Renaltrex by Global Healing Center

POSSIBLY EFFECTIVE

• Kidney stones (nephrolithiasis). Although some research disagrees, most clinical research shows that taking chanca piedra might improve clearance and decrease the size of kidney stones. However, it seems that disease severity, stone location, and chanca piedra dose and/or formulation may alter the likelihood of benefit. Details: Preliminary clinical research in adults with kidney stones shows that taking a specific chanca piedra product (Uriston) 2 grams orally daily for up to 3 months after undergoing 1-3 extracorporeal shock wave lithotripsy sessions increases clearance of kidney stones within 30-60 days by 1-2 times that of control (41224). Other preliminary clinical research in patients with kidney stones smaller than 10 mm also shows that drinking a chanca piedra tea, prepared with 4.5 grams of dried extract in 250 mL boiled water, twice daily for 12 weeks decreases the number of kidney stones by 38% and kidney stone size by 40% when compared with baseline (99849). However, a small clinical trial in adults with kidney stones failed to demonstrate beneficial effects from chanca piedra extract 450 mg three times daily orally for 3 months (41202). Some subgroup and other analyses also suggest that chanca piedra may be more effective in patients with hyperoxaluria or hyperuricosuria at baseline or those with smaller kidney stones of less than 6 mm or 10 mm (41224,99849,102692). Preliminary clinical research also shows that, in patients taking chanca piedra leaf extract 225 mg with magnesium stearate 152 mg and vitamin B6 2 mg twice daily for 3 months, stone-free status occurs in about 55% of patients with middle or upper kidney stones and about 14% of those with lower stones when compared with baseline (102692).

LIKELY INEFFECTIVE

• Hepatitis B. Most clinical research shows that oral chanca piedra is not effective for treating hepatitis B. Details: Despite preliminary clinical research suggesting that chanca piedra may be beneficial in patients with hepatitis B (41287), multiple follow-up clinical trials show that taking chanca piedra 200-900 mg three times daily for 1-6 weeks is not effective for treating hepatitis B, decreasing the duration of acute hepatitis B, or decreasing levels of hepatitis B surface antigen (HBsAg) (3924,3925,41180,41242,41255,41259,41294,41318).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Abdominal pain. Although there has been interest in using oral chanca piedra for abdominal pain, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Anemia of chronic disease. Although there has been interest in using oral chanca piedra for anemia of chronic disease, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Asthma. Although there has been interest in using oral chanca piedra for asthma, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Benign prostatic hyperplasia (BPH). Oral chanca piedra has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with BPH, some of whom were already receiving treatment for their symptoms, shows that taking a specific product containing water-soluble extracts of chanca piedra, boldo, goldenrod, fireweed, and spiny restharrow (Fluxonorm, Omega Pharma) for 30 days improves lower urinary tract symptom scores by about 50% when compared with baseline. Maximum urinary flow rate and quality of life were also improved when compared with baseline (106432). The validity of these findings is limited by the lack of a comparator group.
• Colic. Although there has been interest in using oral chanca piedra for colic, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Diabetes. It is unclear if oral chanca piedra is beneficial in patients with diabetes. Details: Preliminary clinical research in patients with types 2 diabetes shows that taking chanca piedra extract 12.5 grams orally twice daily for 7 days does not affect fasting or postprandial blood glucose levels when compared with baseline. The extract was prepared as 25 grams boiled in 200 mL of water (41186). The validity of this study is limited by the lack of a comparator group.
• Gallbladder disease. Although there has been interest in using oral chanca piedra for gallbladder disease, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Gastric cancer. Although there has been interest in using oral chanca piedra for gastric cancer, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Gonorrhea. Although there has been interest in using oral chanca piedra for gonorrhea, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Hangover. It is unclear if oral chanca piedra is beneficial in patients with hangover. Details: Preliminary clinical research in a small number of healthy adults shows that taking a standardized extract of chanca piedra (PHYLLPRO, Biotropics Malaysia Berhad) 375 mg orally twice daily for 10 days prior to heavy alcohol consumption may improve alcohol clearance, but does not improve hangover symptom scores or mood scores, when compared with placebo (99846). However, the study may have been inadequately powered to detect a difference between groups.
• Hypertension. It is unclear if oral chanca piedra is beneficial in patients with hypertension. Details: Preliminary clinical research in patients with hypertension shows that taking chanca piedra 1.6 grams orally three times daily for 10 days does not reduce systolic or diastolic blood pressure when compared with baseline (3928). The validity of this study is limited by the lack of a comparator group.
• Intestinal parasite infection. Although there has been interest in using oral chanca piedra for intestinal parasite infection, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Lymphedema. Although there has been interest in using oral chanca piedra for lymphedema, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Malaria. Although there has been interest in using oral chanca piedra for malaria, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Miscarriage. Although there has been interest in using oral chanca piedra for miscarriage, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Osteoarthritis. It is unclear if topical chanca piedra is beneficial in patients with osteoarthritis. Details: Preliminary clinical research in patients with knee osteoarthritis shows that topical application of a chanca piedra gel with phonophoresis once daily for 10 days reduces pain and improves function when compared with placebo gel. Pain was reduced by 78%, compared with a reduction of 44% in those using the placebo gel, and patients using chanca piedra were able to walk 62 meters farther in 6 minutes when compared with placebo gel (102691).
• Premature ejaculation. Oral chanca piedra has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in adults with premature ejaculation shows that taking a specific combination product containing chanca piedra, cardamom, vitamin B6, tribulus, tryptophan, thiamine, and winter savory (Eiacumev, Farmaceutica MEV) orally once daily for 3 months improves premature ejaculation severity scores and increases time to ejaculation when compared with sexual counseling. Time to ejaculation increased by around 30 seconds when compared with control (97016). The validity of this study is limited by the lack of randomization and placebo-control.
• Pruritus. Although there has been interest in using oral chanca piedra for pruritus, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Respiratory tract infections. Although there has been interest in using oral chanca piedra for respiratory tract infections, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Sexual dysfunction. Although there has been interest in using oral chanca piedra for sexual dysfunction, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Solid tumors. Although there has been interest in using oral chanca piedra for solid tumors, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Tonsillopharyngitis. Oral chanca piedra has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with tonsillopharyngitis shows that taking chanca piedra 50 mg and black seed 360 mg orally three times daily for 7 days moderately relieves pain when compared with placebo (36199).
• Urinary tract infections (UTIs). Although there has been interest in using oral chanca piedra for UTIs, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Vaginitis. Although there has been interest in using oral chanca piedra for vaginitis, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose.
• Vertigo. Although there has been interest in using oral chanca piedra for vertigo, there is insufficient reliable information about the clinical effects of chanca piedra for this purpose. More evidence is needed to rate chanca piedra for these uses.

