Eucalyptus by Pflueger USA

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alopecia areata. Although there has been interest in using oral aconite for alopecia areata, there is insufficient reliable information about the clinical effects of aconite for this purpose.
• Amenorrhea. Although there has been interest in using oral aconite for amenorrhea, there is insufficient reliable information about the clinical effects of aconite for this purpose.
• Asthma. Although there has been interest in using oral aconite for asthma, there is insufficient reliable information about the clinical effects of aconite for this purpose.
• Coronavirus disease 2019 (COVID-19). Although there has been interest in using injectable aconite for COVID-19, there is insufficient reliable information about the clinical effects of aconite for this purpose.
• Diarrhea. Although there has been interest in using oral aconite for diarrhea, there is insufficient reliable information about the clinical effects of aconite for this purpose.
• Heart failure. It is unclear if oral aconite is beneficial in patients with left ventricular failure. Details: Preliminary clinical research in patients with left ventricular failure shows that taking heat processed aconite tuber 1000 mg daily for up to 7 months modestly improves heart and kidney function when compared with placebo (30314).
• Pneumonia. Injectable aconite has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Oral aconite has not been evaluated for this use. Details: A meta-analysis of 20 small, low-quality randomized and non-randomized studies in older Chinese adults with severe pneumonia shows that 77% of patients receiving an injection containing aconite extract 0.1 mg/mL and panax ginseng extract 0.8 mg/mL had improvement in symptoms such as fever, cough, and chest tightness when compared with 61% of those who received standard treatment. This combination injection may also modestly reduce disease severity and the risk of mortality when compared with standard treatment. However, these outcomes were not evaluated in all studies, and dosing regimens were heterogenous, with doses ranging from 60-100 mL daily or twice daily for 7-14 days (110472).
• Raynaud syndrome. Although there has been interest in using oral aconite for Raynaud syndrome, there is insufficient reliable information about the clinical effects of aconite for this purpose. More evidence is needed to rate aconite for these uses.

(Read more about ACONITE)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Common Cold. Preliminary clinical research shows that taking a specific homeopathic product (Eupatorium perfoliatum D2) derived from boneset has a similar effect to aspirin on symptoms of the common cold (36793). More evidence is needed to rate boneset for this use.

(Read more about BONESET)

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

(Read more about GELSEMIUM)

POSSIBLY INEFFECTIVE

• Urine drug tests. Drinking water with goldenseal or adding goldenseal tea to urine does not appear to cause a false negative urine drug screen for amphetamines, barbiturates, benzodiazepines, cocaine, opiates, phencyclidine, or tetrahydrocannabinol (THC). Details: Goldenseal is often promoted to mask illicit drugs in the urine, but drinking one gallon of water with goldenseal or adding goldenseal tea to urine samples does not seem to cause a false negative immunoassay (EMIT and TDx) for cocaine, amphetamines, barbiturates, benzodiazepines, or opiates. It also does not produce a false negative for Microgenics CEDIA DAU assays for amphetamines, barbiturates, benzodiazepines, cocaine, opiates, phencyclidine, or THC (260,261,52599). Although adding goldenseal tea to urine samples at 15 grams per liter may produce a false-negative EMIT reading for the presence of THC, the adulteration is obvious due to a brownish color in the urine (52599). Some people also claim that goldenseal can cause a false positive on a drug screen. However, goldenseal does not seem to cause false positives for the fluorescent polarization immunoassay (FPIA) or thin-layer chromatography (TLC) assays for amphetamines, opiates, cocaine, methadone, or their metabolites (2590).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Although there has been interest in using topical goldenseal for acne, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Allergic rhinitis (hay fever). Although there has been interest in using oral goldenseal for allergic rhinitis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Anorexia nervosa. Although there has been interest in using oral goldenseal for anorexia nervosa, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Atopic dermatitis (eczema). Although there has been interest in using topical goldenseal for atopic dermatitis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Chronic fatigue syndrome (CFS). Although there has been interest in using oral goldenseal for CFS, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Conjunctivitis. Although there has been interest in using goldenseal as an eye drop for conjunctivitis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Dandruff. Although there has been interest in using topical goldenseal for dandruff, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Flatulence. Although there has been interest in using oral goldenseal for flatulence, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Gastritis. Although there has been interest in using oral goldenseal for gastritis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Gingivitis. Although there has been interest in using goldenseal as a mouthwash for gingivitis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Hemorrhoids. Although there has been interest in using oral goldenseal for hemorrhoids, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Herpes labialis (cold sores). Although there has been interest in using topical goldenseal for herpes labialis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Menorrhagia. Although there has been interest in using oral goldenseal for menorrhagia, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Otitis media. Although there has been interest in using goldenseal as an ear drop for otitis media, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Peptic ulcers. Although there has been interest in using oral goldenseal for peptic ulcers, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Respiratory tract infections. Although there has been interest in using oral goldenseal for various respiratory tract infections, including influenza, pneumonia, rhinosinusitis, and the common cold, there is insufficient reliable information about the clinical effects of goldenseal for these conditions.
• Tinnitus. Although there has been interest in using goldenseal as an ear drop for tinnitus, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Urinary tract infections (UTIs). Although there has been interest in using oral goldenseal for UTIs, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Uveitis. Although there has been interest in using goldenseal as an eye drop for uveitis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Vaginitis. Although there has been interest in using oral goldenseal for vaginitis, there is insufficient reliable information about the clinical effects of goldenseal for this purpose.
• Wound healing. Although there has been interest in using topical goldenseal for wound healing, there is insufficient reliable information about the clinical effects of goldenseal for this purpose. There is insufficient reliable information available about the effectiveness of goldenseal for its other uses.

