Eczema & Skin Renewal (External) by Alternative Health & Herbs Remedies

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there has been interest in using oral Baikal skullcap for allergic rhinitis, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Anxiety. Although there has been interest in using oral Baikal skullcap for anxiety, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Atherosclerosis. Although there has been interest in using oral Baikal skullcap for atherosclerosis, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Attention deficit-hyperactivity disorder (ADHD). Although there has been interest in using oral Baikal skullcap for ADHD, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Bronchiolitis. Intravenous Baikal skullcap has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that a combination of Baikal skullcap, forsythia, and honeysuckle, known as Shuang Huang Lian in traditional Chinese medicine, given intravenously, with or without antibiotics, decreases the duration of cough by about 1.5-2 days, the duration of wheezing by about 2 days, and the duration of hospitalization by about 2-3 days when compared with antibiotics alone in children with respiratory syncytial virus (RSV) infection. Baikal skullcap injection was administered as a 20 mL dose for patients under 6 months, a 40 mL dose for patients 7-36 months, or a 60 mL dose for patients older than 36 months (12613).
• Cancer. Although there has been interest in using oral Baikal skullcap for cancer, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Diabetes. It is unclear if oral Baikal skullcap is beneficial in patients with diabetes. Details: A very small clinical trial in patients with uncontrolled diabetes taking metformin 500 mg daily shows that taking Baikal skullcap extract 3.52 grams in three divided doses daily for 8 weeks does not decrease levels of fasting glucose or insulin or improve levels of glycated hemoglobin (HbA1c) when compared with placebo. However, taking Baikal skullcap reduces blood glucose levels during an oral glucose tolerance test (OGTT) at 60 minutes, but not 120 minutes, when compared with placebo (101738). This study may have been inadequately powered to detect a difference between groups.
• Epilepsy. Although there has been interest in using oral Baikal skullcap for epilepsy, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Hand, foot, and mouth disease. It is unclear if intravenous Baikal skullcap is beneficial in patients with hand, foot, and mouth disease. Details: Low-quality observational research in children hospitalized with severe hand, foot, and mouth disease has found that children who are given Baikal skullcap intravenously as a Tanreqing injection 0.3-0.5 mL/kg once daily have a shorter duration of fever, oral ulcers, and rash, as well as reduced viral load, when compared with those given ribavirin 10 mg/kg once daily (96281). The validity of these findings is limited by the retrospective nature of the study.
• Headache. Although there has been interest in using oral Baikal skullcap for headache, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Hemorrhoids. Although there has been interest in using oral Baikal skullcap for hemorrhoids, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Hepatitis. Although there has been interest in using oral Baikal skullcap for hepatitis, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• HIV/AIDS. Although there has been interest in using oral Baikal skullcap for HIV/AIDS, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Insomnia. Although there has been interest in using oral Baikal skullcap for insomnia, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Osteoarthritis. Oral Baikal skullcap has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a specific product (Limbrel, Primus Pharmaceuticals) that contains flavocoxid, a blend of Baikal skullcap extract and catechu flavonoid extract, 500 mg once or twice daily for up to 12 weeks reduces symptoms of osteoarthritis of the knee when compared with baseline. These studies found no significant difference between this combination product and naproxen 440 mg once daily to 500 mg twice daily for reducing symptoms (17030,18012,92776). However, in 2017, the US Food and Drug Administration (FDA) formally requested the recall of all non-expired lots of this product due to the risk for liver and lung injury (106042). See the Adverse Effects section for more information.
• Peyronie disease. It is unclear if oral Baikal skullcap is beneficial in patients with Peyronie disease. Details: Observational research has found that taking oral Baikal skullcap root extract 150 mL twice daily for 6 months is associated with reduced time to disease stabilization, with an average reduction of 5 months, when compared with no treatment. In addition, 17% of patients taking Baikal skullcap had pain resolution and only 33% required surgical correction, compared with 0% and 58%, respectively, of control patients. In patients requiring surgery, taking Baikal skullcap did not appear to affect resolution; however, the study may have been inadequately powered to detect a difference between groups (105867).
• Prostate cancer. Although there has been interest in using oral Baikal skullcap for prostate cancer, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Psoriasis. Although there has been interest in using oral Baikal skullcap for psoriasis, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Seizures. Although there has been interest in using oral Baikal skullcap for seizures, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose.
• Upper respiratory tract infection (URTI). Although there has been interest in using oral and intravenous Baikal skullcap for upper respiratory tract infections, there is insufficient reliable information about the clinical effects of Baikal skullcap for this purpose. More evidence is needed to rate Baikal skullcap for these uses.

(Read more about BAIKAL SKULLCAP)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Coronary heart disease (CHD). It is unclear if consuming black walnut as part of the diet can reduce the risk for CHD. Details: Epidemiological research has found that people who increase dietary consumption of nuts in general might have a lower risk of CHD and death due to coronary events. However, there is no available evidence showing that eating black walnut, specifically, reduces the risk of CHD (8478,13299). Still, in 2004, the US Food and Drug Administration (FDA) determined that it would allow a qualified health claim stating that consuming 1.5 ounces of walnuts per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD. The FDA has concluded that this claim is based on supporting, rather than conclusive, evidence (102335).
• Wound healing. Although there is interest in using topical black walnut hull and bark for wound healing, there is insufficient reliable information about the clinical effects of black walnut for this purpose. More evidence is needed to rate the effectiveness of black walnut for these uses.

