Organic Rooibos with Honeybush by Traditional Medicinals

POSSIBLY EFFECTIVE

• Hypertension. Oral Hibiscus sabdariffa seems to lower blood pressure by a small amount in patients with mild to moderate hypertension. Details: Most research shows that drinking Hibiscus sabdariffa tea daily can modestly lower blood pressure in patients with pre-hypertension or mild hypertension after 2-6 weeks of treatment (16894,54985,54995,90159,93817,101730,108867). In addition, some research shows that drinking Hibiscus sabdariffa tea daily can modestly lower blood pressure in patients with either untreated or insufficiently treated mild to moderate hypertension (54989,93815,101733,108867). These studies have used tea made from 1.25-10 grams or 150 mg/kg, brewed in 150 mL to 500 mL of water and taken one to three times daily for 2-6 weeks (16894,54985,54989,54995,90159,93815,93817,101730,101733,108867). The dose has been increased to 15 or 20 grams, brewed in 1000 mL for daily consumption for 2-3 weeks if needed (101733,108867). In this population, research shows that drinking Hibiscus sabdariffa tea or infusions is more effective than hydrochlorothiazide 25 mg daily and as effective as captopril 25 mg twice daily for lowering systolic and diastolic blood pressure (54989,93815). Pooled analyses of results from clinical research shows that drinking Hibiscus sabdariffa tea or taking Hibiscus sabdariffa extract lowers systolic blood pressure by 5-8 mmHg and diastolic blood pressure by about 4 mmHg in patients with or without mild hypertension (93817,105304). The clinical relevance of these results is uncertain due to the small size and low quality of the included studies. Some researchers suggest that there is insufficient reliable evidence to determine if the effects of Hibiscus sabdariffa are clinically relevant (17114). Taking Hibiscus sabdariffa in combination with other ingredients has also showed beneficial effects on blood pressure in clinical research. In one study, a specific product containing Hibiscus sabdariffa extract in combination with olive leaf extract (NW Roselle) for 8 weeks was found to be as effective as captopril 25 mg twice daily for reducing systolic and diastolic blood pressure (105302). In another study, a specific product (MetabolAid, Monteloeder S.L.) providing Hibiscus sabdariffa and lemon verbena extracts for 12 weeks reduced systolic, but not diastolic, blood pressure. However, these effects were limited to daytime ambulatory readings (105303).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Although there has been interest in using oral Hibiscus sabdariffa for cancer, there is insufficient reliable information about the clinical effects of Hibiscus sabdariffa for this condition.
• Constipation. Although there has been interest in using oral Hibiscus sabdariffa for constipation, there is insufficient reliable information about the clinical effects of Hibiscus sabdariffa for this purpose.
• Diabetes. It is unclear if oral Hibiscus sabdariffa is beneficial for diabetes. Details: Pooled analyses of results from clinical research show that taking Hibiscus sabdariffa lowers fasting blood glucose levels by approximately 4 mg/dL (105304,105305). However, only one low-quality study included in one of these analyses examined the effects of Hibiscus sabdariffa on fasting blood glucose levels in patients with type 2 diabetes (105305). Therefore, any benefit specific to this population is unclear.
• Dry mouth. Topical Hibiscus sabdariffa has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with dry mouth shows that taking a specific mucoadhesive tablet (Aqualief, Helsinn Healthcare SA), containing a combination of Hibiscus sabdariffa and carnosine, 400 mg three times daily after meals for 6 days increases saliva production and improves symptoms of dry mouth when compared to baseline. While saliva production was also increased in patients taking placebo, the increase was 3-fold greater with the combination product, and significant improvements in dry mouth symptoms were lacking in the placebo group (103288). It is unclear if these findings are due to Hibiscus sabdariffa, carnosine, or the combination.
• Dry skin. It is unclear if oral Hibiscus sabdariffa is beneficial for dry skin. Details: A crossover clinical study in healthy adults shows that drinking Hibiscus sabdariffa 100 mL twice daily for 6 months improves skin moisture but does not improve skin surface water loss or sebum secretion when compared to baseline (112426). However, it is unclear whether any improvements are clinically significant or apply to patients with dry skin.