(Read more about GOLDENSEAL)

POSSIBLY INEFFECTIVE

• Poisoning. Historically, ipecac syrup was commonly used to manage poisoning (15,56380,56387,56403,56415). However, the American Academy of Pediatrics, American Academy of Clinical Toxicologists, and European Association of Poisons Centres and Clinical Toxicologists state that ipecac should not be used routinely for poisoning due to a lack of evidence of improved outcomes over available alternatives and an increased risk for adverse consequences (11349,12394,56389). Research shows that inducing emesis with oral ipecac syrup within 10 minutes of poison ingestion can remove 28% to 54% of the poison dose from the patient (56408,56419,56455). However, as the interval between poison ingestion and ipecac-induced emesis is extended, the percentage of poison dose recovered declines, approaching zero after 90 minutes (56454,56466). Furthermore, ipecac syrup does not appear to be more effective than activated charcoal (103744). While some research shows that taking 30 mL of ipecac syrup within one hour of poison ingestion can reduce absorption of poisons by about the same amount as taking 50-60 grams of activated charcoal (56411), most research shows that ipecac syrup is less effective than activated charcoal (56427,56442,56444). Also, using ipecac followed by activated charcoal after cessation of vomiting does not provide any benefit over earlier administration of activated charcoal alone (56403,56451,103744), and may increase patient recovery times (56392). Finally, there are also adverse consequences of ipecac use, including an increased risk for aspiration pneumonia and the need to delay administration of activated charcoal, poison-specific oral antidotes, or fluids for whole bowel irrigation after ipecac administration in order to avoid emesis of these treatments (12394,56392,56406,56444,103744). There is insufficient reliable information available about the effectiveness of ipecac for its other uses.

(Read more about IPECAC)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Common cold. Clinical research shows that taking three tablets of a specific combination product (Esberitox, Schaper & Brümmer GmbH & Co. KG) containing dry extracts of echinacea root, thuja leaf, and wild indigo root three times daily for 7-9 days improves the severity of cold symptoms, general well-being, and overall response rate when compared with placebo in patients experiencing moderate cold symptoms (6392). It is not clear if these effects are due to wild indigo, the other ingredients, or the combination. More evidence is needed to rate wild indigo for this use.