(Read more about BLACK WALNUT)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angina. Although there has been interest in using oral comfrey for angina, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Back pain. It is unclear if topical comfrey is beneficial in patients with back pain. Details: Clinical research in patients with lower or upper back pain shows that applying a specific ointment (Kytta-Salbe f, Merck Selbstmedikation GmbH) containing comfrey root extract 35% as 4 grams three times daily for 5 days decreases pain approximately 2-fold when compared with placebo (44912). Other clinical research shows that applying a specific cream (Kytta-Balsam f, Merck Selbstmedikation GmbH) containing comfrey root extract 35% and methyl nicotinate 1.2% as 4 grams three times daily for 5 days decreases pain scores by 54% at rest and by 50% during active motion when compared with placebo. These improvements were 24% and 27%, respectively, when compared with methyl nicotinate alone (92570).
• Bronchitis. Although there has been interest in using oral comfrey for bronchitis, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Bruises. It is unclear if topical comfrey is beneficial in patients with bruises. Details: Preliminary clinical research in adults with bruises from therapeutic subcutaneous enoxaparin injections shows that applying comfrey 10% ointment four times daily for 5 days reduces the average bruise size by 77% when compared with placebo. Topical comfrey also improved the bruise color (108668).
• Cancer. Although there has been interest in using oral comfrey for cancer, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Cough. Although there has been interest in using oral comfrey for cough, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Diarrhea. Although there has been interest in using oral comfrey for diarrhea, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Gastritis. Although there has been interest in using oral comfrey for gastritis, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Menorrhagia. Although there has been interest in using oral comfrey for menorrhagia, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Osteoarthritis. It is unclear if topical comfrey is beneficial in patients with osteoarthritis. Details: Preliminary clinical research in patients with knee osteoarthritis shows that applying a specific ointment (Kytta-Salbe f, Merck Selbstmedikation GmbH) containing comfrey root extract 35% three times daily for 3 weeks decreases pain scores 4-fold to 5-fold more than placebo. Applying comfrey root extract ointment also improved functional scores when compared with placebo (44904). Other clinical research in adults with knee osteoarthritis shows that applying a specific cream (4Jointz, Arthritis Relief Plus Ltd) containing comfrey extract 10% to 20%, plus tannic acid, aloe vera gel, eucalyptus oil, and frankincense oil three times daily for 6-12 weeks decreases pain approximately 2-fold more than placebo. The combination product also improved stiffness and physical functioning when compared with placebo (44919,92571).
• Peptic ulcers. Although there has been interest in using oral comfrey for peptic ulcers, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Pharyngitis. Although there has been interest in using oral or topical comfrey for pharyngitis, there is insufficient reliable information about the clinical effects of comfrey for this purpose.
• Sprains. It is unclear if topical comfrey is beneficial in patients with sprains. Details: Preliminary clinical research in adults with acute ankle sprains shows that applying a specific ointment (Kytta-Salbe f, Merck Selbstmedikation GmbH) containing comfrey root extract 35% as 2 grams four times daily for 8 days reduces pain and swelling and improves ankle mobility when compared with placebo (44898). Other research in adults with acute ankle sprains also shows that applying the same ointment reduces pain and tenderness scores to a similar extent as diclofenac gel 1.16% (44902).
• Tuberculosis. Although there has been interest in using oral comfrey for tuberculosis, there is insufficient reliable information about the clinical effects of comfrey for this purpose. More evidence is needed to rate comfrey for these uses.

(Read more about COMFREY)

There is insufficient reliable information available about the effectiveness of gravel root.

(Read more about GRAVEL ROOT)

POSSIBLY INEFFECTIVE

• Smoking cessation. Some small clinical studies have evaluated the use of lobeline, a constituent of lobelia, for smoking cessation and stopping use of smokeless tobacco over a 48-hour period. These studies show inconsistent effects of lobelia on tobacco use, with many finding no benefit. The validity of these findings is limited by low study quality and the short duration of use (16413,16414,59987). There is insufficient reliable information available about the effectiveness of lobelia for its other uses.

(Read more about LOBELIA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• ACE inhibitor-induced cough. It is unclear if oral marshmallow root is beneficial in patients with cough due to ACE inhibitors. Details: A small clinical study in patients with ACE inhibitor-induced cough shows that taking marshmallow root 40 mg (20 drops) three times daily for 4 weeks improves cough when compared to baseline (62027). The validity of this finding is limited by the lack of a control group.
• Atopic dermatitis (eczema). It is unclear if topical marshmallow is beneficial in children with eczema. Details: A very small clinical study in children ages 3 months to 12 years with a recent diagnosis of mild to moderate eczema shows that applying a marshmallow 1% ointment twice daily for 1 week and then three times weekly for 3 weeks seems to reduce symptoms, as measured on the SCORing Atopic Dermatitis (SCORAD) scale, when compared with applying hydrocortisone 1% ointment (105437). This finding is limited by the large number of drop-outs due to non-compliance, most of which were in the marshmallow group.
• Breast engorgement. It is unclear if topical marshmallow is beneficial in women with this condition. Details: A small clinical study in breastfeeding women with breast engorgement shows that applying a compress containing 40-50 mL of a solution made from marshmallow leaves and stems 3 times daily for 2 days in conjunction with standard treatment improves patient-reported breast engorgement scores when compared with standard treatment alone. Standard treatment consisted of massage and alternating warm and cold compresses before and after breastfeeding (92845).
• Constipation. Although there is interest in using oral marshmallow for constipation, there is insufficient reliable information about the clinical effects of marshmallow for this condition.
• Cough. Although there is interest in using oral marshmallow for cough, there is insufficient reliable information about the clinical effects of marshmallow for this condition.
• Diarrhea. Although there is interest in using oral marshmallow for diarrhea, there is insufficient reliable information about the clinical effects of marshmallow for this condition.
• Fever. It is unclear if topical marshmallow is beneficial for pediatric fever. Details: A moderate-sized clinical study in children aged 6 months-10 years with fever receiving rectal acetaminophen shows that applying marshmallow extract body wash and lukewarm water reduces the time to defervescence by 8 minutes when compared with lukewarm water alone, but does not improve the change in body temperature, number of acetaminophen doses given, or incidence of fever recurrence (112375). However, the interpretation of these findings is limited to patients without fevers greater than 40 degrees Celsius or history of febrile seizures since these patients were not studied.
• Leishmania lesions. Topical marshmallow has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research suggests that the topical application of an herbal extract containing a combination of marshmallow and Althaea rosa to affected areas for 5 days can help promote curing of Leishmania lesions (62020).
• Respiratory tract infections. Although there is interest in using oral marshmallow for respiratory tract infections, there is insufficient reliable information about the clinical effects of marshmallow for this condition.
• Vaginal candidiasis. It is unclear if vaginal marshmallow is beneficial for vulvovaginal candidiasis. Details: A small clinical study in adults with vulvovaginal candidiasis shows that applying a vaginal cream comprised of marshmallow extract 4% and clotrimazole 1% daily for 7 days improves itching, dyspareunia, and dysuria at 7 days when compared with clotrimazole 1% alone. At 30 days, the marshmallow intervention also results in fewer positive yeast cultures and sustained reduction in itching (112371). However, the validity of these results is limited by significant differences between groups at baseline for dyspareunia and dysuria, and lack of adjustment for multiple comparisons which can increase false positive findings. Additionally, all primary outcomes were patient-reported.
• Venous leg ulcers. Although there is interest in using topical marshmallow for venous leg ulcers, there is insufficient reliable information about the clinical effects of marshmallow for this condition.
• Wounds. Although there is interest in using topical marshmallow for wounds, there is insufficient reliable information about the clinical effects of marshmallow for this condition. More evidence is needed to rate marshmallow for these uses.

