adjustments might be necessary.

ASPIRIN Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, aspirin might increase the severity of allergic reactions to parsley.  Details In one case, severe urticaria and swelling were reported after taking aspirin with parsley in an individual with a known mild parsley allergy (5054).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, parsley might increase serum levels of CYP1A2 substrates.  Details Laboratory research suggests that parsley can inhibit CYP1A2 (68176).

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, parsley might enhance or interfere with the effects of diuretic drugs.  Details Animal research suggests that parsley seed extract increases urine elimination (68119). Parsley leaf and root might also interfere with diuretic therapy due their purported aquaretic effects (512).

PENTOBARBITAL (Nembutal) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, parsley might increase the duration of pentobarbital effects.  Details Animal research suggests that parsley juice prolongs the action of pentobarbital, perhaps by decreasing cytochrome P450 levels (25362). It is not known if this occurs in humans or if this applies to other barbiturates or sedatives.

SIROLIMUS (Rapamune) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, large quantities of parsley might increase sirolimus levels.  Details In one case report, an adult female with a history of kidney transplant presented with elevated blood sirolimus levels, approximately 4-7 times greater than previous measures, after daily consumption of a juice containing approximately 30 grams of parsley for 7 days. Sirolimus levels returned to normal a week after the parsley juice was discontinued (106010).

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, large amounts of parsley leaf and root might decrease the effects of warfarin.  Details Parlsey contains vitamin K (19).

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CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, uva ursi may decrease the metabolism of CYP2C19 substrates.  Details In vitro, uva ursi appears to inhibit cytochrome CYP2C19 (98550). This effect has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, uva ursi may decrease the metabolism of CYP3A4 substrates.  Details In vitro, uva ursi appears to inhibit CYP3A4 (98550). This effect has not been reported in humans.

GLUCURONIDATED DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, uva ursi may increase levels of drugs metabolized by glucuronidation.  Details In vitro, uva ursi extract appears to strongly inhibit UDP-glucuronosyltransferase (UGT) 1A1 (UGT1A1). However, uva ursi extract does not appear to inhibit UGT1A1 in animal models (98549). This effect has not been reported in humans.

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, uva ursi may increase lithium levels, necessitating a decrease in dose.  Details Uva ursi may have diuretic properties (81637). Diuretics may increase lithium reabsorption with sodium in the proximal tubule of the kidney. Theoretically, uva ursi might reduce excretion and increase levels of lithium.

P-GLYCOPROTEIN SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, uva ursi may alter the levels of drugs transported by P-glycoprotein.  Details In vitro, uva ursi appears to inhibit the multi-drug transporter protein, P-glycoprotein (98550). This effect has not been reported in humans.

URINARY ACIDIFYING AGENTS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Effects of uva ursi in the urinary tract may be reduced by urinary acidifying agents.  Details Uva ursi seems to work best in alkaline urine. Theoretically, taking uva ursi with medications known to acidify the urine may decrease any effects of uva ursi on the urinary tract (19).

(Read more about UVA URSI)

General ...Orally, buchu leaf can cause GI and kidney irritation (4,6) and increase menstrual flow (6). Buchu is also a reported abortifacient (4).

Gastrointestinal ...Orally, buchu may cause gastrointestinal irritation (4,6).

Genitourinary ...Orally, buchu may increase menstrual flow (6). Buchu is also a reported abortifacient (4).

Renal ...Orally, buchu may cause kidney irritation (4,6).

(Read more about BUCHU)

General ...Orally, celery seems to be well tolerated.
Most Common Adverse Effects:
Orally: Photosensitivity. Oral allergy syndrome in sensitive individuals.
Topically: Photosensitivity. Contact dermatitis in sensitive individuals.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis in sensitive individuals.

Dermatologic ...Due to its psoralen content, contact with or ingestion of celery and exposure to ultraviolet radiation may cause photodermatitis (4,34347,40968,40969,40986,41085,41087,41143,41146,41151). Acute symptoms include skin eruption with edema and erythema; the main chronic symptom is hyperpigmentation at the eruption site (41093).
Celery can also cause contact or atopic dermatitis (19,41118,41124) and urticaria pigmentosa (40908).

