| Ingredients | Amount Per Serving |
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A 4:1 Proprietary Herbal Extract Blend
(A 4:1 Proprietary Herbal Extract Blend Note: Equivalent to 2,000 mg raw, dried, unprocessed herbs. )
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500 mg |
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(Polygala tenuifolia )
(root)
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(Ziziphus spinosa )
(fruit)
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(Poria cocos )
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(Biota orientalis )
(seed)
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(Gardenia jasminoides )
(fruit)
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(Citrus reticulata )
(peel)
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(Atractylodes macrocephala )
(rhizome)
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(Glycyrrhiza uralensis )
(root)
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Platycodon Root Extract
(Platycodon grandiflorum )
(root)
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(Rehmannia glutinosa )
(root)
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(Coix lacryma-jobi )
(seed)
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Microcrystalline Cellulose, Cellulose, Croscarmellose Sodium, Stearic Acid (Alt. Name: C18:0), Silica
Below is general information about the effectiveness of the known ingredients contained in the product Tran-Q. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
There is insufficient reliable information is available about the effectiveness of oriental arborvitae.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Tran-Q. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
There is insufficient reliable information available about the safety of atractylodes.
PREGNANCY: POSSIBLY UNSAFE
when used orally.
In animals, atractylodes has caused reproductive toxicity, including fetal death, as well as changes in gestation, growth, and skeletal formation (94304).
LACTATION:
There is insufficient reliable information available about the safety of atractylodes when used during breast-feeding.
There is insufficient reliable information available about the safety of gardenia.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when consumed orally and appropriately as a food. Job's tears has been safely eaten in amounts up to 60 grams daily for 4 weeks (15368). There is not enough information available to know if Job's tears extracts from the root or seed are safe when taken as a supplement.
PREGNANCY: POSSIBLY UNSAFE
when used orally.
In animal models, Job's tears seed extract induces embryo toxicity and increases uterine contractions during pregnancy (15373); avoid using during pregnancy.
LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Licorice has Generally Recognized as Safe (GRAS) status in the US (4912).
POSSIBLY SAFE ...when licorice products that do not contain glycyrrhizin (deglycyrrhizinated licorice) are used orally and appropriately for medicinal purposes. Licorice flavonoid oil 300 mg daily for 16 weeks, and deglycyrrhizinated licorice products in doses of up to 4.5 grams daily for up to 16 weeks, have been used with apparent safety (6196,11312,11313,17727,100984,102960). ...when licorice products containing glycyrrhizin are used orally in low doses, short-term. Licorice extract 272 mg, containing glycyrrhizin 24.3 mg, has been used daily with apparent safety for 6 months (102961). A licorice extract 1000 mg, containing monoammonium glycyrrhizinate 240 mg, has been used daily with apparent safety for 12 weeks (110320). In addition, a syrup providing licorice extract 750 mg has been used twice daily with apparent safety for 5 days (104558). ...when applied topically. A gel containing 2% licorice root extract has been applied to the skin with apparent safety for up to 2 weeks. (59732). A mouth rinse containing 5% licorice extract has been used with apparent safety four times daily for up to one week (104564).
POSSIBLY UNSAFE ...when licorice products containing glycyrrhizin are used orally in large amounts for several weeks, or in smaller amounts for longer periods of time. The European Scientific Committee on Food recommends that a safe average daily intake of glycyrrhizin should not exceed 10 mg (108577). In otherwise healthy people, consuming glycyrrhizin daily for several weeks or longer can cause severe adverse effects including pseudohyperaldosteronism, hypertensive crisis, hypokalemia, cardiac arrhythmias, and cardiac arrest. Doses of 20 grams or more of licorice products, containing at least 400 mg glycyrrhizin, are more likely to cause these effects; however, smaller amounts have also caused hypokalemia and associated symptoms when taken for months to years (781,3252,15590,15592,15594,15596,15597,15599,15600,16058)(59731,59740,59752,59785,59786,59787,59792,59795,59805,59811)(59816,59818,59820,59822,59826,59828,59849,59850,59851,59867)(59882,59885,59888,59889,59895,59900,59906,97213,110305). In patients with hypertension, cardiovascular or kidney conditions, or a high salt intake, as little as 5 grams of licorice product or 100 mg glycyrrhizin daily can cause severe adverse effects (15589,15593,15598,15600,59726).