(Read more about MARSHMALLOW)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Although there is interest in using oral mullein for asthma, there is insufficient reliable information about the clinical effects of mullein for this condition.
• Bronchitis. Although there is interest in using oral mullein for bronchitis, there is insufficient reliable information about the clinical effects of mullein for this condition.
• Cough. Although there is interest in using oral mullein for cough, there is insufficient reliable information about the clinical effects of mullein for this purpose.
• Diarrhea. Although there is interest in using oral mullein for diarrhea, there is insufficient reliable information about the clinical effects of mullein for this purpose.
• Hemorrhoids. Although there is interest in using topical mullein for hemorrhoids, there is insufficient reliable information about the clinical effects of mullein for this purpose.
• Influenza. Although there is interest in using oral mullein for influenza, there is insufficient reliable information about the clinical effects of mullein for this condition.
• Migraine headache. Although there is interest in using oral mullein for migraine headache, there is insufficient reliable information about the clinical effects of mullein for this condition.
• Otitis media. Topical mullein 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 combination product containing mullein, garlic, calendula, and St. John's wort in olive oil (Otikon Otic Solution, Healthy-On Ltd), five drops into the affected ear three times daily for 3 days, reduces ear pain in children and adolescents with otitis media (39500,39552). Whether this effect is due to mullein, one of the other ingredients, or the combination is unclear.
• Pneumonia. Although there is interest in using oral mullein for pneumonia, there is insufficient reliable information about the clinical effects of mullein for this condition.
• Wound healing. It is unclear if topical mullein is helpful for healing episiotomy wounds. Details: In preliminary clinical research in primiparous patients with episiotomy wounds, applying a cream containing mullein flower extract 7.5%, 2 cm twice daily for 10 days, improves redness, edema, ecchymoses, discharge, and wound edge adhesions (REEDA score for episiotomy wound healing) at 10 days, but not earlier, when compared with placebo (107873). More evidence is needed to rate mullein for these uses.

(Read more about MULLEIN)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there has been interest in using oral skullcap for allergic rhinitis (hay fever), there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Anxiety. It is unclear if oral skullcap is beneficial for reducing symptoms of anxiety. Details: Preliminary clinical research shows that healthy people who take a single dose of freeze-dried skullcap extract 100-350 mg feel more relaxed when compared to baseline. This effect appears to last for about 2 hours (12216). However, other preliminary clinical research in healthy patients shows that taking freeze-dried skullcap (Skullcap, Eclectic Institute) 350 mg three times daily for 2 weeks does not reduce anxiety scores when compared with placebo (91690). Because these were short-term studies in healthy patients, it's unclear if skullcap is beneficial in anxiety disorders or if extended use is beneficial.
• Atherosclerosis. Although there has been interest in using oral skullcap for atherosclerosis, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Contact dermatitis. Although there has been interest in using oral skullcap for contact dermatitis, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Epilepsy. Although there has been interest in using oral skullcap for epilepsy, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Hyperlipidemia. Although there has been interest in using oral skullcap for hyperlipidemia, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Insomnia. Although there has been interest in using oral skullcap for insomnia, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Premenstrual dysphoric disorder (PMDD). Although there has been interest in using oral skullcap for PMDD, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Spasticity. Although there has been interest in using oral skullcap for spasticity, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Stress. Although there has been interest in using oral skullcap for stress, there is insufficient reliable information about the clinical effects of skullcap for this purpose.
• Stroke. Although there has been interest in using oral skullcap for stroke, there is insufficient reliable information about the clinical effects of skullcap for this purpose. More evidence is needed to rate skullcap for this use.

(Read more about SKULLCAP)

There is insufficient reliable information available about the effectiveness of white oak bark.

(Read more about WHITE OAK)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Biliary disorders. Although there has been interest in using oral wormwood for biliary disorders, there is insufficient reliable information about the clinical effects of wormwood for this purpose.
• Crohn disease. Small clinical studies suggest that oral wormwood may modestly improve symptoms in patients with Crohn disease. Details: Preliminary clinical research in patients with Crohn disease shows that taking a specific product (SedaCrohn, Noor Herbals, LLC) containing powdered wormwood 750 mg 2-3 times daily for 6-10 weeks improves quality of life and mood, increases symptom remission, and reduces corticosteroid requirements when compared with placebo (86545,93468). Clinical remission occurred in 8 out of 10 patients taking wormwood, compared with only 2 out of 10 patients taking placebo (93468).
• Depression. Although there has been interest in using oral wormwood for depression, there is insufficient reliable information about the clinical effects of wormwood for this purpose.
• Dyspepsia. Although there has been interest in using oral wormwood for dyspepsia, there is insufficient reliable information about the clinical effects of wormwood for this purpose.
• Gastritis. Although there has been interest in using oral wormwood for gastritis, there is insufficient reliable information about the clinical effects of wormwood for this purpose.
• IgA nephropathy. It is unclear if oral wormwood is beneficial in patients with IgA nephropathy. Details: Preliminary clinical research in patients with IgA nephropathy shows that taking powdered wormwood (Seda-Leukin, Noor Herbals LLC) 600 mg three times daily for 6 months along with standard treatment reduces proteinuria when compared with baseline. The urinary protein:creatinine ratio decreased from 2340 mg/gram to 315 mg/gram over 6 months. Furthermore, systolic and diastolic blood pressures decreased by 10% and 14%, respectively (93469). The validity of these findings is limited by the lack of a comparator group.
• Insect bite. Although there has been interest in using topical wormwood for insect bites, there is insufficient reliable information about the clinical effects of wormwood for this purpose.
• Osteoarthritis. It is unclear if topical wormwood is beneficial in patients with knee osteoarthritis. Details: Preliminary clinical research in patients with knee osteoarthritis shows that applying an ointment or liniment containing wormwood extract 3% to the knee three times daily for 4 weeks might improve pain, although any pain improvement was not maintained 2 weeks after discontinuation. Topical wormwood appears to be less effective than topical piroxicam gel, which improves pain, stiffness, and physical function when compared with baseline, with benefits maintained 2 weeks after discontinuation (95925). More evidence is needed to rate wormwood for these uses.