(Read more about CHANCA PIEDRA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). It is unclear if oral fulvic acid is beneficial in patients with allergic rhinitis. Details: Preliminary clinical research in people with allergic rhinitis shows that taking fulvic acid solution 3.8%, 40 mL orally twice daily for 7 days, reduces the size of cutaneous wheals from pollen prick tests by about 1.5 mm when compared with baseline (90589). The validity of this finding is limited by the lack of a comparator group.
• Alzheimer disease. Although there has been interest in using oral fulvic acid for Alzheimer disease, there is insufficient reliable information about the clinical effects of fulvic acid for this purpose.
• Atopic dermatitis (eczema). It is unclear if topical fulvic acid is beneficial in patients with atopic dermatitis. Details: Preliminary clinical research in adults with eczema shows that applying fulvic acid 5% in an emollient base twice daily to affected areas for 4 weeks modestly improves eczema symptom scores when compared with placebo (90588).
• Cancer. Although there has been interest in using oral fulvic acid for cancer, there is insufficient reliable information about the clinical effects of fulvic acid for this purpose.
• Fatigue. Although there has been interest in using oral fulvic acid for fatigue, there is insufficient reliable information about the clinical effects of fulvic acid for this purpose.
• Lead toxicity. Although there has been interest in using oral fulvic acid for lead toxicity, there is insufficient reliable information about the clinical effects of fulvic acid for this purpose.
• Respiratory tract infections. Although there has been interest in using oral fulvic acid for respiratory tract infections, there is insufficient reliable information about the clinical effects of fulvic acid for this purpose. More evidence is needed to rate fulvic acid for these uses.