(Read more about WILD INDIGO)

UNSAFE ...when used orally or topically. Aconite root contains toxic alkaloids that are strong, fast-acting poisons that affect the heart and central nervous system, causing severe arrhythmias, reduced consciousness, and death (15499,19669,30294,30300,30301,30303,30309,30334,30335,30336,92276,104514,106706). All species of this plant are dangerous. Severe poisoning has been reported after ingestion of 0.2-2 mg of aconitine, 1 gram of the raw plant, or 6 grams of processed and cured aconite (3490,104514). Even when a processed product is used, aconite can cause toxicity including nausea, vomiting, dizziness, muscle spasms, hypothermia, paralysis of the respiratory system, and heart rhythm disorders (15499). Aconite can also be absorbed through the skin and cause significant toxicity (12).

PREGNANCY AND LACTATION: UNSAFE
when used orally or topically (15499).

(Read more about ACONITE)

POSSIBLY UNSAFE ...when used orally. Boneset can cause severe diarrhea and vomiting. Hepatotoxic pyrrolizidine alkaloids (PAs) are common in this genus of plants; however, the alkaloids in boneset have not been adequately characterized to determine their toxic potential (12842,102557).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally. Hepatotoxic PAs are common in this genus of plants; however, the alkaloids in boneset have not been adequately characterized to determine their toxic potential (12842,102557). Hepatotoxic PAs might be teratogenic; avoid using.

(Read more about BONESET)

UNSAFE ...when the rhizome or root are used orally. All parts of the plant contain toxic alkaloids. The adult lethal dose is 2-3 grams or 4 mL of the fluid extract (18).

CHILDREN: UNSAFE
when used orally. The lethal dose is 500 mg (18).

PREGNANCY AND LACTATION: UNSAFE
when used orally due to toxicity (6).

(Read more about GELSEMIUM)

POSSIBLY SAFE ...when used orally and appropriately as a single dose (260,261). There is insufficient reliable information available about the safety of goldenseal when used as more than a single dose.

CHILDREN: LIKELY UNSAFE
when used orally in newborns. The berberine constituent of goldenseal can cause kernicterus in newborns, particularly preterm neonates with hyperbilirubinemia (2589).

PREGNANCY: LIKELY UNSAFE
when used orally. Berberine is thought to cross the placenta and may cause harm to the fetus. Kernicterus has developed in newborn infants exposed to goldenseal (2589).

LACTATION:
LIKELY UNSAFE when used orally. Berberine and other harmful constituents can be transferred to the infant through breast milk (2589). Use during lactation can cause kernicterus in the newborn and several resulting fatalities have been reported (2589).

(Read more about GOLDENSEAL)

POSSIBLY SAFE ...when the rhizome or syrup of ipecac is used orally and appropriately, as a single dose. A single 15-30 mL dose of syrup containing 10-21 mg ipecac has been used with apparent safety in clinical research (12,56419,103744).

POSSIBLY UNSAFE ...when in contact with skin or when inhaled. The constituent emetine is a skin irritant, and ipecac powder is a respiratory irritant (6,18).

LIKELY UNSAFE ...when used orally long-term or in amounts greater than 30 mL. Misuse can lead to serious toxicity, including cardiomyopathy and death. Chronic ingestion of ipecac 30 mL (21 mg) 2-3 times daily for 5 months has been associated with cardiomyopathy. The acute lethal dose of ipecac is 850-1780 mL (600-1250 mg) (6,12,19,56412,56460,56467). ...when a total dose of more than 1 gram is injected, it can cause nervous system symptoms, blood in the urine, and circulatory collapse (6).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately as an emetic (272,11349).

CHILDREN: LIKELY UNSAFE
when used orally in large doses and in infants under 1 year old (12,19). Children are more sensitive to large doses and effects on the nervous system than adults (19).

PREGNANCY: LIKELY UNSAFE
when used orally; ipecac is a potential uterine stimulant (12,19).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about IPECAC)

LIKELY UNSAFE ...when used orally in large doses. Wild indigo is considered poisonous when consumed in doses of about 30 grams (12,19).

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally or topically due to its toxic potential (12,19).