(Read more about WORMWOOD)

POSSIBLY SAFE ...when used orally and appropriately, short-term. Oral Baikal skullcap 0.5-3.52 grams daily has been used with apparent safety for up to 8 weeks (92776,101738,101739,110023). However, a high quality assessment of safety has not been conducted. A specific product (Limbrel, Primus Pharmaceuticals) containing flavocoxid, a mixture of Baikal skullcap flavonoid extract and catechu extract, has been associated with an increased risk for liver and lung injury. In 2017, the US Food and Drug Administration (FDA) formally requested the recall of all non-expired lots of this product (106042). It is unclear if these effects were due to Baikal skullcap, catechu, or the combination. There is insufficient reliable information available about the safety of Baikal skullcap when used intravenously or topically.

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

(Read more about BAIKAL SKULLCAP)

LIKELY SAFE ...when the fruit (nut) is consumed in amounts normally found in food.

POSSIBLY UNSAFE ...when the bark is used orally or topically, due to its juglone content (2). When applied topically, juglone-containing bark can cause skin irritation. When used orally on a daily basis, the juglone-containing bark of a related species (English walnut) is associated with increased risk of tongue cancer and lip leukoplakia (2,12). There is insufficient reliable information available about the safety of the leaf or hull when used orally as a medicine or when applied topically.

PREGNANCY AND LACTATION: LIKELY SAFE
when the fruit (nut) is consumed in amounts normally found in foods.

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when the bark is used orally or topically (12); avoid using. There is insufficient reliable information available about the safety of black walnut leaf or hull when used orally in medicinal amounts during pregnancy or lactation; avoid using.

(Read more about BLACK WALNUT)

POSSIBLY SAFE ...when used topically for less than 6 weeks on unbroken skin at a daily dose providing no more than 100 mcg of pyrrolizidine alkaloid (PA) constituents. PAs are absorbed through the skin (11990,44898,44902,92568).

POSSIBLY UNSAFE ...when used for extended durations or in high concentrations on unbroken skin. Topically, hepatotoxic pyrrolizidine alkaloids (PAs) in comfrey can be absorbed in quantities sufficient to cause toxicity with extended use for greater than 6 weeks or in quantities providing more than 100 mcg of PAs (11990,92568). ...when used topically on broken skin. PAs can be absorbed through broken skin. In countries where the PA content of comfrey is not regulated, including Australia and the United States, creams containing comfrey are required to include a warning not to use on broken skin (44950,44951).

LIKELY UNSAFE ...when used orally because of its potential for acute or chronic liver toxicity. Comfrey contains hepatotoxic pyrrolizidine alkaloids (PAs). Chronic ingestion of more than 1 mg daily for 2 weeks or more than 100 mcg daily for longer durations can cause liver disease. PAs may also be carcinogenic (11987,99068). The FDA has recommended removal of oral comfrey products from the market (11988).

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally or topically. In addition to hepatotoxicity and possible carcinogenicity, the pyrrolizidine alkaloids (PAs) in comfrey might be teratogenic. PAs are absorbed through the skin (11987,11988,11990).

(Read more about COMFREY)

LIKELY UNSAFE ...when products containing hepatotoxic pyrrolizidine alkaloid (PA) constituents are used orally. Repeated exposure to low concentrations of hepatotoxic PAs can cause severe veno-occlusive disease. Hepatotoxic PAs might also be carcinogenic and mutagenic (12841,12842). Tell patients not to use gravel root preparations that are not certified and labeled as hepatotoxic PA-free. ...when products containing hepatotoxic PAs are used topically on abraded or broken skin. Absorption of hepatotoxic PAs through broken skin can lead to systemic toxicities (12841). Tell patients not to use topical gravel root preparations that are not certified and labeled as hepatotoxic PA-free. There is insufficient reliable information available about the safety of using PA-free gravel root orally or topically.

PREGNANCY: LIKELY UNSAFE
when used orally. Gravel root preparations containing hepatotoxic pyrrolizidine alkaloid (PA) constituents might be teratogenic and hepatotoxic (12841,12842). There is insufficient reliable information available about the safety of using gravel root products that do not contain hepatotoxic PAs during pregnancy.

LACTATION: LIKELY UNSAFE
when used orally. Hepatotoxic pyrrolizidine alkaloid (PA) constituents in gravel root are excreted in milk (12841,12842). There is insufficient reliable information available about the safety of using gravel root products that do not contain hepatotoxic PAs during lactation.

(Read more about GRAVEL ROOT)

LIKELY UNSAFE ...when used orally (3,11). Lobelia leaf can be toxic in doses of 600-1000 mg; 4000 mg of the leaf may be fatal (18). There is insufficient reliable information available about the safety of lobelia when used topically.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally due to its emetic effects (4,12). There is insufficient reliable information available about the safety of lobelia when used topically during pregnancy and lactation.

(Read more about LOBELIA)

LIKELY SAFE ...when marshmallow root and leaf are used in amounts commonly found in foods. Marshmallow root has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).