PREGNANCY: UNSAFE
when used orally.
Licorice has abortifacient, estrogenic, and steroid effects. It can also cause uterine stimulation. Heavy consumption of licorice, equivalent to 500 mg of glycyrrhizin per week (about 250 grams of licorice per week), during pregnancy seems to increase the risk of delivery before gestational age of 38 weeks (7619,10618). Furthermore, high intake of glycyrrhizin, at least 500 mg per week, during pregnancy is associated with increased salivary cortisol levels in the child by the age of 8 years. This suggests that high intake of licorice during pregnancy may increase hypothalamic-pituitary-adrenocortical axis activity in the child (26434); avoid using.
LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when the leafy twig is used orally in tea at appropriate doses, short-term. Traditionally, tea made with 6-15 grams of raw or charred leafy twig has been used with apparent safety, short-term (12).
POSSIBLY UNSAFE ...when the leafy twig is used orally long-term or at higher doses. Oriental arborvitae contains thujone. Using thujone-containing herbs long-term or at higher doses may cause harmful adverse effects, including kidney damage and convulsions (12). There is insufficient reliable information available about the safety of oriental arborvitae seed when used orally or about the safety of any part of oriental arborvitae when used topically.
PREGNANCY: POSSIBLY UNSAFE
when the leafy twig is used orally during pregnancy.
Oriental arborvitae contains thujone (12). Thujone might stimulate uterine activity (19); avoid using. There is insufficient reliable information available about the safety of oriental arborvitae when used topically during pregnancy; avoid using.
LACTATION:
There is insufficient reliable information available about the safety of oriental arborvitae when used orally or topically during lactation; avoid using.
There is insufficient reliable information available about the safety of poria mushroom.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used orally and appropriately, short term. Rehmannia root extract 4 grams daily or rehmannia leaf extract 800 mg daily has been used with apparent safety for 8 weeks in clinical studies (93660,93662).
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used orally and appropriately, short-term (12). Senega extract has been used with apparent safety in clinical research at doses of 300 mg daily for 4-8 weeks (96991,96992).
POSSIBLY UNSAFE ...when used orally, long-term. Prolonged use can cause gastrointestinal irritation (12). There is insufficient reliable information available about the safety of senega when used topically.
PREGNANCY: LIKELY UNSAFE
when used orally; senega appears to have uterine and menstrual flow stimulant effects (12,19).
There is insufficient reliable information available about the safety of the topical use of senega during pregnancy.
LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Tangerine has Generally Recognized as Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of tangerine when used orally or topically as a medicine.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when zizyphus fruit is consumed in the amounts typically found in foods.
POSSIBLY SAFE ...when zizyphus fruit or seed is used orally and appropriately, short-term. Zizyphus fruit powder has been used with apparent safety at doses up to 30 grams daily for up to 12 weeks (93317,104507). Zizyphus fruit extract has been used with apparent safety at a dose of 20-40 drops daily for up to 12 weeks (93316). Zizyphus seed extract has been used with apparent safety at a dose of 2 grams daily for 4 weeks (107921). There is insufficient reliable information available about the safety of zizyphus when used topically.
PREGNANCY AND LACTATION: LIKELY SAFE
when zizyphus fruit is consumed in the amounts typically found in foods.
There is insufficient reliable information available about the safety of zizyphus fruit in amounts greater than those found in foods; avoid using.
Below is general information about the interactions of the known ingredients contained in the product Tran-Q. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Theoretically, atractylodes might increase the risk of bleeding when used concomitantly with anticoagulant and antiplatelet drugs.
 Details
Laboratory research suggests that atractylenolides II and III, constituents of atractylodes, reduce platelet activation (94299). So far, this has not been shown in humans.
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Theoretically, atractylodes may have an additive effect when used with other aromatase inhibitors.
Details
Laboratory research suggests that atractylodes and its constituents exhibit aromatase inhibitor effects (94302).
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Theoretically, taking atractylodes may prolong the therapeutic and adverse effects of hexobarbital.
Details
In animals, atractylodes has been shown to prolong the effects of hexobarbital (94303). These effects have not been shown in humans.