(Read more about WILD INDIGO)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, combining aconite with other antiplatelet or anticoagulant drugs might increase the risk of bruising and bleeding.  Details Higenamine, a constituent of aconite, is thought to have antiplatelet and antithrombotic effects. In an animal model of thrombosis, higenamine inhibited platelet aggregation and reduced the size of thrombus formation (92282).

STIMULANT DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, combining aconite with other stimulant drugs might alter the effects of the stimulant drug or increase the risk of cardiovascular toxicity.  Details Aconite and its constituents have stimulant effects due to agonist activity at beta-2-adrenoreceptors. In cardiac muscle, aconite appears to have a positive inotropic effect and increases heart rate and blood pressure (2634,15499,30296,92282). However, some constituents of aconite can reduce heart rate and blood pressure (15499,30343).

(Read more about ACONITE)

(Read more about BONESET)

(Read more about GELSEMIUM)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.  Details Goldenseal contains berberine. In vitro and animal research shows that berberine can inhibit platelet aggregation (33660,33694). However, this effect has not been reported in humans.

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase the risk of hypoglycemia when used with antidiabetes drugs.  Details Goldenseal contains berberine. Clinical research shows that berberine can lower blood glucose levels (20579,34247,34265,34282). However, this effect has not been reported with goldenseal.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase the risk of hypotension when taken with antihypertensive drugs.  Details Goldenseal contains berberine. Animal research shows that berberine can have hypotensive effects (33692,34308). Also, an analysis of clinical research shows that taking berberine in combination with amlodipine can lower systolic and diastolic blood pressure when compared with amlodipine alone (91956). However, this effect has not been reported with goldenseal.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase the sedative effects of CNS depressants.  Details Goldenseal contains berberine. Animal research shows that berberine can have sedative effects (13519,33650,33664,33692). However, this effect has not been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase serum levels of drugs metabolized by CYP2C9.  Details In vitro research shows that goldenseal root extract can modestly inhibit CYP2C9. This effect may be due to its alkaloid constituents, hydrastine and berberine (21117). However, this effect has not been reported in humans.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Goldenseal might increase serum levels of drugs metabolized by CYP2D6.  Details Clinical and in vitro research shows that goldenseal can significantly inhibit CYP2D6 enzymes, potentially increasing levels of drugs metabolized by CYP2D6 (13536,16848,35907).

CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase serum levels of drugs metabolized by CYP2E1.  Details In vitro research shows that goldenseal root extract can inhibit the activity of CYP2E1 (94140). However, 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 = B Goldenseal might increase serum levels of drugs metabolized by CYP3A4.  Details Most clinical and in vitro research shows that goldenseal inhibits CYP3A4 enzyme activity and increases serum levels of CYP3A4 substrates, such as midazolam (6450,13536,21117,91740,111725). However, in one small clinical study, goldenseal did not affect the levels of indinavir, a CYP3A4 substrate, in healthy volunteers (10690,93578). This is likely due to the fact that indinavir has a high oral bioavailability, making it an inadequate probe for CYP3A4 interactions (13536,91740) and/or that it is primarily metabolized by hepatic CYP3A, while goldenseal has more potential to inhibit intestinal CYP3A enzyme activity (111725). Both goldenseal extract and its isolated constituents berberine and hydrastine inhibit CYP3A, with hydrastine possibly having more inhibitory potential than berberine (111725).

DEXTROMETHORPHAN (Robitussin DM, others) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase serum levels of dextromethorphan.  Details Goldenseal contains berberine. A small clinical study shows that berberine can inhibit cytochrome P450 2D6 (CYP2D6) activity and reduce the metabolism of dextromethorphan (34279).

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = B Goldenseal might increase serum levels of digoxin, although this effect is unlikely to be clinically significant.  Details Clinical research shows that goldenseal modestly increases digoxin peak levels by about 14% in healthy volunteers. However, goldenseal does not seem to affect other pharmacokinetic parameters such as area under the curve (AUC) (15132). This suggests that goldenseal does not cause a clinically significant interaction with digoxin. Digoxin is a P-glycoprotein substrate. Some evidence suggests that goldenseal constituents might affect P-glycoprotein; however, it is unclear whether these constituents inhibit or induce P-glycoprotein.