(Read more about FULVIC ACID)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Benign prostatic hyperplasia (BPH). Oral goldenrod has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with BPH, some of whom were already receiving treatment for their symptoms, shows that taking 1200 mg of a specific product containing water-soluble extracts of goldenrod, boldo, chanca piedra, fireweed, and spiny restharrow (Fluxonorm, Omega Pharma) for 30 days improves lower urinary tract symptom scores by about 50% when compared to baseline. Maximum urinary flow rate and quality of life were also improved when compared with baseline (106432). The validity of these findings is limited by the lack of a comparator group.
• Dental plaque. Topical goldenrod has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy adults shows that using a specific toothpaste (Bucovia, Givaudan) containing goldenrod extract 0.3% and sodium fluoride 0.15% twice daily for 4 weeks improves plaque index scores when compared to baseline. These effects were not different from use of a toothpaste containing only sodium fluoride 0.15%, although the study may have been inadequately powered to detect a difference between groups. Also, it is unclear if these effects are due to goldenrod, sodium fluoride, or the combination (105115).
• Kidney stones (nephrolithiasis). Although there has been interest in using oral goldenrod for kidney stones, there is insufficient reliable information about the clinical effects of goldenrod for this purpose.
• Urinary tract infections (UTIs). Oral goldenrod has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A secondary analysis of clinical research in females with a UTI who were not taking antibiotics shows that taking a specific combination supplement (Aqualibra, Medice Arzneimittel Pütter GmbH & Co. KG) containing extracts of goldenrod 360 mg, Java tea 180 mg, and spiny restharrow root 160 mg three times daily for 7 days modestly improves clinical symptom scores when compared with placebo. Individuals taking the combination supplement also had a 63% reduction in microbial count, compared with 25% in those taking placebo. Additionally, antibiotics were prescribed in only 15% of those taking the combination product, compared with 49% of those taking placebo (102763). It is unclear if these findings are due to goldenrod, other ingredients, or the combination. More evidence is needed to rate goldenrod for these uses.

(Read more about GOLDENROD)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Androgenic alopecia. Although there is interest in using oral horsetail for alopecia, there is insufficient reliable information about the clinical effects of horsetail for this condition.
• Hypertension. Oral horsetail seems to reduce blood pressure in patients with hypertension. Details: A clinical trial in patients with stage 1 systemic arterial hypertension shows that taking horsetail extract 900 mg daily for 3 months decreases systolic and diastolic blood pressure by 13 mmHg and 8 mmHg, respectively, and is similarly effective to hydrochlorothiazide 25 mg daily (108849). The validity of this finding is limited due to high withdrawal rates and low adherence to treatment protocols.
• Kidney stones (nephrolithiasis). Although there is interest in using oral horsetail for kidney stones, there is insufficient reliable information about the clinical effects of horsetail for this condition.
• Obesity. Although there is interest in using oral horsetail for weight loss, there is insufficient reliable information about the clinical effects of horsetail for this purpose.
• Osteoporosis. It is unclear if oral horsetail is beneficial for osteoporosis. Details: Preliminary clinical research shows that taking two tablets of either dried horsetail extract or a specific combination of horsetail extract with calcium (Osteosil Calcium) daily for 2-month intervals separated by 2 weeks of no treatment for up to one year can increase bone density when compared with no treatment in postmenopausal patients with osteoporosis. The effect of horsetail extract plus calcium (Osteosil Calcium) seems to be greater than the effect of dried horsetail extract alone (55578).
• Tonsillitis. Oral horsetail has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in children with acute non-bacterial tonsillitis shows that taking a specific combination product (Imupret) for 10 days in addition to standard symptomatic therapy accelerates recovery by a small amount when compared with symptomatic therapy alone. Overall treatment response after 10 days occurred in 82% of patients taking the combination product compared with 65% of patients receiving symptomatic therapy alone. Withdrawal from antipyretic drugs occurred approximately one day earlier in children using the horsetail product. Per 100 grams, Imupret provides 29 grams of an alcoholic extract produced from horsetail 0.5 grams, marshmallow root 0.4 grams, chamomile flowers 0.3 grams, walnut leaves 0.4 grams, English walnut leaves 0.4 grams, yarrow 0.4 grams, oak bark 0.2 grams, and dandelion 0.4 grams. In children aged 6-11 years, 15 drops 6 times daily for 5 days and then 15 drops 3 times daily for 5 days was used. In children aged 12-18 years, 25 drops 6 times daily for 10 days was used. (100347). Due to the small difference between the two groups and the open-label design, the clinical relevance of this study is unclear. Also, it is unclear if these benefits are due to horsetail, the other ingredients, or the combination.
• Urinary incontinence. Oral horsetail 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 supplement (Urox, Seipel Group) 840 mg, containing a combination of horsetail stem, three-leaf caper, and lindera root daily with food for 8 weeks modestly decreases urinary frequency, stress incontinence, and urgency incontinence when compared with placebo in patients with urinary incontinence and/or overactive bladder (97575). It is unclear if these effects are due to horsetail, the other ingredients, or the combination.
• Urinary tract infections (UTIs). Although there is interest in using oral horsetail for UTIs, there is insufficient reliable information about the clinical effects of horsetail for this condition. More evidence is needed to rate horsetail for these uses.