Endocrine ...Celery has been associated with hyperthyroidism in otherwise healthy adults. In one case report a 36-year-old female presented with weight loss, blurred vision, nausea, palpitations, sweating, exophthalmos, elevated serum T4 levels, and low thyroid stimulating hormone (TSH) levels after taking 8 grams of a powdered celery extract for 78 days (102912). In another case report, a 48-year-old male presented with weight loss, exophthalmos, sweating, elevated serum T4 levels, and low TSH levels after taking 4 grams of dried celery leaves for 45 days (102914). In both of these cases, symptoms resolved and thyroid function tests normalized after discontinuing celery and completing a course of methimazole.
In contrast, several cases of hypothyroidism with low T4 levels have been reported in people who were previously stabilized on levothyroxine and then started taking celery seed tablets. They presented with symptoms such as lethargy, bloating, and dry skin, and recovered when celery seed was stopped (10646).

Gastrointestinal ...Symptoms of celery allergy have included oral allergy syndrome, characterized by itching and burning in the mouth and throat (41159,40977), and laryngeal edema (40953).

Immunologic ...Raw celery, cooked celery, and celery juice can all cause allergic reactions (40908,40926,41118,41131,92852,92855). Symptoms of celery allergy include laryngeal edema, skin reactions, an urticaria-edema-anaphylactic shock syndrome, celery-dependent exercise-induced anaphylaxis, and anaphylactic shock (40953,41100,41102,41107,41115,41124,41129,41135,41137,92852)(92855). Additionally, in clinical research, itchy throat has been reported in individuals taking celery seed powder (112410).
There is a case report of anaphylactic shock involving hypotension, tachycardia, and tachypnea in a patient who had ingested raw celery 15 minutes prior to symptom onset. The patient was treated with epinephrine, dexamethasone, and antazoline (92855). Another case report describes a patient with positive skin prick tests to celery, pollens including birch, chrysanthemum, mugwort, and ragweed, and to dust mites. When celery was consumed 30 minutes prior to exercise, the patient had an anaphylactic reaction that required treatment with intravenous pheniramine and corticosteroid, as well as nebulized albuterol (92852). Another patient with a history of anaphylactic reactions to undeclared celery in restaurant meals was able to undergo desensitization with gradually increasing oral doses of celery juice over several months, and then chronic daily ingestion of the juice to maintain hyposensitization (40908).

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General ...Orally and topically, juniper seems to be generally well tolerated when used short-term in low doses. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Topically: Allergies, skin irritation.

Dermatologic ...Topically, juniper can cause skin irritation. Signs of topical poisoning include burning, erythema, inflammation with blisters, and edema (4). Repeated exposure to the juniper pollen can cause occupational allergies that affect the skin (6). In a case report, a 62-year-old woman developed burn-like blistering lesions after carrying juniper in close contact to her skin. Concurrent sun exposure was thought to worsen the skin irritation caused by juniper (103756).

Genitourinary ...Orally, large amounts of the juniper berry can cause purplish urine (4).

Pulmonary/Respiratory ...Repeated exposure to the juniper pollen can cause occupational allergies that affect the respiratory tract (6).

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General ...Orally, parsley seems to be well tolerated when used low to moderate doses. Large doses may be unsafe.
Serious Adverse Effects (Rare):
Orally, Hallucinations, hemolytic anemia, hypotension, hepatic impairment, kidney impairment, nephrotic syndrome, paralysis, and thrombocytopenia purpura when taken in very high doses (200 grams parsley oil or 10 grams or more of parsley's apiole or myristicin constituents).

Cardiovascular ...Parsley contains the potentially toxic constituent, myristicin, which can cause significant adverse effects at high doses (11). Adverse effects specifically associated with myristicin include hypotension and bradycardia (4).