• Dyslipidemia. It is unclear if oral Hibiscus sabdariffa is beneficial for dyslipidemia. Details: Some preliminary clinical research shows that drinking Hibiscus sabdariffa tea or taking Hibiscus sabdariffa extract can decrease total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides, and can increase high-density lipoprotein (HDL) cholesterol, in patients with metabolic disorders (54997,54999). These studies used Hibiscus sabdariffa 2 grams in 240 mL boiling water, steeping for 20-30 minutes, twice daily and Hibiscus sabdariffa extract 100 mg daily, each for 4 weeks (54997,54999). Clinical research also shows that taking powdered dried Hibiscus sabdariffa 6 grams daily reduces LDL cholesterol by approximately 8% in obese adolescents with dyslipidemia (93816). Additionally, two meta-analyses shows that taking Hibiscus sabdariffa extract modestly reduces LDL cholesterol levels (105305,105306). However, other preliminary clinical research shows that taking Hibiscus sabdariffa extract does not improve cholesterol or triglyceride levels in patients with hypercholesterolemia (17415,55000). Two pooled analyses of clinical data show that Hibiscus sabdariffa does not improve total cholesterol, HDL cholesterol, LDL cholesterol, or triglycerides when compared with placebo, a change in diet, or black tea in patients with hyperlipidemia, metabolic disorders, or obesity (93805,105304). The differing conclusions of these trials and meta-analyses are related to their inclusion and exclusion criteria with respect to age and populations of focus.
• Kidney stones (nephrolithiasis). Although there has been interest in using oral Hibiscus sabdariffa for kidney stones, there is insufficient reliable information about the clinical effects of Hibiscus sabdariffa for this condition.
• Metabolic syndrome. Some small clinical studies suggest that oral Hibiscus sabdariffa may be beneficial for metabolic syndrome. Details: In adults with metabolic syndrome, a small clinical trial shows that taking Hibiscus sabdariffa powder 500 mg daily for 4 weeks modestly reduces systolic blood pressure and triglyceride levels by 5% and 15%, respectively, when compared with baseline. These changes were significant when compared with placebo. However, there was no effect on diastolic blood pressure, fasting glucose or insulin levels, cholesterol levels, or body mass index (105307). Other preliminary clinical research in adults with metabolic syndrome shows that taking Hibiscus sabdariffa extract 100 mg daily for one month modestly reduces fasting glucose and low-density lipoprotein (LDL) cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels when compared with baseline. When taken in combination with recommendations to follow the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) diet, triglyceride levels and blood pressure were also modestly reduced (54999).
• Obesity. Oral Hibiscus sabdariffa has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Two small clinical trials in overweight and obese females show that taking a combination product (MetabolAid, Monteloeder SL) containing Hibiscus sabdariffa and lemon verbena extracts as 500 mg per capsule daily for 2 months modestly increases weight loss when compared with placebo (97290,101731). This combination also reduces hunger and increases satiety, and has small to moderate beneficial effects on low-density lipoprotein (LDL) cholesterol, heart rate, and blood pressure (97290). The effects in obese individuals seem to be less than those seen in overweight individuals, with no overall change in abdominal circumference or percent body fat in obese individuals (101731). A meta-analysis of these two studies and several others in overweight or obese individuals shows that taking Hibiscus sabdariffa in combination with other ingredients daily for 6-12 weeks modestly improves body mass index, weight, and body fat percentage when compared with control (112427). However, the validity of these results is limited by the heterogeneity of the included studies. Additionally, it is unknown if these effects are due to Hibiscus sabdariffa, other ingredients, or the combination.
• Urinary tract infections (UTIs). It is unclear if oral Hibiscus sabdariffa is beneficial for UTIs. Details: Population research in patients with urinary catheters living in long-term care facilities has found that drinking Hibiscus sabdariffa tea is associated with a 36% lower risk of UTIs when compared with not drinking tea (93807). Some small clinical studies that have evaluated the use of Hibiscus sabdariffa in combination with other ingredients suggest that they might reduce the occurrence of symptomatic UTIs in females with recurrent UTIs. One study used a product containing Hibiscus sabdariffa 200 mg, D-mannose 1000 mg, and Lactobacillus plantarum Lp-115 (1 billion colony forming units) daily for 15 days each month for 6 months (101734); the other study used a specific product (Monurelle Plus, Zambon Italia) containing Hibiscus sabdariffa 100 mg, xyloglucan 100 mg, gelatin 50 mg, and propolis 100 mg twice daily for 14 days (101735). Also, a small observational study in patients with an uncomplicated UTI has found that taking two tablets of a specific combination product (Acidif plus) containing Hibiscus sabdariffa extract 100 mg, boswellia gummy dry extract 100 mg, and L-methionine 400 mg daily for 7 days is associated with reduced UTI symptoms and reduced bacteriuria when compared with taking an unreported dose of fosfomycin for two days (103783). However, due to the poor quality of these studies, the magnitude of benefit is unclear. Also, it is unknown whether these effects are due to Hibiscus sabdariffa, other ingredients, or the combination.
• Wound healing. Although there has been interest in using topical Hibiscus sabdariffa for wound healing, there is insufficient reliable information about the clinical effects of Hibiscus sabdariffa for this purpose.