POSSIBLY SAFE ...when marshmallow root and leaf are used orally in medicinal amounts (4,12). ...when used topically (4,62020). There is insufficient reliable information available about the safety of marshmallow flower.

PREGNANCY AND LACTATION:
Insufficient reliable information available.

(Read more about MARSHMALLOW)

There is insufficient reliable information available about the safety of skullcap.

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

(Read more about SKULLCAP)

POSSIBLY SAFE ...when used orally for up to 3-4 days for treating diarrhea (2,12,7). ...when used topically up to 2-3 weeks on intact skin (2).

LIKELY UNSAFE ...when used topically on extensive areas of damaged skin or for longer than 2-3 weeks (2).

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

(Read more about WHITE OAK)

LIKELY SAFE ...when used orally in the amounts commonly found in foods. Wormwood extracts are included in bitters, vermouth, absinthe, and other food or drink products (12814,15007). Wormwood products that are thujone-free have Generally Recognized As Safe (GRAS) status for use in foods in the US (4912); however, products containing thujone might not be safe. Wormwood is described in the pharmacopoeia of various European countries. After being banned for a period of time, it is now allowed in European Union countries; however, beverages must not contain thujone in concentrations greater than 35 mg/kg (12814,15007,86551).

POSSIBLY SAFE ...when wormwood products not containing thujone are used orally in medicinal amounts, short-term (93468,93469). A specific product

POSSIBLY UNSAFE ...when wormwood products containing thujone are used orally. Thujone is a neurotoxin that is present in wormwood oil (12617). Seizures, rhabdomyolysis, and acute kidney failure can occur when as little as 10 mL of wormwood oil is ingested (662,12817).

PREGNANCY:
LIKELY UNSAFE . .when used orally in amounts greater than those found in foods (662,12817). Some wormwood products contain thujone, a neurotoxin. Theoretically, thujone also has potential uterine and menstrual stimulant effects (12617). There is insufficient reliable information available about the safety of wormwood when used topically during pregnancy.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about WORMWOOD)

ALCOHOL (Ethanol) Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, Baikal skullcap might potentiate the sedative effects of alcohol.  Details In vitro and animal research suggests that Baikal skullcap binds to GABA-A receptors and causes sedation. Theoretically, Baikal skullcap might potentiate the sedative effects of alcohol (6290,6291,33477). Preliminary clinical research has not identified clinically relevant sedation after use of Baikal skullcap; however, a thorough evaluation of safety outcomes has not been conducted.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Baikal skullcap might increase the risk of bleeding when used concomitantly with anticoagulant and antiplatelet drugs.  Details Preliminary clinical research suggests that taking capsules containing a combination of astragalus, goldthread, and Baikal skullcap daily for 4 weeks inhibits platelet aggregation; the effect seems to be similar to that of aspirin 50 mg daily (33075). It is unclear if this effect is due to Baikal skullcap, other ingredients, or the combination.

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, concomitant use of Baikal skullcap with antidiabetes drugs might enhance blood glucose lowering effects.  Details Baicalein, a constituent of Baikal skullcap, has alpha-glucosidase inhibitory activity in vitro (6292). Animal research also suggests that Baikal skullcap enhances the antidiabetic effects of metformin (33408). However, in a small human study, taking Baikal skullcap extract did not enhance the antidiabetic effects of metformin, although it did modestly lower glucose levels during an oral glucose tolerance test (OGTT) (101738). Until more is known, use cautiously.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of Baikal skullcap with antihypertensive drugs might have additive effects and increase the risk of hypotension.  Details Animal research suggests that baicalein, a constituent of Baikal skullcap, might lower blood pressure (33374).

ANTITHYROID DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of Baikal skullcap and antithyroid drugs may result in additive activity and increase the risk of hypothyroidism.  Details In an animal hyperthyroid model, Baikal skullcap improved levels of triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) (101736). The clinical significance of this effect is unclear.

CNS DEPRESSANTS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, Baikal skullcap might cause additive therapeutic and adverse effects when used concomitantly with drugs with sedative properties.  Details In vitro and animal research suggests that Baikal skullcap binds to GABA-A receptors and causes sedation. Theoretically, Baikal skullcap might cause additive therapeutic and adverse effects when used concomitantly with drugs with sedative properties (6290,6291,33477). Preliminary clinical research has not identified clinically relevant sedation after use of Baikal skullcap; however, a thorough evaluation of safety outcomes has not been conducted.

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Baikal skullcap may increase levels of drugs metabolized by CYP1A2 enzymes.  Details In vitro evidence suggests that constituents of Baikal skullcap inhibit the activity of CYP1A2 (33346,33484). This effect has not been reported in humans.

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Baikal skullcap might increase levels of drugs metabolized by CYP2C19 enzymes.  Details In vitro evidence suggest that wogonin, a constituent of Baikal skullcap, modestly inhibits the activity of CYP2C19 enzymes (33484). This effect has not been reported in humans.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of large amounts of Baikal skullcap might interfere with hormone replacement therapy, due to competition for estrogen receptors.  Details In vitro evidence suggests that Baikal skullcap has estrogenic activity (16061).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Baikal skullcap might reduce lithium excretion and increase serum levels of lithium.  Details Baikal skullcap is thought to have diuretic properties, which may reduce lithium excretion (5541). The dose of lithium might need to be decreased.

ORGANIC ANION-TRANSPORTING POLYPEPTIDE SUBSTRATES (OATP) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = B Theoretically, Baikal skullcap might alter the levels and clinical effects of OATP substrates.  Details Some pharmacokinetic research shows that baicalin, a constituent of Baikal skullcap, can decrease plasma levels of rosuvastatin. The mechanism is thought to involve stimulation of the activity of the organic anion-transporting polypeptide 1B1 (OATP1B1), which transports rosuvastatin into the liver. This decreases plasma levels of the drug, but increases levels at the site of action in the liver. The degree to which rosuvastatin levels are affected depends on the OATP1B1 haplotype of the individual (16395). Baikal skullcap might also affect other OATP1B1 substrates (16396,16397,16398).

