Rsp [Discontinued] by Loomis Enzymes

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Preliminary clinical research shows that applying a gel formulation consisting of basil essential oil 5% and sweet orange essential oil 3% daily for 8 weeks can clear lesions in patients with acne (76896). The effect of basil essential oil alone on acne is unclear.
• Mental alertness. Preliminary clinical research shows that inhalation of aromatherapy consisting of basil, peppermint, and sandy everlasting essential oils improves attention, mental alertness, and mental focus when compared with placebo in patients reporting mental exhaustion with moderate burnout. After one week, patients in the aromatherapy group improved by about 21%, while patients in the control group improved by only 11% (68534). The effect of basil essential oil aromatherapy alone on mental alertness is unclear.
• Migraine headache. Preliminary clinical research in adults with migraine headaches shows that applying 2%, 4%, or 6% basil essential oil every 8 hours to the forehead and temples for 12 weeks reduces the intensity of migraine headache pain and the frequency of attacks in a dose- and time-dependent manner when compared with placebo (103622). More evidence is needed to rate basil for these uses.

(Read more about BASIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Celiac disease. Although there has been interest in using oral lipase for celiac disease, there is insufficient reliable information about the clinical effects of lipase for this purpose.
• Dyspepsia. It is unclear if oral lipase is beneficial for improving symptoms of postprandial distress syndrome. Details: A small clinical trial shows that taking a specific acid-resistant lipase (Amano Enzyme USA) 280 mg immediately before a high-fat meal does not reduce postprandial bloating and nausea when compared with placebo in individuals with postprandial distress syndrome (101900).
• Inflammatory bowel disease (IBD). Although there has been interest in using oral lipase for IBD, there is insufficient reliable information about the clinical effects of lipase for this purpose.
• Prematurity. It is unclear if adding a specific form of lipase, recombinant human bile salt-stimulated lipase (rhBSSL), to infant formula improves outcomes in premature infants. Some research suggests a potential increased risk for adverse effects. Details: Human breast milk contains rhBSSL, but it is inactivated when breast milk is pasteurized for donation. Clinical research in infants born before 32 weeks' gestation shows that adding rhBSSL as 8700 units per 100 mL formula or pasteurized breast milk, for 4 weeks does not increase growth velocity, body length, or head circumference over the next 12 months when compared with formula or pasteurized breast milk devoid of lipase. However, the infants who were small for gestational age (SGA), which made up approximately 15% of the study population, grew by an additional 1.9 grams/kg daily on average when compared with placebo (101940). More evidence is needed to rate lipase for these uses.

(Read more about LIPASE)

INSUFFICIENT RELIABLE EVIDENCE to RATE

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

(Read more about MULLEIN)

Proteolytic enzymes represent a wide group of enzymes that are used alone or in combination. See specific monographs for effectiveness information.

(Read more about PROTEOLYTIC ENZYMES (PROTEASES))

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Biliary disorders. Although there has been interest in using oral radish for biliary disorders, there is insufficient reliable information about the clinical effects of radish for this purpose.
• Diabetes. Although there has been interest in using oral radish for diabetes, there is insufficient reliable information about the clinical effects of radish for this purpose. More evidence is needed to rate radish for these uses.

(Read more about RADISH)

POSSIBLY EFFECTIVE

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

INSUFFICIENT RELIABLE EVIDENCE to RATE

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

(Read more about ROSE HIP)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Although there has been interest in using oral sarsaparilla for cancer, there is insufficient reliable information about the clinical effects of sarsaparilla for this purpose.
• Psoriasis. Although there has been interest in using oral sarsaparilla for psoriasis, there is insufficient reliable information about the clinical effects of sarsaparilla for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral sarsaparilla for RA, there is insufficient reliable information about the clinical effects of sarsaparilla for this purpose. More evidence is needed to rate sarsaparilla for these uses.

(Read more about SARSAPARILLA)

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)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Diabetes. There is preliminary clinical evidence that taking a tea prepared from white horehound three times daily before meals for 21 days, in addition to conventional medicines for type 2 diabetes, slightly reduces fasting blood glucose by about 0.64% compared with baseline. However, the reduction in blood glucose following treatment with white horehound was significantly less than the blood glucose reduction observed for patients who drank tea prepared from guarumo (Cecropia obtusifolia) (86369). It is not clear whether white horehound has a clinically significant effect when taken alone. More information is needed to rate white horehound for this use.

(Read more about WHITE HOREHOUND)

There is insufficient reliable information available about the effectiveness of wild cherry.