  More evidence is needed to rate Hibiscus sabdariffa for these uses.

(Read more about HIBISCUS SABDARIFFA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there has been interest in using oral rooibos for allergic rhinitis, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• Age-related cognitive decline. Although there has been interest in using oral rooibos for age-related cognitive decline, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• Anxiety. Although there has been interest in using oral rooibos for anxiety, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• Cardiovascular disease (CVD). Although there has been interest in using oral rooibos for CVD, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• Cancer. Although there has been interest in using oral rooibos for cancer, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• Diabetes. Although there has been interest in using oral rooibos for diabetes, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• Dyspepsia. Although there has been interest in using oral rooibos for dyspepsia, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• HIV/AIDS. Although there has been interest in using oral rooibos for HIV/AIDS, there is insufficient reliable information about the clinical effects of rooibos for this purpose.
• Obesity. Although there has been interest in using oral rooibos for obesity, there is insufficient reliable information about the clinical effects of rooibos for this purpose. More evidence is needed to rate rooibos for these uses.

(Read more about ROOIBOS)

POSSIBLY EFFECTIVE

• Osteoarthritis. When used alone or in combination with other ingredients, oral rose hip seems to reduce pain and improve function in patients with osteoarthritis. Details: Orally, rose hip seems to have beneficial effects when used to treat osteoarthritis. Most clinical research shows that taking a specific Rosa canina rose hip powder product (LitoZin/i-flex, Hyben Vital), 2.5 grams orally twice daily for 3-4 months, reduces pain and stiffness, improves function and mobility, and decreases use of rescue medication when compared with placebo (71646,71658,71660,71661). Clinical research in adults with knee osteoarthritis shows that taking a specific combination product containing Rosa canina rose hip fruit puree 24 grams, stinging nettle leaf 160 mg, devil's claw 108 mg, and vitamin D 200 IU (Rosaxan, Medagil Gesundheitsgesellschaft) daily for 12 weeks reduces pain by 66% and improves quality of life, but does not reduce analgesic use, when compared with a control group (97937). However, one crossover study shows mixed results. Rose hip was shown to be effective for osteoarthritis only when administered after, but not before, placebo treatment (71641). This inconsistency might be due to a carryover effect of rose hip or delayed activity of the supplement.
• Postoperative pain. When taken immediately prior to surgery, oral rose hip seems to reduce pain following a Cesarean section. Details: Clinical research shows that taking a single dose of Rosa damascena rose hip extract 1600 mg, 15 minutes prior to anesthesia for a Cesarean section, delays the need for postoperative analgesics and reduces their use over the next 24 hours when compared with placebo. Almost all patients taking placebo requested analgesics within 2 hours of surgery, compared with only 11% of those taking rose hip extract. In addition, this rose hip extract moderately reduced the level of pain over the 24-hour period (104556).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if oral rose hip is beneficial for improving wrinkles. Details: Preliminary clinical research shows that taking Rosa canina rose hip powder (Hyben Vital) 1.5 grams twice daily for 8 weeks improves wrinkles, skin moisture, and elasticity when compared with baseline. However, it is unclear if these benefits are clinically significant (104557). Also, the validity of these findings is limited by the lack of a comparator group.