P-GLYCOPROTEIN SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Baikal skullcap might increase levels of drugs transported by P-glycoprotein.  Details In vitro and animal research suggests that baicalein, oroxylin A, and wogonin, constituents of Baikal skullcap, can inhibit P-glycoprotein (33372,33395,33440,33462). This effect has not been reported in humans.

(Read more about BAIKAL SKULLCAP)

(Read more about BLACK WALNUT)

CYTOCHROME P450 3A4 (CYP3A4) INDUCERS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, CYP3A4 inducers might increase the risk of adverse effects from the pyrrolizidine alkaloid constituents in comfrey.  Details CYP3A4 enzymes convert pyrrolizidine alkaloids, constituents of comfrey, to toxic metabolites (11990). Some case reports show that enzyme inducers, such as phenobarbital, seem to enhance the toxicity of comfrey (12841,12860).

HEPATOTOXIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, comfrey might have additive adverse effects on the liver when used with hepatotoxic drugs.  Details Due to its pyrrolizidine alkaloid constituents, comfrey can cause hepatotoxic effects, including ascites, cirrhosis, hepatic fibrosis, hepatomegaly, and sinusoidal obstruction syndrome (11988,11990).

(Read more about COMFREY)

(Read more about GRAVEL ROOT)

(Read more about LOBELIA)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, marshmallow flower might have antiplatelet effects.  Details Animal research suggests that marshmallow flower extract has antiplatelet effects (92846). However, the root and leaf of marshmallow, not the flower, are the plant parts most commonly found in dietary supplements. Theoretically, use of marshmallow flower with anticoagulant/antiplatelet drugs can have additive effects, and might increase the risk for bleeding in some patients.

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, due to potential diuretic effects, marshmallow might reduce excretion and increase levels of lithium.  Details Marshmallow is thought to have diuretic properties. To avoid lithium toxicity, the dose of lithium might need to be decreased when used with marshmallow.

ORAL DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, mucilage in marshmallow might impair absorption of oral drugs.  Details Marshmallow contains mucilage which can affect oral drug absorption (1,11,12,19). To avoid changes in absorption, take marshmallow 30-60 minutes after oral medications.

(Read more about MARSHMALLOW)

(Read more about MULLEIN)

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, skullcap can have additive effects when used with other CNS depressants.  Details Animal and clinical research suggests that skullcap can cause sedation and cognitive impairment (12216,74008).

(Read more about SKULLCAP)

(Read more about WHITE OAK)

ANTICONVULSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking wormwood might interfere with the effects of anticonvulsant drugs.  Details Thujone, a constituent of wormwood, has convulsant effects (12816).

(Read more about WORMWOOD)

General ...Orally, Baikal skullcap seems to be well-tolerated. There is currently a limited amount of information on the adverse effects of intravenous and topical Baikal skullcap.
Most Common Adverse Effects:
Orally: Abdominal pain, constipation, diarrhea, erythema, nausea, pruritus, and vomiting.
Intravenously: Skin reactions.
Topically: Dermatitis.
Serious Adverse Effects (Rare):
Orally: Hepatotoxicity and hypersensitivity pneumonitis have been reported with a specific combination product (Limbrel, Primus Pharmaceuticals) containing extracts of Baikal skullcap and catechu.

Cardiovascular ...Orally, in a small clinical study evaluating the safety of baicalein, a constituent of Baikal skullcap, in healthy adults, elevated triglyceride levels occurred in 1 of 10 patients who received 400 mg every 8 hours and 2 of 10 patients treated with 600 mg every 8 hours, compared with 0 of 10 patients who received 200 mg every 8 hours and 0 of 6 patients who received placebo. Triglyceride elevations were considered mild and resolved after discontinuation (110023).

Dermatologic ...Orally, taking Baikal skullcap may cause erythema and pruritus (105867). Intravenously, Baikal skullcap as part of a Tanreqing injection has been associated with reports of skin reactions in some pediatric patients (96281).
Topically, several cases of allergic contact dermatitis have been reported after applying sunscreen containing Baikal skullcap extract (105869,105870). Allergic contact dermatitis has also been reported after applying a facial cream (Resveratrol BE, Skinceuticals) containing Baikal skullcap root extract 0.5% and resveratrol 1%. Patch testing identified a positive reaction to both ingredients (110024). Baikal skullcap-induced dermatitis appears to respond to treatment with a topical corticosteroid and calcineurin inhibitor (105870).

Gastrointestinal ...Orally, use of Baikal skullcap has been associated with epigastric pain, abdominal pain, constipation, diarrhea, nausea, and vomiting (101738,105867).

Hepatic ...A specific combination product (Limbrel, Primus Pharmaceuticals) containing flavocoxid, a mixture of Baikal skullcap flavonoid extract and catechu extract, has been linked to several reports of acute liver damage. There have been at least five published reports of liver damage associated with this product. In all cases, the patients were females aged 54-68 years taking doses of 250-500 mg twice daily for 1-3 months. Signs and symptoms included jaundice, pruritus, abdominal pain, fever, rash, and elevated serum bilirubin and liver transaminase levels. All patients fully recovered and levels normalized within 3 months after discontinuation (18009,96282). In addition to these published case reports, approximately 30 liver-related adverse events have been reported to the manufacturer of this product (18009). The mechanism of hepatotoxicity is unclear (18009,18010); it is estimated that the incidence of hepatotoxicity with this product is around 1 in 10,000, although the actual incidence is unknown (18010). In 2017, the US Food and Drug Administration (FDA) formally requested the recall of all non-expired lots of this product due to the risk for liver and lung injury (106042). It is unclear if these effects were due to Baikal skullcap, catechu, or the combination.
Hepatotoxicity has also been reported in two patients taking a specific dietary supplement (Move Free Advanced, Reckitt Benckiser) containing Baikal skullcap, black catechu, glucosamine, chondroitin, and hyaluronic acid (33460) and in a patient taking Baikal skullcap, elderflower, horseradish, and white willow (101737). The investigators determined that the hepatotoxicity was likely caused by Baikal skullcap in these cases (33460,101737). Additionally, cases of liver injury are reported in 4 of 37 patients taking various Kampo formulations containing Baikal skullcap and other herbs daily. Patients presented with elevated liver function tests 7 to 38 days after consumption (112179). It is unclear if this adverse effect is from Baikal skullcap, other ingredients, or the combination.
In a small study evaluating the safety of baicalein, a constituent of Baikal skullcap, in healthy adults, liver transaminase elevations occurred in 2 of 10 patients who received 400 mg every 8 hours for 6 days, compared with 0 of 6 patients who received placebo. No patients receiving either 200 mg or 600 mg every 8 hours experienced liver transaminase elevations. The elevations were considered mild and resolved after discontinuation (110023).