(Read more about HORSETAIL)

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

(Read more about HYDRANGEA)

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)

POSSIBLY INEFFECTIVE

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

INSUFFICIENT RELIABLE EVIDENCE to RATE

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

(Read more about UVA URSI)

POSSIBLY SAFE ...when taken orally in doses of up to 2 grams daily for up to 3 months (3924,3928,41180,41186,41224,41287,41294,41318,98846,107946). There is insufficient reliable information available about the safety of chanca piedra when used topically.

PREGNANCY: POSSIBLY UNSAFE
when used during pregnancy or in those trying to become pregnant. Animal research shows that chanca piedra, particularly at high doses, may have contraceptive effects or may increase the risk of low birth weight or birth defects (41183,41316,41317); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CHANCA PIEDRA)

POSSIBLY SAFE ...when used topically as a toothpaste, short-term. A specific toothpaste (Bucovia, Givaudan) containing goldenrod extract 0.3% and sodium fluoride 0.15% has been used safely twice daily for up to 4 weeks (105115). There is insufficient reliable information available about the safety of goldenrod when used orally or when applied topically to the skin.

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

(Read more about GOLDENROD)

POSSIBLY UNSAFE ...when horsetail products containing thiaminase are used orally, long-term. Thiaminase is an enzyme that destroys thiamine, which could theoretically lead to thiamine deficiency. In Canada, horsetail products are required to be thiaminase-free (105301).

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

(Read more about HORSETAIL)

POSSIBLY UNSAFE ...when used orally in excessive amounts. Doses of dried hydrangea rhizome/root greater than 2 grams have been associated with reports of dizziness and a feeling of tightness in the chest (4,12). There is insufficient reliable information available about the safety of hydrangea when used in lower amounts.

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

(Read more about HYDRANGEA)

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)

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

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

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

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

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about UVA URSI)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, chanca piedra might increase the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs.  Details In vitro research suggests that methyl brevifolincarboxylate, a constituent isolated from chanca piedra, can inhibit platelet aggregation (41234). This effect has not been reported in humans.

ANTIDIABETES DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, concomitant use with antidiabetes drugs might affect glucose control and increase the risk of hypoglycemia.  Details Animal research suggests that chanca piedra can have hypoglycemic effects (19,41226,41280,41305,41306,41307). However, a small clinical study in adults with diabetes shows that chanca piedra extract 25 grams orally daily for 1 week does not lower fasting or postprandial blood glucose levels (41186).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, concomitant use of chanca piedra with antihypertensive drugs might have additive blood pressure lowering effects.  Details Animal research suggests that chanca piedra can decrease blood pressure (41245). However, this effect was not observed in most hypertensive patients treated with chanca piedra for 10 days (3928).

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of chanca piedra with diuretics might increase diuresis.  Details Some preliminary clinical research in adults with hypertension shows that chanca piedra has diuretic properties (3928). However, higher quality research in adults with kidney stones shows taking chanca piedra does not increase urine volume when compared with placebo (41202). Until more is known, use cautiously in patients taking diuretic drugs.

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, chanca piedra might reduce excretion and increase levels of lithium.  Details Some preliminary clinical research in adults with hypertension shows that chanca piedra has diuretic properties (3928). However, higher quality research in adults with kidney stones shows that taking chanca piedra does not increase urine volume when compared with placebo (41202). Until more is known, use cautiously in patients taking lithium. The dose of lithium might need to be decreased.

NOREPINEPHRINE (Levophed) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, chanca piedra may reduce the effects of norepinephrine.  Details Animal research suggests that methyl brevifolincarboxylate, a constituent isolated from chanca piedra, can reverse blood vessel contraction caused by norepinephrine (41215).