LOSARTAN (Cozaar) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might decrease the conversion of losartan to its active form.  Details Goldenseal contains berberine. A small clinical study shows that berberine inhibits cytochrome P450 2C9 (CYP2C9) activity and reduces the metabolism of losartan (34279). However, this effect has not been reported with goldenseal.

METFORMIN (Glucophage) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might reduce blood levels of metformin.  Details In vitro research shows that goldenseal extract decreases the bioavailability of metformin, likely by interfering with transport, intestinal permeability, or other processes involved in metformin absorption. It is unclear which, if any, of metformin's transporters are inhibited by goldenseal. Goldenseal does not appear to alter the clearance or half-life of metformin (105764).

OSELTAMIVIR (Tamiflu) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might reduce the therapeutic effects of oseltamivir by decreasing its conversion to its active form.  Details In vitro evidence suggests that goldenseal reduces the formation of the active compound from the prodrug oseltamivir (105765). The mechanism of action and clinical relevance is unclear.

P-GLYCOPROTEIN SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = B Theoretically, goldenseal might increase or decrease serum levels of P-glycoprotein (P-gp) substrates.  Details There is conflicting evidence about the effect of goldenseal on P-gp. In vitro research suggests that berberine, a constituent of goldenseal, modestly inhibits P-gp efflux. Other evidence suggests that berberine induces P-gp. In healthy volunteers, goldenseal modestly increases peak levels of the P-gp substrate digoxin by about 14%. However, it does not seem to affect other pharmacokinetic parameters such as area under the curve (AUC) (15132). This suggests that goldenseal is not a potent inhibitor of P-gp-mediated drug efflux. Until more is known, goldenseal should be used cautiously with P-gp substrates.

PENTOBARBITAL (Nembutal) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase the sedative effects of pentobarbital.  Details Animal research shows that berberine, a constituent of goldenseal, can prolong pentobarbital-induced sleeping time (13519). However, this effect has not been reported with goldenseal.

TACROLIMUS (Prograf) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, goldenseal might increase serum levels of tacrolimus.  Details Goldenseal contains berberine. In a 16-year-old patient with idiopathic nephrotic syndrome who was being treated with tacrolimus 6.5 mg twice daily, intake of berberine 200 mg three times daily increased the blood concentration of tacrolimus from 8 to 22 ng/mL. Following a reduction of tacrolimus dosing to 3 mg daily, blood levels of tacrolimus decreased to 12 ng/mL (91954).

(Read more about GOLDENSEAL)

(Read more about IPECAC)

(Read more about WILD INDIGO)

General ...Orally and topically, aconite is generally regarded as unsafe for use. Any benefits of therapy might not outweigh the risk of toxicity.
Most Common Adverse Effects:
All routes of administration: Serious neurologic, cardiovascular, gastrointestinal, and respiratory adverse effects have been reported.

Cardiovascular ...Orally and topically, aconite can cause hypotension, palpitations, chest tightness, pulmonary edema, arrhythmia, bradycardia, tachycardia, sustained or bidirectional ventricular tachycardia, ventricular fibrillation, and Torsade de pointes (558,559,561,562,563,3490,15499,15650,30294,30295)(30300,30305,30323,30336,92276,92277,92278,104514,106706,110473)(112901). Cardioversion has been reported to be ineffective for the reversal of aconite-induced dysrhythmia, but the use of agents such as amiodarone, lidocaine, and magnesium have been successful in some cases (2634,3490,106706,112901).

Gastrointestinal ...Orally, aconite can cause nausea, vomiting, diarrhea, and gastric pain (563,30297,30341,92277,92278). Topically, aconite can cause nausea and vomiting (92276).

Neurologic/CNS ...Orally, aconite can cause weakness, sweating, restlessness, dizziness, numbness, paresthesia, seizures, and reduced consciousness (558,559,561,562,563,3490,15499,15650,30335,30336,30341,92277,92278,104513). Topically, aconite can cause generalized paresthesia, fatigue, sweating, dizziness and tongue numbness (92276).

Ocular/Otic ...Orally, aconite has been reported to cause visual blurring and yellow-green vision with pupil dilation (30319).