Pulmonary/Respiratory ...A specific combination product (Limbrel, Primus Pharmaceuticals) containing flavocoxid, a mixture of Baikal skullcap flavonoid extract and catechu extract, has been linked to several reports of hypersensitivity pneumonitis. Symptoms include fever, chills, headache, cough, chronic bronchitis, shortness of breath, weight loss, and fatigue. In 2017, the US Food and Drug Administration (FDA) formally requested the recall of all non-expired lots of this product due to the risk for liver and lung injury (106042). It is unclear if these effects were due to Baikal skullcap, catechu, or the combination.

Renal ...Orally, in a small clinical study evaluating the safety of baicalein, a constituent of Baikal skullcap, in healthy adults, proteinuria of undefined severity occurred in 1 of 10 patients who received 200 mg every 8 hours for 6 days, 3 of 10 patients who received 400 mg every 8 hours for 6 days, and 5 of 10 patients who received 600 mg every 8 hours for 6 days, compared with 1 of 6 patients who received placebo. The proteinuria was considered mild and resolved after discontinuation (110023).

(Read more about BAIKAL SKULLCAP)

General ...Orally, black walnut fruit (nut) is well tolerated. However, the leaf, bark, and hull of black walnut contain high quantities of tannins, which may cause adverse effects when used orally or topically.
Most Common Adverse Effects:
Orally: The leaf, bark, and hull can cause gastrointestinal upset.
Topically: Hull preparations may cause a temporary yellow or brown discoloration at the site of application. The leaf, bark, and hull can cause skin irritation.
Serious Adverse Effects (Rare):
Orally: The bark may increase the risk for tongue cancer or lip leukoplakia when used long-term.
All routes of administration: Allergic reactions, including anaphylaxis.

Dermatologic ...Topically, black walnut leaf, bark, or hull may have an irritating effect on the skin due to tannin content. Black walnut hull preparations might cause a temporary yellow or brown discoloration of the skin at the site of application (12).

Gastrointestinal ...Orally, black walnut leaf, bark, or hull may cause gastrointestinal upset due to tannin content (12). Also, daily use of the juglone-containing bark of a related species (English walnut) is associated with increased risk of tongue cancer and lip leukoplakia (2,12).

Hepatic ...Orally, black walnut leaf, bark, or hull may cause liver damage if taken for extended periods of time due to tannin content (12).

Immunologic ...Tree nuts, which include black walnuts, can cause allergic reactions in sensitive individuals. Due to the prevalence of this allergy in the general population, tree nuts are classified as a major food allergen in the United States (105410).

Renal ...Orally, black walnut leaf, bark, or hull may cause kidney damage if taken for extended periods of time due to tannin content (12).

(Read more about BLACK WALNUT)

General ...When used orally, comfrey may be unsafe. Topically, comfrey is generally well tolerated when applied to intact skin.
Most Common Adverse Effects:
Topically: Eczema, erythema, irritation, itching, rash.
Serious Adverse Effects (Rare):
All ROAs: Ascites, cirrhosis, death, hepatic fibrosis, hepatomegaly, pulmonary hypertension, and sinusoidal obstruction syndrome. These adverse effects are likely related to the pyrrolizidine alkaloid constituents of comfrey.

Dermatologic ...Topically, comfrey-containing creams and ointments may cause skin redness, irritation, itching, rash, and eczema (44902,44912,44917,44919,92566,92570,92571).

Hepatic ...The pyrrolizidine alkaloid constituents of comfrey can cause acute sinusoidal obstruction syndrome characterized by sudden abdominal pain, vomiting, ascites, and hepatomegaly. In subacute disease, comfrey can cause ascites, hepatomegaly, abdominal pain, diarrhea, vomiting, and abdominal swelling. Chronic toxicity appears as asthenia and progressive ascites. Hepatic fibrosis and inflammation may resolve, but hepatic failure is common with more severe disease. This may occur as late as 2 years after the initial ingestion. Other signs and symptoms of pyrrolizidine toxicity include bile duct proliferation, fatty changes of the liver, fibrosis, cirrhosis, and vascular lesions (11988). The mortality associated with comfrey toxicity is 50%. However, specific toxic levels seem to vary among individuals (11990).

Pulmonary/Respiratory ...The pyrrolizidine alkaloid constituents of comfrey can damage the lungs, resulting in pulmonary hypertension (11987,11988,11990). A case report involving a 66-year-old female with known arterial hypertension, mild kidney insufficiency, and type 2 diabetes described severe partial respiratory insufficiency and pulmonary hypertension. The patient admitted to using a number of alternative therapies daily, including comfrey (44911).

Other ...Comfrey contains toxic pyrrolizidine alkaloids, which are carcinogenic and mutagenic (12841,12842).

(Read more about COMFREY)

General ...Orally, the major concern with gravel root use is its pyrrolizidine alkaloid (PA) content. These constituents can cause liver and lung injury (12841,12842). Chronic exposure to other plants containing hepatotoxic PA constituents has been associated with veno-occlusive disease (4021). Sub-acute veno-occlusive disease can cause vague symptoms, including colicky pains, vomiting, diarrhea, and ascites within several days; persistent liver enlargement occurs within a few weeks (4021,12842).
Topically, PA can be absorbed through the skin in quantities sufficient to cause systemic toxicity when applied to broken skin or in large quantities (11990).
Gravel root products containing PAs should be avoided. There is currently a limited amount of information available about the adverse effects of PA-free gravel root.