• Benign prostatic hyperplasia (BPH). Although there has been interest in using oral rose hip for BPH, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Cancer. Although there has been interest in using oral rose hip for cancer, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Common cold. Although there has been interest in using oral rose hip for the common cold, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Diabetes. Although there has been interest in using oral rose hip for diabetes, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Dysmenorrhea. It is unclear if oral rose hip is beneficial for reducing menstrual pain. Details: Preliminary clinical research shows that taking Rosa damascena rose hip extract 200 mg every 6 hours for 3 days is as effective as taking mefenamic acid 250 mg on the same dosing schedule for reducing pain associated with dysmenorrhea (104555).
• Gout. Although there has been interest in using oral rose hip for gout, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Hyperlipidemia. Although there has been interest in using oral rose hip for hyperlipidemia, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Hypertension. Although there has been interest in using oral rose hip for hypertension, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Influenza. Although there has been interest in using oral rose hip for influenza, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Obesity. It is unclear if oral rose hip is beneficial for obesity. Details: Preliminary clinical research shows that taking Rosa canina rose hip powder 40 grams daily mixed with apple juice for 6 weeks does not significantly affect weight or glucose tolerance when compared with placebo. However, it decreases total cholesterol by 5%, low-density lipoprotein (LDL) cholesterol by 6%, and systolic blood pressure by 4% when compared with placebo (18104).
• Rheumatoid arthritis (RA). It is unclear if oral rose hip is beneficial for RA. Details: Preliminary clinical research in adults with RA shows that taking a specific Rosa canina rose hip powder product (LitoZin/i-flex, Hyben Vital) 2.5 grams (5 capsules) twice daily over 6 months improves patient scores on a disability index, as well as other subjective physician- and patient-based assessments, when compared with placebo (17416).
• Sciatica. Although there has been interest in using oral rose hip for sciatica, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Sexual dysfunction. Oral rose hip has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in women with sexual dysfunction shows that taking a specific combination tablet (Lady Prelox, Horphag Research) containing a standardized extract of rose hip (Rosvita) 50 mg, maritime pine bark (Pycnogenol, Horphag Research) 20 mg, L-arginine 200 mg, and L-citrulline 200 mg orally daily for 8 weeks, in combination with a management program consisting of lifestyle, diet, exercise, and stress control changes, improves overall sexual function when compared with the management program alone (91963). Taking the same product in a dose of 2 tablets twice daily for 8 weeks, in addition to the lifestyle management program, improves vaginal dryness in pre- and post-menopausal women when compared with lifestyle management alone (103611). The effect of rose hip extract alone on sexual dysfunction is unclear.
• Stretch marks (striae gravidarum). Topical rose hip has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that applying a specific formulation containing hydroxyprolisilane C, rose hip oil, gotu kola triterpenes, and vitamin E (Velastisa Antiestrías, ISDIN) twice daily during pregnancy, beginning at week 10-14 and continuing throughout pregnancy, decreases the severity of both new and old stretch marks when compared with placebo. It also appears to decrease the incidence of stretch marks by about 84% in women without previous striae (92507).
• Urinary tract infections (UTIs). It is unclear if oral rose hip is beneficial for UTI prevention. Details: Preliminary clinical research in women who have undergone a Cesarean section shows that taking Rosa canina rose hip powder 500 mg twice daily, starting 2 days post-partum and continuing for 20 days, reduces the odds of asymptomatic, culture-positive UTIs by 68% when compared with placebo. However, rose hip does not appear to reduce the incidence of symptomatic UTIs in these patients (97938).
• Vitamin C deficiency. Although there has been interest in using oral rose hip for vitamin C deficiency, there is insufficient reliable information about the clinical effects of rose hip for this condition. More evidence is needed to rate rose hip for these uses.