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Theoretically, gardenia might increase the effects and adverse effects of stimulant laxatives.
Details
Animal research shows that geniposide, a glucoside found in gardenia fruit, may function as a laxative and cause diarrhea when taken orally (26534).
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Preliminary evidence shows that constituents of Job's tears might have hypoglycemic effects (15363). Theoretically, concomitant use with drugs that decrease blood glucose levels might increase the risk of hypoglycemia. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
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Animal research suggests that Job's tears might enhance absorption of chlorzoxazone in the small intestine. Single dose and short-term oral administration of Job's tears bran ethanolic extract along with oral administration of a five-drug cocktail containing chlorzoxazone increases chlorzoxazone peak plasma concentration and area under the plasma concentration-time curve (AUC) without altering major cytochrome P450 activities in the liver (106531). This effect has not been reported in humans.
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Animal research suggests that Job's tears might enhance absorption of dextromethorphan in the small intestine. Single dose oral administration of Job's tears bran ethanolic extract along with oral administration of a five-drug cocktail containing dextromethorphan increases dextromethorphan area under the plasma concentration-time curve (AUC) without altering major cytochrome P450 activities in the liver (106531). This effect has not been reported in humans.
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Animal research suggests that Job's tears might enhance absorption of diltiazem in the small intestine. Single dose oral administration of Job's tears bran ethanolic extract along with oral administration of a five-drug cocktail containing diltiazem increases diltiazem peak plasma concentration and area under the plasma concentration-time curve (AUC) without altering major cytochrome P450 activities in the liver (106531). This effect has not been reported in humans.
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Animal research suggests that Job's tears might enhance absorption of theophylline in the small intestine. Single dose and short-term oral administration of Job's tears bran ethanolic extract along with oral administration of a five-drug cocktail containing theophylline increases theophylline peak plasma concentration and area under the plasma concentration-time curve (AUC) without altering major cytochrome P450 activities in the liver (106531). This effect has not been reported in humans.
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Theoretically, licorice might reduce the effects of antihypertensive drugs.
Details
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Theoretically, licorice might reduce the effects of cisplatin.
Details
In animal research, licorice diminished the therapeutic efficacy of cisplatin (59763).
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Theoretically, concomitant use of licorice and corticosteroids might increase the side effects of corticosteroids.
Details
Case reports suggest that concomitant use of licorice and oral corticosteroids, such as hydrocortisone, can potentiate the duration of activity and increase blood levels of corticosteroids (3252,12672,20040,20042,48429,59756). Additionally, in one case report, a patient with neurogenic orthostatic hypertension stabilized on fludrocortisone 0.1 mg twice daily developed pseudohyperaldosteronism after recent consumption of large amounts of black licorice (108568).
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Theoretically, licorice might increase levels of drugs metabolized by CYP2B6.
Details
In vitro research shows that licorice extract and glabridin, a licorice constituent, inhibit CYP2B6 isoenzymes (10300,94822). Licorice extract from the species G. uralensis seems to inhibit CYP2B6 isoenzymes to a greater degree than G. glabra extract in vitro (94822). Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2B6; however, these interactions have not yet been reported in humans.
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Theoretically, licorice might increase levels of drugs metabolized by CYP2C19.
Details
In vitro, licorice extracts from the species G. glabra and G. uralensis inhibit CYP2C19 isoenzymes in vitro (94822). Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C19; however, this interaction has not yet been reported in humans.
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Theoretically, licorice might increase levels of drugs metabolized by CYP2C8.
Details
In vitro, licorice extract from the species G. glabra and G. uralensis inhibits CYP2C8 isoenzymes (94822). Theoretically, these species of licorice might increase levels of drugs metabolized by CYP2C8; however, this interaction has not yet been reported in humans.
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Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP2C9.
Details
There is conflicting evidence about the effect of licorice on CYP2C9 enzyme activity. In vitro research shows that extracts from the licorice species G. glabra and G. uralensis moderately inhibit CYP2C9 isoenzymes (10300,94822). However, evidence from an animal model shows that licorice extract from the species G. uralensis can induce hepatic CYP2C9 activity (14441). Until more is known, licorice should be used cautiously in people taking CYP2C9 substrates.
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Theoretically, licorice might increase or decrease levels of drugs metabolized by CYP3A4.