Pulmonary/Respiratory ...Orally, aconite overdose can lead to respiratory failure (104513).

Renal ...Orally and topically, aconite can cause hypokalemia and metabolic and/or respiratory acidosis (558,559,561,562,563,3490,15499,15650).

Other ...Orally and topically, aconite has been reported to cause death in both adults and children (559,3490,3491,30301,30334,30341,92276,92278). In one case report, topical application of aconite to an infant led to cardiogenic shock with multi-organ failure and death (92276). Poisoning has been reported in 15 patients after consuming a homemade liquor containing aconite. Patients presented with tongue or extremity numbness, vomiting, dizziness, or heart palpitations, and 5 died (110471). Death has also been reported in individuals who cooked aconite tubers as vegetables or for health purposes (92278).
The first symptoms of aconite poisoning after oral ingestion of the leaves or root usually occur within 10-90 minutes, although toxicity may be delayed until a second or third dose (559,15499,104513,110471). Recovery time from aconite poisoning ranges from 1.5-2 days for mild intoxication to 7-9 days for patients with cardiovascular complications; fatalities in treated patients are about 5% (15499). Treatment of aconite toxicity is typically supportive, although charcoal hemoperfusion has aided in detoxification (15499,106706).

(Read more about ACONITE)

General ...Orally, boneset is reported to cause nausea and severe diarrhea and vomiting (12842). Additionally, other plants in the Eupatorium genus contain the hepatotoxic pyrrolizidine alkaloids (PAs). However, the alkaloids in boneset have not been adequately characterized to determine their toxic potential (12842,102557). Liver toxicity and liver damage may be possible in high doses.

Gastrointestinal ...Orally, boneset has been reported to cause nausea and severe diarrhea and vomiting (12842).

Hepatic ...Other plants in the Eupatorium genus contain hepatotoxic pyrrolizidine alkaloids (PAs). However, the alkaloids in boneset have not been adequately characterized to determine their toxic potential (12842,102557). Liver toxicity and liver damage may be possible in high doses.

(Read more about BONESET)

General ...Orally, gelsemium can cause headache, drooping of the eyelid, double vision, difficulty swallowing, dizziness, muscle weakness or rigidity, seizures, dyspnea, and bradycardia. Death due to failure of respiratory muscles can occur (18).

Neurologic/CNS ...Orally, gelsemium can cause headache, drooping of the eyelid, double vision, difficulty swallowing, dizziness, muscle weakness or rigidity, seizures, dyspnea, and bradycardia. Death due to failure of respiratory muscles can occur (18).

(Read more about GELSEMIUM)

General ...There is limited reliable information available about the safety of goldenseal when used in more than a single dose. Berberine, a constituent of goldenseal, is generally well tolerated when used orally.
Most Common Adverse Effects:
Orally: Berberine, a constituent of goldenseal, can cause abdominal distension, abdominal pain, bitter taste, constipation, diarrhea, flatulence, headache, nausea, and vomiting.

Dermatologic ...Orally, berberine, a constituent of goldenseal, may cause rash. However, this appears to be rare (34285). A case of photosensitivity characterized by pruritic, erythematous rash on sun-exposed skin has been reported in a 32-year-old female taking a combination product containing goldenseal, ginseng, bee pollen, and other ingredients. The rash resolved following discontinuation of the supplement and treatment with corticosteroids (33954). It is not clear if this adverse effect is due to goldenseal, other ingredients, or the combination.

Endocrine ...A case of severe, reversible hypernatremia has been reported in an 11-year-old female with new-onset type 1 diabetes and diabetic ketoacidosis who took a goldenseal supplement (52592).

Gastrointestinal ...Orally, berberine, a constituent of goldenseal, may cause diarrhea, constipation, flatulence, vomiting, abdominal pain, abdominal distention, and bitter taste (33648,33689,34245,34247,34285,91953). Theoretically, these effects may occur in patients taking goldenseal. However, this hasn't been reported in clinical research or case reports.