(Read more about ROSE HIP)

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

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts. Hibiscus sabdariffa tea has been safely consumed in amounts of up to 720 mL daily for up to 6 weeks (16894,93805,93814). Hibiscus sabdariffa extracts, including a specific Hibiscus sabdariffa leaf extract (Green Chem), have also been safely used in doses of up to 1000 mg daily for up to 90 days (17415,54989,93805,93809,105307).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately. Hibiscus sabdariffa calyx powder has been used with apparent safety at a dose of 2 grams three times daily for 4 weeks by adolescents aged 12-18 years (93816).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Hibiscus sabdariffa is thought to be a menstrual stimulant, and might have abortifacient effects (19).

LACTATION: POSSIBLY UNSAFE
when used orally in large amounts. Animal research found that administering large doses of Hibiscus sabdariffa during lactation decreases food and water intake during pregnancy and delays puberty in offspring (93810); however, this has not been assessed in humans.

(Read more about HIBISCUS SABDARIFFA)

LIKELY SAFE ...when used orally in food amounts (6,4120). There is insufficient reliable information available about the safety of rooibos when used orally in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about ROOIBOS)

LIKELY SAFE ...when rose hip extract is used orally in the amounts found in foods. Rose hip extract has Generally Recognized as Safe (GRAS) status in the US (4912). ...when rose hip from Rosa canina is used orally and appropriately in medicinal amounts. A specific formulation of rose hip powder from Rosa canina (LitoZin/i-flex, Hyben Vital), taken in doses of up to 2.5 grams (5 capsules) twice daily, has been safely used for up to 6 months (17416,71641,71646,71658,71660,71661,104557). Rose hip powder from Rosa canina, 40 grams daily mixed in apple juice, has been used safely for up to 6 weeks (18104). Rose hip powder from Rosa canina, 500 mg twice daily for 20 days, has also been safely used (97938).

POSSIBLY SAFE ...when rose hip from Rosa damascena is used orally and appropriately in medicinal amounts. Rose hip extract from Rosa damascena has been used safely in doses of 200 mg every 6 hours for 3 days (104555). There is insufficient reliable information available about the safety of medicinal amounts of rose hip from other Rosa species. There is also insufficient reliable information available about the safety of rose hip when used topically.

PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of rose hip when used orally or topically in medicinal amounts; avoid using in amounts greater than those found in foods.

(Read more about ROSE HIP)

ACETAMINOPHEN (Tylenol, others) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Probable •  Level of Evidence = B Theoretically, taking Hibiscus sabdariffa with acetaminophen might decrease the clinical effects of acetaminophen.  Details There is some evidence that consuming a Hibiscus sabdariffa beverage (Zobo drink) before taking acetaminophen can decrease the elimination half-life of acetaminophen. Hibiscus sabdariffa does not seem to decrease maximum concentration or area under the curve of acetaminophen (12184). The clinical significance of this is unknown.