Details
Pharmacokinetic research shows that the licorice constituent glycyrrhizin, taken in a dosage of 150 mg orally twice daily for 14 days, modestly decreases the area under the concentration-time curve of midazolam by about 20%. Midazolam is a substrate of CYP3A4, suggesting that glycyrrhizin modestly induces CYP3A4 activity (59808). Animal research also shows that licorice extract from the species G. uralensis induces CYP3A4 activity (14441). However, licorice extract from G. glabra species appear to inhibit CYP3A4-induced metabolism of testosterone in vitro. It is thought that the G. glabra inhibits CYP3A4 due to its constituent glabridin, which is a moderate CYP3A4 inhibitor in vitro and not present in other licorice species (10300,94822). Until more is known, licorice should be used cautiously in people taking CYP3A4 substrates.
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Theoretically, concomitant use of licorice with digoxin might increase the risk of cardiac toxicity.
Details
Overuse or misuse of licorice with cardiac glycoside therapy might increase the risk of cardiac toxicity due to potassium loss (10393).
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Theoretically, concomitant use of licorice with diuretic drugs might increase the risk of hypokalemia.
Details
Overuse of licorice might compound diuretic-induced potassium loss (10393,20045,20046,59812). In one case report, a 72-year-old male with a past medical history of hypertension, type 2 diabetes, hyperlipidemia, arrhythmia, stroke, and hepatic dysfunction was hospitalized with severe hypokalemia and uncontrolled hypertension due to pseudohyperaldosteronism. This was thought to be provoked by concomitant daily consumption of a product containing 225 mg of glycyrrhizin, a constituent of licorice, and hydrochlorothiazide 12.5 mg for 1 month (108577).
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Theoretically, licorice might increase or decrease the effects of estrogen therapy.
Details
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Theoretically, loop diuretics might increase the mineralocorticoid effects of licorice.
Details
Theoretically, loop diuretics might enhance the mineralocorticoid effects of licorice by inhibiting the enzyme that converts cortisol to cortisone; however, bumetanide (Bumex) does not appear to have this effect (3255).
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Theoretically, licorice might increase levels of methotrexate.
Details
Animal research suggests that intravenous administration of glycyrrhizin, a licorice constituent, and high-dose methotrexate may delay methotrexate excretion and increase systemic exposure, leading to transient elevations in liver enzymes and total bilirubin (108570). This interaction has not yet been reported in humans.
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Theoretically, licorice might decrease levels of midazolam.
Details
In humans, the licorice constituent glycyrrhizin appears to moderately induce the metabolism of midazolam (59808). This is likely due to induction of cytochrome P450 3A4 by licorice. Until more is known, licorice should be used cautiously in people taking midazolam.
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Theoretically, licorice might decrease the absorption of P-glycoprotein substrates.
Details
In vitro research shows that licorice can increase P-glycoprotein activity (104561).
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Theoretically, licorice might decrease plasma levels and clinical effects of paclitaxel.
Details
Multiple doses of licorice taken concomitantly with paclitaxel might reduce the effectiveness of paclitaxel. Animal research shows that licorice 3 grams/kg given orally for 14 days before intravenous administration of paclitaxel decreases the exposure to paclitaxel and increases its clearance. Theoretically, this occurs because licorice induces cytochrome P450 3A4 enzymes, which metabolize paclitaxel. Notably, a single dose of licorice did not affect exposure or clearance of paclitaxel (102959).
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Theoretically, licorice might decrease plasma levels and clinical effects of warfarin.
Details
Licorice seems to increase metabolism and decrease levels of warfarin in animal models. This is likely due to induction of cytochrome P450 2C9 (CYP2C9) metabolism by licorice (14441). Advise patients taking warfarin to avoid taking licorice.
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Theoretically, poria mushroom might decrease the clinical effects of anticholinergic drugs.
Details
In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.
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Theoretically, poria mushroom might have additive effects when used with cholinergic drugs.
Details
In animal research, poria mushroom essential oil reduces acetylcholinesterase activity (111917). This interaction has not been shown in humans.
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Theoretically, taking poria mushroom extract may enhance the therapeutic and adverse effects of sedatives.