Neurologic/CNS ...Orally, berberine, a constituent of goldenseal, may cause headache when taken in a dose of 5 mg/kg daily (33648). Theoretically, this may occur with goldenseal, but this hasn't been reported in clinical research or case reports.

(Read more about GOLDENSEAL)

General ...Orally, ipecac syrup can cause nausea, vomiting, diarrhea, GI irritation, dizziness, hypotension, dyspnea, and tachycardia. Rarely, it can also cause intracerebral hemorrhage, pneumomediastinum, retropneumoperitoneum, esophageal bleeding (3,6,11,13,15,18,56390,56440,56447,56448)(56449,56464). Chronic use is associated with myopathies and death (6,18,56391,56412,56413,56414,56416,56421,56422,56424)(56433,56441,56446,56459,56462,56467). Overdose is associated with erosion of GI tract mucous membranes, cardiac arrhythmias, disorders of respiratory function, convulsions, shock, and coma (18).
Topically, emetine is a skin irritant (6).
When inhaled, ipecac powder is a respiratory irritant and can result in allergic symptoms such as rhinitis, as well as aspiration pneumonitis (18,56406,56445).
Intravenously, emetine may cause inflammation of the muscle tissue at the injection site with chronic administration. In total doses over 1 gram, it can lead to gastrointestinal and nervous system symptoms, hematuria and circulatory collapse (6).

Cardiovascular ...Orally, ipecac can cause hypotension, dyspnea, and tachycardia (11,56440). Chronic use is associated with cardiac myopathy and death related to heart failure (6,18,56391,56409,56424,56467). Overdose is associated with shock and cardiac arrhythmias (18).
Intravenously, ipecac in total doses over 1 gram can lead to circulatory collapse (6).

Dermatologic ...Topically, emetine, a constituent of ipecac syrup, is a skin irritant (6).

Gastrointestinal ...Orally, ipecac causes nausea, vomiting, diarrhea, and GI irritation (3,6,11,13,15,18,56390,56464). In some cases, these adverse effects are severe. There is a case report of a pneumomediastinum (air in the membrane around the heart) and retropneumoperitoneum (air behind the chest cavity) indicative of esophageal rupture following administration of a therapeutic dose of ipecac (56448). There is also a case report of esophageal bleeding following therapeutic use of ipecac (56447). Overdose is associated with erosion of GI tract mucous membranes (18).
Intravenously, ipecac in total doses over 1 gram can lead to gastrointestinal symptoms (6).

Hematologic ...Orally, a case of intracerebral hemorrhage related to the use of ipecac syrup has been reported in an elderly patient (56449).

Immunologic ...When inhaled, ipecac powder has resulted in occupational allergy symptoms, such as rhinitis (56445).

Musculoskeletal ...Orally, progressive muscular weakness has occurred following ipecac abuse, in some cases resulting in death. Discontinuation of ipecac seems to reverse the myopathy (56391,56412,56413,56414,56416,56421,56422,56424,56433,56441)(56446,56459,56462).
Intravenously, emetine may cause inflammation of the muscle tissue at the injection site with chronic administration (6).

Neurologic/CNS ...Orally, ipecac may cause dizziness (11). Overdose is associated with convulsions and coma (18).
Intravenously, ipecac in total doses over 1 gram can lead to nervous system symptoms (6).

Pulmonary/Respiratory ...Orally, ipecac causes dyspnea (11). Overdose is associated with disorders of respiratory function (18).
When inhaled, ipecac powder is a respiratory irritant and can result in aspiration pneumonitis (18,56406).

Renal ...Intravenously, ipecac in total doses over 1 gram can lead to hematuria (6).

(Read more about IPECAC)

General ...Orally, large doses of wild indigo are considered poisonous and can cause vomiting, diarrhea, gastrointestinal complaints, and spasms (12). Wild indigo has also been studied in combination with other herbal extracts.

Gastrointestinal ...Orally, large doses of wild indigo can cause vomiting, diarrhea, and gastrointestinal complaints (12).

Musculoskeletal ...Orally, large doses of wild indigo are considered poisonous and can cause spasms (12).

(Read more about WILD INDIGO)