Hepatic ...Orally, gravel root might cause liver damage. The major concern with gravel root use is its hepatotoxic pyrrolizidine alkaloid (PA) content (12841,12842). Chronic exposure to other plants containing hepatotoxic PA constituents is associated with veno-occlusive disease (4021). Sub-acute veno-occlusive disease can cause vague symptoms, including colicky pains, vomiting, diarrhea, and ascites within several days; persistent liver enlargement occurs within a few weeks (4021,12842).

Pulmonary/Respiratory ...Orally, gravel root might cause lung damage. The major concern with gravel root use is its pyrrolizidine alkaloid (PA) content. These constituents can cause lung damage with pulmonary-arterial hypertension (12841,12842).

(Read more about GRAVEL ROOT)

General ...Orally, lobelia can cause nausea, vomiting, diarrhea, coughing, dizziness, tremors, and throat irritation. These adverse effects have been reported with doses as low as 50 mg (4,16414). Lobelia leaf can cause toxicity when taken in doses of 600 mg or higher. Symptoms of lobelia toxicity include sweating, tachycardia, convulsions, hypothermia, hypotension, coma, and death (4,11).

Cardiovascular ...Orally, high doses of lobelia leaf can cause toxicity. Symptoms of lobelia toxicity include tachycardia, hypotension, and death (4,11).

Gastrointestinal ...Orally, lobelia can cause nausea, vomiting, diarrhea, and throat irritation (4,16414).

Neurologic/CNS ...Orally, lobelia can cause dizziness and tremors. High doses of lobelia leaf can cause toxicity. Symptoms of lobelia toxicity include convulsions, coma, and death (4,11).

Pulmonary/Respiratory ...Orally, lobelia can cause coughing and throat irritation (4,16414).

Other ...Orally, high doses of lobelia leaf can cause toxicity resulting in death. Toxicity has been reported to occur at doses as low as 600 mg, with doses of 4000 mg or more considered to be fatal (4,11).

(Read more about LOBELIA)

General ...Orally and topically, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about MARSHMALLOW)

General ...Information regarding the adverse effects of mullein is limited. A thorough evaluation of safety outcomes has not been conducted.

Dermatologic ...Two case reports have described dermatitis, with positive patch tests, after topical exposure to the whole plant, or by occupational inhalation of plant dust (92839,97316). In the case of topical exposure, the patient also had positive patch tests to other plants.

(Read more about MULLEIN)

General ...There is currently a limited amount of information available on the adverse effects of skullcap.
Most Common Adverse Effects:
Orally: Cognitive impairment, digestive disturbances, sedation.

Gastrointestinal ...Orally, mild digestive disturbances were reported in around 9% of patients taking skullcap 350 mg three times daily for 2 weeks (91690).

Hepatic ...There are four reports of hepatotoxicity associated with products thought to contain skullcap. However, it is uncertain whether the products actually contained skullcap. It is thought that the products might have been contaminated with an adulterant such as germander (515), which is known to cause liver damage.

Neurologic/CNS ...A single skullcap extract dose of 100 mg does not seem to have adverse CNS effects. However, a higher dose of 200 mg might cause sedation and cognitive impairment (12216). One patient taking skullcap 350 mg three times daily for 2 weeks reported vivid dreams (91690). It is unclear if this event was associated with skullcap.

(Read more about SKULLCAP)

General ...White oak bark seems to be well tolerated when used orally to topically on unbroken skin, short-term. White oak pollen may cause allergic reactions in some people (86395).

Immunologic ...White oak pollen may cause allergic reactions in some people (86395).

(Read more about WHITE OAK)

General ...Wormwood contains thujone, a neurotoxin. When products containing thujone are used orally in medicinal amounts, wormwood may be unsafe.
Most Common Adverse Effects:
Orally: The oil from wormwood leaves can cause diffuse muscle aches, nausea, and vomiting.
Serious Adverse Effects (Rare):
Orally: The oil from wormwood leaves can cause acute kidney toxicity, rhabdomyolysis, and seizures.

Dermatologic ...Topically, a single case report describes a sensitivity or first degree chemical burn reaction, with facial pain and erythema, after a 50-year-old adult applied a homemade poultice containing wormwood to the face for an unreported length of time (93466).

Gastrointestinal ...Orally, the oil from wormwood leaves can cause nausea and vomiting (662). Use of a home-prepared wormwood extract has been associated with vomiting and severe diarrhea in an infant (93467).

Hematologic ...Orally, use of a home-prepared wormwood extract has been associated with severe metabolic acidosis in an infant (93467).

Immunologic ...Theoretically, wormwood might cause an allergic reaction in people sensitive to the Asteraceae/Compositae family (12815). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

Musculoskeletal ...Orally, the oil from wormwood leaves can cause diffuse muscle aches and rhabdomyolysis (662).

Neurologic/CNS ...Orally, the oil from wormwood leaves can cause seizures (662).

Renal ...Orally, the oil from wormwood leaves can cause acute kidney toxicity and acute kidney failure (662).

Other ...Chronic ingestion of absinthe, an alcoholic beverage that contains wormwood extract, has been linked to absinthism. Absinthism was first described in the 1800s when absinthe was at its peak levels of consumption. It has been characterized by addiction, gastrointestinal adverse effects, insomnia, auditory and visual hallucinations, tremors, paralysis, epilepsy, and brain damage. There is also increased risk of psychiatric disease and suicide (662,12814,15008). Increasing thujone concentrations of absinthe increases anxiety and decreases attention in healthy individuals (86541). A case of bradyarrhythmias associated with absinthe intoxication has also been reported (86543). However, there is speculation that some of the symptoms of absinthism originally described might be attributed to adulteration with metals or toxic plants such as calamus and tansy, rather than the ingredients usually used in absinthe drinks (15007). Some researchers also suggest that absinthism is not a unique condition and is indistinguishable from alcohol use disorder. In fact, some evidence suggests that the thujone concentrations in the absinthe formulations from the 1800s were too low to cause significant thujone-related toxicities (15008,15009).

(Read more about WORMWOOD)