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Hibiscus sabdariffa with antidiabetes drugs might increase the risk of hypoglycemia.  Details Most clinical research shows that Hibiscus sabdariffa can reduce blood glucose levels (54999,105304,105305).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Hibiscus sabdariffa with antihypertensive drugs might increase the risk of hypotension.  Details Most clinical evidence suggests that taking Hibiscus sabdariffa reduces systolic and diastolic blood pressure (16894,54985,54995,105304). In animal research, Hibiscus sabdariffa increased the hypotensive effects of single doses of losartan and amlodipine (102459,107901).

CHLOROQUINE (Aralen) Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = B Taking Hibiscus sabdariffa tea along with chloroquine seems to reduce levels of chloroquine.  Details When taken together, Hibiscus sabdariffa tea significantly reduces the bioavailability of chloroquine (55004). This may reduce its clinical effects. People taking chloroquine for the treatment or prevention of malaria should avoid Hibiscus sabdariffa tea.

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP1A2 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP1A2 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 2A6 (CYP2A6) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP2A6 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP2A6 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 2B6 (CYP2B6) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP2B6 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP2B6 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP2C19 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP2C19 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa might reduce the metabolism of CYP2C8 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP2C8 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP2C9 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP2C9 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP2D6 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP2D6 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP2E1 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP2E1 (93811). This interaction has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa extract might reduce the metabolism of CYP3A4 substrates.  Details In vitro research shows that Hibiscus sabdariffa calyx extract inhibits CYP3A4 (93811). This interaction has not been reported in humans.

DICLOFENAC (Voltaren, others) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Taking Hibiscus sabdariffa with diclofenac may increase the levels and adverse effects of diclofenac.  Details Pharmacokinetic research in humans shows that drinking a beverage made with Hibiscus sabdariffa flowers reduces the excretion of diclofenac by approximately 38% when compared with water. The clinical significance of this is unknown (101726).

LOSARTAN (Cozaar) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Hibiscus sabdariffa might increase the levels and clinical effects of losartan.  Details Animal research in rats with laboratory-induced hypertension shows that providing Hibiscus sabdariffa for 14-17 days prior to a single administration with losartan modestly increases losartan concentrations and increases hypotensive effects when compared with a single administration of losartan alone (102459). It is not clear if Hibiscus sabdariffa alters the concentration or effects of losartan when taken continuously. Additionally, this interaction has not been shown in humans.

SIMVASTATIN (Zocor) Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = B Taking Hibiscus sabdariffa with simvastatin might reduce the levels and clinical effects of simvastatin.  Details A pharmacokinetic study in humans shows that taking a beverage prepared with dried Hibiscus sabdariffa flower 300 grams concurrently with a single dose of simvastatin 40 mg increases the clearance of simvastatin by about 45% and reduces peak levels of simvastatin by 18% (96270).

(Read more about HIBISCUS SABDARIFFA)

ACE INHIBITORS (ACEIs) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rooibos with ACEIs may increase the therapeutic and adverse effects of ACEIs.  Details Clinical research in healthy adults shows that taking a single dose of rooibos tea, 400 mL orally, inhibits angiotensin-converting enzyme activity (101253).

ATORVASTATIN (Lipitor) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rooibos with atorvastatin may increase the therapeutic and adverse effects of atorvastatin.  Details Animal research shows that consuming green rooibos extract with atorvastatin daily for 3 weeks increases the maximum plasma concentration of atorvastatin by 6-fold and reduces the clearance of atorvastatin (104211).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rooibos with CYP1A2 substrates may increase the effects of CYP1A2 substrates.  Details In vitro research shows that the methanol extract of rooibos leaves and stems inhibits CYP1A2 enzyme activity (101251).

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rooibos with CYP2C19 substrates may increase the effects of CYP2C19 substrates.  Details In vitro research shows that the methanol extract of rooibos leaves and stems strongly inhibits CYP2C19 enzyme activity (101251).

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rooibos with CYP2C9 substrates may increase the effects of CYP2C9 substrates.  Details In vitro research shows that the methanol extract of rooibos leaves and stems inhibits CYP2C9 enzyme activity (101251).