(Read more about CHANCA PIEDRA)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking fulvic acid may decrease the effectiveness of anticoagulant and antiplatelet drugs.  Details In vitro evidence shows that fulvic acid, formed from the oxidation and polymerization of protocatechuic acid, can shorten prothrombin time in human plasma, increasing the risk of clot formation (27726).

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking fulvic acid might decrease the effects of immunosuppressive therapy.  Details Animal research shows that fulvic acid stimulates immune function (27727).

THYROID HORMONE Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking fulvic acid with thyroid hormone therapy might interfere with the ability to normalize thyroid function.  Details Animal research shows that fulvic acid increases the plasma level of thyroid-stimulating hormone (TSH) and decreases the thyroxine (T4):triiodothyronine (T3) ratio (27727).

(Read more about FULVIC ACID)

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenrod might increase the effects and adverse effects of diuretic drugs.  Details In vitro and animal research suggests that goldenrod has diuretic effects (512,52565,52570,52571,52572).

(Read more about GOLDENROD)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking horsetail with antidiabetes drugs might increase the risk of hypoglycemia.  Details Equisetum myriochaetum has demonstrated hypoglycemic activity in clinical research (13576). In an animal diabetic model, Equisetum giganteum had hypoglycemic effects (105300). It is unclear whether other horsetail species have hypoglycemic effects.

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking horsetail with diuretic drugs might increase potassium loss and the risk of hypokalemia.  Details Laboratory research shows that various species of horsetail have diuretic properties (13574,13575). Due to its diuretic effects, there has been concern that taking horsetail along with potassium-depleting diuretics might increase the risk for hypokalemia. However, pharmacokinetic research in humans shows that taking horsetail 900 mg daily for 4 days does not affect urinary excretion of electrolytes, including potassium and sodium, despite having a diuretic effect similar to taking hydrochlorothiazide 25 mg daily (92288). It is unclear if taking horsetail for a longer duration would affect electrolyte levels. Until more is known, use with caution.

EFAVIRENZ (SUSTIVA) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, horsetail might decrease the levels and clinical effects of efavirenz.  Details In two case reports, patients were found to have detectable viral loads when taking horsetail-containing supplements along with an antiretroviral regimen that included efavirenz. In one case, the antiretroviral regimen included zidovudine, lamivudine, and efavirenz; in the other case, the regimen consisted of emtricitabine, tenofovir disoproxil fumarate, and efavirenz. One month after discontinuing horsetail, the viral loads became undetectable in both cases. The exact mechanism of this interaction is unknown (97573). It is also unclear if this interaction is specific to efavirenz or if it is related to various components of antiretroviral therapy.

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, horsetail might increase the levels and adverse effects of lithium.  Details Animal research suggests that horsetail has diuretic properties (13574). Theoretically, due to these potential diuretic effects, horsetail might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, horsetail might decrease the levels and clinical effects of NRTIs.  Details In two case reports, patients were found to have detectable viral loads when taking horsetail-containing supplements along with an antiretroviral therapy. In one case, the antiretroviral regimen included zidovudine, lamivudine, and efavirenz; in the other case, the regimen consisted of emtricitabine, tenofovir disoproxil fumarate, and efavirenz. One month after discontinuing the supplement, the viral loads became undetectable in both cases. The exact mechanism of these interactions is unknown (97573). It is also unclear if these interactions are specific to NRTIs or if they are related to various components of antiretroviral therapy.

(Read more about HORSETAIL)

(Read more about HYDRANGEA)

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)

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

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

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

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

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

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

(Read more about UVA URSI)

General ...Orally, chanca piedra seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Abdominal pain, nausea, vomiting.

Gastrointestinal ...Orally, use of chanca piedra can cause abdominal pain, nausea, and vomiting (99849,107946).

Ocular/Otic ...Orally, chanca piedra was associated with cases of visual impairment in one clinical trial (107946).

Other ...Orally, chanca piedra was associated with cases of fatigue in one clinical trial (107946).

(Read more about CHANCA PIEDRA)

General ...Orally, fulvic acid appears to be well tolerated. Topically, adverse effects seem to be rare; however, a thorough safety evaluation has not been conducted.
Most Common Adverse Effects:
Orally: Diarrhea, headache, sore throat.
Serious Adverse Effects (Rare):
Orally: Kashin-Beck bone disease.