Details
Animal research shows that poria mushroom extract has sedative properties (111916). This interaction has not been shown in humans.
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Theoretically, rehmannia might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Details
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Theoretically, rehmannia might increase the risk of hypotension when taken with antihypertensive drugs.
Details
Animal research shows that rehmannia may have hypotensive effects. Laboratory research shows that formulations of dried and processed rehmannia root inhibit angiotensin-converting enzyme (ACE) (104272).
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In vitro, tangeretin, a constituent of tangerine, induces a 52% increase in the metabolism of midazolam by cytochrome P450 3A4 (CYP3A4) (28609). This suggests that tangeretin may stimulate CYP3A4 activity. However, in humans, drinking tangerine juice 200 mL slightly delayed the absorption, but did not affect the metabolism, of midazolam, a CYP3A4 substrate (28609). Theoretically, tangerine juice might increase CYP3A4 activity and decrease levels of drugs metabolized by this enzyme. However, this effect is unlikely.
Details
Some drugs metabolized by CYP3A4 include amitriptyline (Elavil), amiodarone (Cordarone), citalopram (Celexa), felodipine (Plendil), lansoprazole (Prevacid), ondansetron (Zofran), prednisone (Deltasone, Orasone), sertraline (Zoloft), sibutramine (Meridia), and many others.
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In vitro, tangeretin, a constituent of tangerine, appears to increase the metabolism of midazolam in human liver microsomes by up to 52% (28609). However, in humans, drinking tangerine juice 200 mL slightly delayed the absorption, but did not affect the metabolism, of midazolam (28609). Theoretically, tangerine juice might increase the metabolism and reduce the effects of midazolam. However, this effect is unlikely.
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Theoretically, zizyphus might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Details
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Theoretically, zizyphus might cause additive sedative effects when taken with CNS depressants.
Details
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Theoretically, zizyphus might decrease the levels and clinical effects of drugs metabolized by CYP1A2.
Details
Animal research shows that zizyphus induces CYP1A2 enzymes (93311). However, this effect has not been reported in humans.
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Below is general information about the adverse effects of the known ingredients contained in the product Tran-Q. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General
...There is currently a limited amount of information on the adverse effects of atractylodes.
A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Allergic reaction, dry mouth, nausea.
Gastrointestinal ...Orally, atractylenolide I, an isolated constituent of atractylodes, can cause bad taste, nausea, and dry mouth (15706).
Immunologic ...Atractylodes can cause an allergic reaction in people sensitive to the Asteraceae/Compositae family (12450). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.
General
...There is currently a limited amount of information on the adverse effects of gardenia.
Most Common Adverse Effects:
Topically: Allergic contact dermatitis in sensitive individuals.
Dermatologic
...Topically, exposure to gardenia fruit extract or the whole plant has been associated with allergic contact dermatitis (26518,49078).
Orally, there is a case report of blue-gray skin pigmentation associated with taking a product containing the extracts of gardenia fruit, phellodendron bark, and licorice for 7 years in a 77-year-old female. The pigmentation was thought to be due to melanin deposition enhanced by genipin, a constituent of gardenia. The patient gradually improved over 9 months after stopping this treatment (102698).
Gastrointestinal ...Orally, there are case reports of mesenteric phlebosclerosis, a thickening of the walls of the intestine and mesenteric veins, which can lead to obstruction and occlusion. Typical presenting symptoms are paroxysmal abdominal pain with nausea and vomiting, and imaging studies reveal thickening and stiffening of the walls of the ascending and transverse colon, with dark purple discoloration of the colonic and rectal mucosa, and linear calcification of the mesenteric veins. Treatment is supportive and conservative, leading to a slow resolution of signs and symptoms. In one case a 61-year-old female had been taking a Chinese herbal combination containing extracts of gardenia fruit, Baikal skullcap root, goldthread, phellodendron bark, honeysuckle, rhubarb, anemarrhenae, and trichosanthis root for 8 years (112954). In another case, a 77-year-old female took a product containing extracts of gardenia fruit, phellodendron bark, and licorice for 7 years. Mesenteric phlebosclerosis is thought to be caused by genipin, formed from geniposide after hydrolysis by intestinal bacteria. It is absorbed from the intestine, reacting with proteins in mesenteric veins, leading to progressive fibrosis, calcification, and venous occlusion (102698,112954).