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rooibos with CYP2D6 substrates may increase the effects of CYP2D6 substrates.  Details In vitro research shows that the methanol extract of rooibos leaves and stems inhibits CYP2D6 enzyme activity (101251).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rooibos with CYP3A4 substrates may increase the effects of CYP3A4 substrates.  Details In vitro research shows that the methanol extract of rooibos leaves and stems strongly inhibits CYP3A4 enzyme activity (101251).

(Read more about ROOIBOS)

ALKYLATING AGENTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, the antioxidant effects of rose hip might reduce the effectiveness of alkylating agents but might also reduce the oxidative damage caused by certain alkylating agents.  Details Rose hip contains vitamin C. The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa (391). In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells (14012,14013). Further, some animal research suggests that the antioxidant effects of rose hip might attenuate cyclophosphamide-induced testicular toxicity (111413). More evidence is needed to determine what effect, if any, antioxidants found in rose hip, such as vitamin C, have on the effectiveness and adverse effects of chemotherapy.

ALUMINUM Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = D Theoretically, rose hip might increase the amount of aluminum absorbed from aluminum compounds.  Details Rose hip contains vitamin C. Theoretically, vitamin C increases the absorption of aluminum. Concomitant use might increase aluminum absorption, but the clinical significance of this is unknown (3046). Administer rose hip two hours before or four hours after antacids.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, rose hip might reduce the effectiveness of anticoagulant or antiplatelet drugs.  Details In vitro and animal research suggests that a constituent of rose hip, rugosin E, can induce platelet aggregation (71653). This has not been shown in humans. Theoretically, concomitant use of rose hip might reduce the effectiveness of antiplatelet or anticoagulant drugs.

ANTITUMOR ANTIBIOTICS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, the antioxidant effects of rose hip might reduce the effectiveness of antitumor antibiotics.  Details Rose hip contains the antioxidant vitamin C. There is concern that antioxidants might reduce the activity of chemotherapy drugs that generate free radicals, such as antitumor antibiotics (391). In contrast, other researchers theorize that antioxidants might make antitumor antibiotic chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells (14012,14013). More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on antitumor antibiotic chemotherapy.

ASPIRIN Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Unlikely •  Level of Evidence = B Theoretically, rose hip might reduce the clearance of aspirin; however, its vitamin C content is likely too low to produce clinically significant effects.  Details Rose hip contains vitamin C. It has been suggested that acidification of the urine by vitamin C can decrease the urinary excretion of salicylates, increasing plasma salicylate levels (3046). However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion (10588,10589). The vitamin C content of rose hip is typically about 500 mg per 100 grams. Thus, a clinically significant interaction between rose hip and aspirin is unlikely.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, rose hip might increase blood levels of estrogens.  Details Rose hip contains vitamin C. Increases in plasma estrogen levels of up to 55% have occured under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products (129,130,11161). It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall (129,11161). When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. However, increases in plasma estrogen levels may occur when women who are deficient in vitamin C take supplements (11161).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, rose hip might increase blood levels of lithium.  Details Rose hip is thought to have diuretic properties (5,18). Theoretically, due to these potential diuretic effects, rose hip might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

WARFARIN (Coumadin) Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, rose hip might reduce the effectiveness of warfarin; however, its vitamin C content is likely too low to produce clinically significant effects.  Details Rose hip contains vitamin C. High doses of vitamin C may reduce the response to warfarin, possibly by causing diarrhea and reducing warfarin absorption (11566). This occurred in two people who took up to 16 grams daily of vitamin C, and resulted in decreased prothrombin time (9804,9806). Lower doses of 5-10 grams daily of vitamin C can also reduce warfarin absorption, but this does not seem to be clinically significant (9805,9806,11566,11567). The vitamin C content of rose hip is typically about 500 mg per 100 grams. Thus, a clinically significant interaction between rose hip and warfarin is unlikely.