Dermatologic ...Orally, parsley oil can cause contact photodermatitis with sun exposure (4).
Topically, parsley can cause contact photodermatitis (4).

Hematologic ...Parsley contains the potentially toxic constituent apiole, which can cause significant adverse effects at high doses (11). Adverse effects specifically associated with more than 10 grams of the constituent apiole include hemolytic anemia and thrombocytopenia purpura (4).

Hepatic ...Parsley contains the potentially toxic constituents, apiole and myristicin, which can cause significant adverse effects at high doses (11). Adverse effects specifically associated with more than 10 grams of the constituent apiole include hepatic dysfunction (4). Adverse effects specifically associated with the constituent myristicin include fatty degeneration of the liver (4).

Immunologic ...A case of anaphylaxis involving severe angioedema leading to unconsciousness has been reported in a woman who consumed parsley 45 minutes prior to symptoms. The patient responded to epinephrine, antihistamines, intravenous fluids, oxygen therapy, and 1 mg/kg methylprednisolone. The woman had consumed one cup of chopped parsley nearly every day for several years, but upon skin testing, the patient tested positive to parsley (92869). There is also a report of lip angioedema after consumption of raw parsley. The patient had anaphylaxis to raw arugula, and reported itchy red lesions after contact with the leaves of either raw parsley or arugula. The patient had positive skin prick tests to both plants. The reaction may have been due to oral allergy syndrome, as the patient could tolerate cooked arugula and parsley, but not raw (92870).

Ocular/Otic ...Parsley contains the potentially toxic constituent, myristicin, which can cause significant adverse effects at high doses (11). An adverse effect specifically associated with the constituent myristicin includes deafness (4).

Psychiatric ...Parsley contains the potentially toxic constituent, myristicin, which can cause significant adverse effects at high doses (11). Adverse effects specifically associated with the constituent myristicin include giddiness and hallucinations (4).

Renal ...Parsley contains the potentially toxic constituents, apiole and myristicin, which can cause significant adverse effects at high doses (11). Adverse effects specifically associated with more than 10 grams of the constituent apiole include nephrosis and kidney irritation (4). Adverse effects specifically associated with the constituent myristicin include fatty degeneration of the kidneys (4).

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General ...Uva ursi is generally well tolerated in low doses, short-term.
Most Common Adverse Effects:
Orally: Diarrhea, nausea, stomach upset, and vomiting.
Serious Adverse Effects (Rare):
Orally: At high doses (20 grams of dried herb), uva ursi has been reported to cause collapse, convulsions, cyanosis, delirium, shortness of breath, and tinnitus. Very high doses of 30 grams or more may be fatal.

Gastrointestinal ...Orally, uva ursi may cause nausea, vomiting, diarrhea, and stomach upset (92148). It can also irritate the gastrointestinal tract (19).

Genitourinary ...Orally, uva ursi may cause the urine to be greenish-brown. It may also cause irritation and inflammation of the urinary tract mucous membranes (18).

Hepatic ...Uva ursi may be hepatotoxic. Theoretically, chronic use, especially in children, can cause liver impairment due its hydroquinone and high tannin content (4,18).

Neurologic/CNS ...Orally, around 20 grams of uva ursi is reported to supply up to one gram of hydroquinone, which can theoretically cause convulsions and delirium (4).

Ocular/Otic ...Orally, uva ursi may potentially cause retinal toxicity due to its hydroquinone content, which reduces melanin synthesis. A 56-year-old female developed bilateral bull's-eye maculopathy, paracentral scotomas, and retinal thinning after 3 years of uva ursi tea ingestion (16900).
Taking around 20 grams of uva ursi orally is reported to supply up to one gram of hydroquinone, which can theoretically cause tinnitus (4).

Pulmonary/Respiratory ...Orally, around 20 grams of uva ursi is reported to supply up to one gram of hydroquinone, which can theoretically cause shortness of breath and cyanosis (4).

(Read more about UVA URSI)