Immunologic ...Topically, exposure to gardenia fruit extract or the whole plant has been associated with allergic contact dermatitis (26518,49078).
General ...Orally, Job's tears is generally well tolerated when consumed as a food (15368). There is no good scientific evidence on the safety and adverse effects of Job's tears taken orally in medicinal amounts.
Dermatologic ...Oral use of Job's tears has been associated with Baboon syndrome -- a condition characterized by a red and itchy rash most often located on the buttocks. In one case report, a 53-year-old woman taking a specific Job's tears-containing supplement (Ibane, JW Pharm) from South Korea experienced severe red and itchy skin around her trunk and groin area. While the supplement also contains riboflavin, pyridoxine, ascorbic acid, nicotinamide, biotin, and L-cysteine, Job's tears was thought to be the cause of this patient's reaction. After two weeks of not taking the supplement the patient's skin returned to normal (95438).
General
...Orally, licorice is generally well tolerated when used in amounts commonly found in foods.
It seems to be well tolerated when licorice products that do not contain glycyrrhizin (deglycyrrhizinated licorice) are used orally and appropriately for medicinal purposes or when used topically, short-term.
Most Common Adverse Effects:
Orally: Headache, nausea, and vomiting.
Topically: Contact dermatitis.
Intravenously: Diarrhea, itching, nausea, and rash.
Serious Adverse Effects (Rare):
Orally: Case reports have raised concerns about acute renal failure, cardiac arrest, cardiac arrhythmias, hypertension, hypokalemia, muscle weakness, paralysis, pseudohyperaldosteronism, and seizure associated with long-term use or large amounts of licorice containing glycyrrhizin.
Cardiovascular
...Orally, excessive licorice ingestion can lead to pseudohyperaldosteronism, which can precipitate cardiovascular complications such as hypertension and hypertensive crisis, ventricular fibrillation or tachycardia, sinus pause, and cardiac arrest.
These effects are due to the licorice constituent glycyrrhizin and usually occur when 20-30 grams or more of licorice product is consumed daily for several weeks (781,15590,15592,15594,15596,15597,15599,15600,16835,97213) (104563,108574,108576,110305,112234). In one case report, an 89-year-old female taking an herbal medicine containing licorice experienced a fatal arrhythmia secondary to licorice-induced hypokalemia. The patient presented to the hospital with recurrent syncope, weakness, and fatigue for 5 days after taking an herbal medicine containing licorice for 2 months. Upon admission to the hospital, the patient developed seizures, QT prolongation, and ventricular arrhythmia requiring multiple defibrillations. Laboratory tests confirmed hypokalemia and pseudohyperaldosteronism (112234).
However, people with cardiovascular or kidney conditions may be more sensitive, so these adverse events may occur with doses as low as 5 grams of licorice product or glycyrrhizin 100 mg daily (15589,15593,15598,15600,59726). A case report in a 54-year-old male suggests that malnutrition might increase the risk of severe adverse effects with excessive licorice consumption. This patient presented to the emergency room with cardiac arrest and ventricular fibrillation after excessive daily consumption of licorice for about 3 weeks. This caused pseudohyperaldosteronism and then hypokalemia, leading to cardiovascular manifestations. In spite of resuscitative treatment, the patient progressed to kidney failure, refused dialysis, and died shortly thereafter (103791).
Dermatologic
...There have been reports of contact allergy, resulting in an itchy reddish eruption, occurring in patients that applied cosmetic products containing oil-soluble licorice extracts (59912).
There have also been at least 3 cases of allergic contact dermatitis reported with the topical application of glycyrrhizin-containing products to damaged skin. In one case report, a 31-year-old female with acne presented with a 2-year history of pruritic erythematous-scaly plaques located predominantly on the face and neck after the use of a cosmetic product containing licorice root extract 1%. The patient had a positive skin patch test to licorice root extract, leading the clinicians to hypothesize that the use of benzoyl peroxide, a strong irritant, might have sensitized the patient to licorice (108578). Burning sensation, itching, redness, and scaling were reported rarely in patients applying a combination of licorice, calendula, and snail secretion filtrate to the face. The specific role of licorice is unclear (110322).