(Read more about ROSE HIP)

General ...Orally, Hibiscus sabdariffa is generally well tolerated.

Gastrointestinal ...Orally, taking a specific Hibiscus sabdariffa leaf extract (Green Chem) 1 gram daily has been associated with reports of transient gastrointestinal symptoms such as abdominal distention, flatulence, and epigastric pain in one clinical trial. However, the overall rate of these adverse effects was similar to placebo (17415). Taking Hibiscus sabdariffa calyx extract 6 grams daily has been associated with single cases of nausea in one clinical trial (55000). Taking Hibiscus sabdariffa calyx powder 6 grams daily has been associated with reports of mild and transient constipation in one clinical trial (93816). Taking 0.5-1 liters of tea daily, made by steeping 10-15 grams of dried Hibiscus sabdariffa calyces, has been associated with one report of stomach pain in one clinical trial (101733).

Genitourinary ...Orally, taking Hibiscus sabdariffa calyx extract 6 grams daily has been associated with one report of dysuria in one clinical trial (55000).

Neurologic/CNS ...Orally, taking Hibiscus sabdariffa calyx extract 3 grams daily has been associated with one report of tremor and headache in one clinical trial (55000).

Ocular/Otic ...Orally, taking Hibiscus sabdariffa calyx extract 3 grams daily has been associated with one report of tinnitus in one clinical trial (55000).

Pulmonary/Respiratory ...Taking 0. 5-1 liters of tea daily, made by steeping 10, 15, or 20 grams of dried Hibiscus sabdariffa calyces, has been associated with two reports of dyspnea in one clinical trial. A clear association with Hibiscus sabdariffa could not be made (101733).

(Read more about HIBISCUS SABDARIFFA)

General ...There is currently a limited amount of information on the adverse effects of roobios. A thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Hepatotoxicity.

Hepatic ...Orally, large and long-term doses of rooibos tea might cause hepatotoxicity in some susceptible patients. In a case-report, a 37-year-old man drinking 10 cups of rooibos tea daily for over a year presented with hepatic dysfunction and thrombocytopenia (101254).

(Read more about ROOIBOS)

General ...Orally, rose hip from Rosa canina is well tolerated. Rose hip from Rosa damascena also seems to be well tolerated. A thorough evaluation of safety outcomes has not been conducted for rose hip derived from other species.
Most Common Adverse Effects:
Orally: Flatulence, loose stools.

Dermatologic ...Orally, one case of mild urticaria has been reported in a clinical trial for a patient taking a specific rose hip powder product (LitoZin/i-flex, Hyben Vital) 2. 5 grams twice daily (71646).

Gastrointestinal ...Orally, gastrointestinal reactions have been reported. These include abdominal cramps, acid reflux, constipation, diarrhea, flatulence, nausea, vomiting, gastrointestinal obstruction, esophagitis, heartburn, acid reflux, and water brash. However, in most cases, these adverse effects occurred at the same frequency in patients taking placebo (15,18104,71641,71646,97938).
Rose hip powder is a source of vitamin C. Osmotic diarrhea and gastrointestinal upset have been reported with doses of vitamin C greater than the tolerable upper intake level (UL) of 2000 mg daily (4844). However, most rose hip products contain only 500 mg of vitamin C per 100 grams.

Genitourinary ...Orally, a few mild cases of frequent voiding have been reported in clinical trials. However, the frequency of occurrence does not seem to differ from those taking placebo (71641,71646).

Immunologic ...When inhaled in the workplace, rose hip dust has caused mild to moderate anaphylaxis (6).

Neurologic/CNS ...Orally, vertigo and headache have been reported rarely (97938).

Ocular/Otic ...A case of keratoconjunctivitis secondary to contact with rose hip has been reported. The adverse effect was attributed to irritant hairs found on the fruit of rose hip. Symptoms resolved after treatment with topical prednisolone 1% eye drops (71642).

(Read more about ROSE HIP)