Gastrointestinal ...In one clinical trial, fulvic acid 3. 8% 40 mL taken orally twice daily resulted in diarrhea and sore throat in some patients (90589).

Musculoskeletal ...Although there is no evidence from well-conducted studies, there is concern that pollution of water with high concentrations of fulvic acids may contribute to the development of Kashin-Beck bone disease, particularly in areas in which selenium intake is insufficient (27722,27725,29971).

Neurologic/CNS ...In one clinical trial, fulvic acid 3. 8% 40 mL taken orally twice daily resulted in headache in some patients (90589).

(Read more about FULVIC ACID)

General ...There is a limited amount of information available about the adverse effects of goldenrod.
Most Common Adverse Effects:
Topically: Allergic contact dermatitis in sensitive individuals.

Dermatologic ...Topically, goldenrod has been reported to cause allergic contact dermatitis (52558,52581).

Immunologic ...Topically, goldenrod has been reported to cause allergic contact dermatitis (52558,52581). Environmental exposure to goldenrod has been reported to cause an allergic reaction involving rhinoconjunctivitis and bronchial asthma in one case report (52558).

Pulmonary/Respiratory ...Environmental exposure to goldenrod has been reported to cause a delayed allergic reaction involving rhinoconjunctivitis and bronchial asthma in one case report of a 42 year-old woman who worked at a flower shop and was exposed to members of the Asteraceae/Compositae family, including goldenrod (52558).

(Read more about GOLDENROD)

General ...There is limited clinical research evaluating the safety of horsetail.
Most Common Adverse Effects:
Orally: Abdominal distension, increased bowel movements, and nausea.

Dermatologic ...In one case report, a patient developed seborrheic dermatitis after topical application of horsetail, requiring treatment with local epinephrine and oral antihistamines. The nicotine component of horsetail was determined to be the likely cause of this reaction (13563).

Gastrointestinal ...Orally, horsetail has been associated with mild gastrointestinal side effects including abdominal distension, increased frequency of bowel movements, and nausea (55576). Orally, chronic consumption of horsetail infusion has been associated with acute pancreatitis. In a case report, a 56-year-old female presenting with recurrent mild acute pancreatitis every 6-7 months, previously thought to be drug-induced, discontinued ingesting horsetail infusions. The patient had a history of bilateral adrenal gland removal and was being treated for hypertension, dyslipidemia, and hormone replacement, and then self-medicated with horsetail infusions. After discontinuing horsetail infusions, there were no further recurrences of pancreatitis during a 14-month follow-up (97574).

Hepatic ...In one case report, a patient with asymptomatic hepatitis B developed symptomatic liver failure following consumption of boiled horsetail juice 500 mL daily for 2 weeks. Liver enzymes returned to normal following discontinuation of the juice (92291). It is not known if the horsetail juice was contaminated or mixed with other ingredients.

Immunologic ...Horsetail has been associated with cross-allergenicity with carrots (13577).

Renal ...There are at least 4 case reports of hyponatremia thought to be at least partially associated with horsetail consumption. In one case report, an elderly patient who had taken oral horsetail 15 mg daily for 10 years presented with hyponatremia and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) secondary to reduced oral intake and nausea for the previous 2 days. Horsetail was thought to be a contributing factor. The patient's symptoms resolved after 5 days of treatment with oral sodium chloride and fluid restriction (108851).

Other ...Crude horsetail contains thiaminase, which can cause thiamine deficiency with prolonged consumption. Canadian Equisetum arvense products are required to be certified as free from thiaminase-like activity (55579,105301). In one case report, the development of autism in a child exposed to both horsetail and alcohol during pregnancy was thought to be caused by thiamine deficiency attributed to this combination (92292). However, it is not known if other genetic or environmental factors were involved in the development of this condition in utero.

(Read more about HORSETAIL)

General ...Orally, hydrangea may cause gastroenteritis, dizziness, and a feeling of tightness in the chest (4).

Cardiovascular ...Orally, hydrangea may cause a feeling of tightness in the chest (4).

Gastrointestinal ...Orally, hydrangea may cause gastroenteritis (4).

Neurologic/CNS ...Orally, hydrangea may cause dizziness (4).

(Read more about HYDRANGEA)

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

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

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

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

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

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

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

(Read more about UVA URSI)