In rare cases, the glycyrrhizin constituent of licorice has caused rash and itching when administered intravenously (59712).
Endocrine
...Orally, excessive licorice ingestion can cause a syndrome of apparent mineralocorticoid excess, or pseudohyperaldosteronism, with sodium and water retention, increased urinary potassium loss, hypokalemia, and metabolic alkalosis due to its glycyrrhizin content (781,10619,15591,15592,15593,15594,15595,15596,15597,15598)(15600,16057,16835,25659,25660,25673,25719,26439,59818,59822)(59832,59864,91722,104563,108568,108574,110305,112234).
These metabolic abnormalities can lead to hypertension, edema, EKG changes, fatigue, syncope, arrhythmias, cardiac arrest, headache, lethargy, muscle weakness, dropped head syndrome (DHS), rhabdomyolysis, myoglobinuria, paralysis, encephalopathy, respiratory impairment, hyperparathyroidism, and acute kidney failure (10393,10619,15589,15590,15593,15594,15596,15597,15599)(15600,16057,16835,25660,25673,25719,26439,31562,59709,59716)(59720,59740,59787,59820,59826,59882,59889,59900,91722,97214,100522) (104563,108576,108577). These effects are most likely to occur when 20-30 grams of licorice products containing glycyrrhizin 400 mg or more is consumed daily for several weeks (781,15590,15592,15594,15596,15597,15599,15600,16835,108574). However, some people may be more sensitive, especially those with hypertension, diabetes, heart problems, or kidney problems (15589,15593,15598,15600,59726,108576,108577) and even low or moderate consumption of licorice may cause hypertensive crisis or hypertension in normotensive individuals (1372,97213). The use of certain medications with licorice may also increase the risk of these adverse effects (108568,108577). One case report determined that the use of large doses of licorice in an elderly female stabilized on fludrocortisone precipitated hypokalemia and hypertension, requiring inpatient treatment (108568). Another case report describes severe hypokalemia necessitating intensive care treatment due to co-ingestion of an oral glycyrrhizin-specific product and hydrochlorothiazide for 1 month (108577). Glycyrrhetinic acid has a long half-life, a large volume of distribution, and extensive enterohepatic recirculation. Therefore, it may take 1-2 weeks before hypokalemia resolves (781,15595,15596,15597,15600). Normalization of the renin-aldosterone axis and blood pressure can take up to several months (781,15595,108568). Treatment typically includes the discontinuation of licorice, oral and intravenous potassium supplementation, and short-term use of aldosterone antagonists, such as spironolactone (108574,108577).
Chewing tobacco flavored with licorice has also been associated with toxicity. Chewing licorice-flavored tobacco, drinking licorice tea, or ingesting large amounts of black licorice flavored jelly beans or lozenges has been associated with hypertension and suppressed renin and aldosterone levels (12671,12837,97214,97215,97217,108574). One case report suggests that taking a combination product containing about 100 mg of licorice and other ingredients (Jintan, Morishita Jintan Co.) for many decades may be associated with hypoaldosteronism, even up to 5 months after discontinuation of the product (100522). In another case report, licorice ingestion led to hyperprolactinemia in a female (59901). Licorice-associated hypercalcemia has also been noted in a case report (59766).
Gastrointestinal ...Nausea and vomiting have been reported rarely following oral use of deglycyrrhizinated licorice (25694,59871). Intravenously, the glycyrrhizin constituent of licorice has rarely caused gastric discomfort, diarrhea, or nausea (59712,59915).
Immunologic ...There have been reports of contact allergy, resulting in an itchy reddish eruption, occurring in patients that applied cosmetic products containing oil-soluble licorice extracts (59912). There have also been at least 3 cases of allergic contact dermatitis reported with the topical application of glycyrrhizin-containing products to damaged skin. In one case report, a 31-year-old female with acne presented with a 2-year history of pruritic erythematous-scaly plaques located predominantly on the face and neck after the use of a cosmetic product containing licorice root extract 1%. The patient had a positive skin patch test to licorice root extract, leading the clinicians to hypothesize that the use of benzoyl peroxide, a strong irritant, might have sensitized the patient to licorice (108578).
Musculoskeletal ...In a case report, excessive glycyrrhizin-containing licorice consumption led to water retention and was thought to trigger neuropathy and carpal tunnel syndrome (59791).
Neurologic/CNS ...Orally, licorice containing larger amounts of glycyrrhizin may cause headaches. A healthy woman taking glycyrrhizin 380 mg daily for 2 weeks experienced a headache (59892). Intravenously, the glycyrrhizin constituent of licorice has rarely caused headaches or fatigue (59721). In a case report, licorice candy ingestion was associated with posterior reversible encephalopathy syndrome accompanied by a tonic-clonic seizure (97218).
Ocular/Otic ...Orally, consuming glycyrrhizin-containing licorice 114-909 grams has been associated with transient visual loss (59714).
Pulmonary/Respiratory ...Orally, large amounts of licorice might lead to pulmonary edema. In one case report, a 64-year old male consumed 1020 grams of black licorice (Hershey Twizzlers) containing glycyrrhizin 3.6 grams over 3 days, which resulted in pulmonary edema secondary to pseudohyperaldosteronism (31561). Intravenously, the glycyrrhizin constituent of licorice has caused cold or flu-like symptoms, although these events are not common (59712,59721).
General ...Orally, taking oriental arborvitae long-term or at high doses might cause adverse effects due to the thujone constituent. Thujone-containing herbs can cause restlessness, vomiting, dizziness, tremors, kidney damage, hallucinations, and convulsions when used long-term or at high doses. Thujone intoxication can cause psychoactivity similar to tetrahydrocannibinol, the active constituent in marijuana. (12).
Gastrointestinal ...Orally, thujone-containing herbs such as oriental arborvitae may cause vomiting when used long-term or at high doses (12).
Musculoskeletal ...Orally, thujone-containing herbs such as oriental arborvitae may cause tremors when used long-term or at high doses (12).
Neurologic/CNS ...Orally, thujone-containing herbs such as oriental arborvitae may cause dizziness and convulsions when used long-term or at high doses (12).
Psychiatric ...Orally, thujone-containing herbs such as oriental arborvitae may cause restlessness and hallucinations when used long-term or at high doses. Thujone intoxication can cause psychoactivity similar to tetrahydrocannibinol, the active constituent in marijuana. (12).
Renal ...Orally, thujone-containing herbs such as oriental arborvitae may cause kidney damage when used long-term or at high doses (12).
General ...Orally, poria mushroom seems to be well tolerated. However, a thorough evaluation of safety outcomes has not been conducted.
Immunologic ...Allergic reactions have been reported rarely, including allergic rhinitis and allergic asthma (12).
General ...Orally, rehmannia seems to be well tolerated.
General ...Orally, senega seems to be well tolerated. The most common adverse effects are gastrointestinal irritation, dyspepsia, diarrhea, queasiness, vomiting, and dizziness. These adverse effects are usually associated with large doses or prolonged use (2,4,8,18,96992).
Gastrointestinal ...Orally, senega can cause mild dyspepsia (96992). Prolonged use of senega can cause gastrointestinal irritation (2). Large doses of senega can cause diarrhea (8), queasiness (18), and vomiting (4).
Immunologic ...There is a case of IgE-mediated occupational asthma and rhinitis due to inhalation of senega powder (96987).
Neurologic/CNS ...Orally, large amounts of senega can cause dizziness (8).
General
...Orally, very few adverse effects have been reported with the medicinal use of tangerine.
However, a thorough evaluation of safety outcomes has not been conducted.
Topically, contact dermatitis has been associated with tangerine essential oil (28610).
Dermatologic ...According to one case report, the essential oil of tangerine in a fragrance has been associated with contact dermatitis (28610).
Gastrointestinal ...In a case report, a 5 year-old patient had a phytobezoar that included tangerine residues (28611). In another case report, orange and tangerine caused obstruction of the small intestine (28612).
General ...Orally, zizyphus fruit extract and powder seem to be well tolerated.
Gastrointestinal ...Orally, zizyphus fruit extract was associated with three cases of mild diarrhea in newborn infants (93306). Zizyphus seed extract was associated with one case of dry mouth and one case of increased bowel movements in a small clinical study (107921).
Neurologic/CNS ...Orally, zizyphus seed extract was associated with two cases of headache in a small clinical study (107921).