(Read more about WILD CHERRY)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Basil has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used topically in medicinal amounts. Solutions containing up to 6% basil essential oil have been used with apparent safety for up to 12 weeks (103622). There is insufficient reliable information available about the safety of basil when inhaled as aromatherapy.

POSSIBLY UNSAFE ...when used orally in medicinal amounts. Both the above ground parts and the oil of basil contain estragole, which might be hepatocarcinogenic and mutagenic (2,8,12).

CHILDREN: LIKELY SAFE
when the above ground parts are used in amounts commonly found in foods.

CHILDREN: POSSIBLY UNSAFE
when used orally in medicinal amounts due to the estragole constituent (2,8).

PREGNANCY AND LACTATION: LIKELY SAFE
when the above ground parts are used in amounts commonly found in foods.

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used in larger amounts due to the estragole constituent of the essential oil. Estragole might have mutagenic effects (2,12).

(Read more about BASIL)

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

CHILDREN: POSSIBLY UNSAFE
when recombinant human bile salt-stimulated lipase (rhBSSL) is used orally by premature infants. Adding rhBSSL to infant formula or pasteurized breast milk increases the risk for serious gastrointestinal adverse effects in premature infants (101940).

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

(Read more about LIPASE)

POSSIBLY SAFE ...when used orally and appropriately. Various proteolytic enzymes have been safely used orally in clinical research (716,964,965,968,969,6252,6253,10622,11457,18281,18284) (91104,91105,91106,91111,96449). Side effects are typically mild to moderate and most often include gastrointestinal effects. See specific monographs for more detailed information related to the safety of individual proteolytic enzymes. ...when used topically and appropriately. Various proteolytic enzymes have been safely used topically in clinical research (67835,67843,67845,91113). Some proteolytic enzymes might cause allergic reactions when used topically. See specific monographs for more detailed information related to the safety of individual proteolytic enzymes.

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

(Read more about PROTEOLYTIC ENZYMES (PROTEASES))

LIKELY SAFE ...when used orally in moderate amounts (18). Large amounts may lead to gastrointestinal irritation (18).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid very large doses.

(Read more about RADISH)

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

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

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

(Read more about ROSE HIP)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Sarsaparilla has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912). There is insufficient reliable information available about the safety of sarsaparilla when taken orally in medicinal amounts.

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

(Read more about SARSAPARILLA)

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)

LIKELY SAFE ...when used orally in amounts commonly found in foods. White horehound has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used orally and appropriately (2,12).

POSSIBLY UNSAFE ...when used orally in excessive amounts; white horehound may have a purgative effects (4,12). There is insufficient reliable information available about the safety of the topical use of white horehound.

PREGNANCY: LIKELY UNSAFE
when used orally; white horehound might have abortifacient effect (19), or stimulate menstrual flow and the uterus (12). There is insufficient reliable information available about the safety of topical use during pregnancy; avoid using.

LACTATION:
There is insufficient reliable information available about the safety of oral use during lactation; avoid amounts greater than those commonly found in foods. There is insufficient reliable information available about the safety of topical use during lactation; avoid using.

(Read more about WHITE HOREHOUND)

LIKELY SAFE ...when used orally in amounts commonly found in foods and beverages. Wild cherry has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used orally and appropriately short-term, in limited amounts (12).

POSSIBLY UNSAFE ...when used orally and long-term or in excessive amounts (12,19). The constituent prunasin hydrolyzes to hydrocyanic acid (HCN) (11,12,13,18).

PREGNANCY: LIKELY UNSAFE
when used orally because prunasin is potentially teratogenic (19).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about WILD CHERRY)

(Read more about BASIL)

(Read more about LIPASE)

(Read more about MULLEIN)

(Read more about PROTEOLYTIC ENZYMES (PROTEASES))

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, radish might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research shows that radish extract, juice, and sprouts can reduce glucose levels (96960). Animal research also shows that radish root juice 300 mg/kg reduces fasting and postprandial blood glucose in a rat model of diabetes, with effects similar to glibenclamide (98051).

(Read more about RADISH)

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

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

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

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

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

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

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

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

(Read more about ROSE HIP)

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of sarsaparilla with digoxin might increase the risk of cardiac toxicity.  Details Sarsaparilla is thought to have diuretic properties, which could potentially cause potassium loss. Overuse or misuse of sarsaparilla with cardiac glycoside therapy might increase the risk of cardiac toxicity due to potassium loss (2,11).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, sarsaparilla might increase the effects and adverse effects of lithium.  Details Sarsaparilla is thought to have diuretic properties (11). Due to these effects, sarsaparilla might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

(Read more about SARSAPARILLA)

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).

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CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D In vitro research suggests that wild cherry can inhibit cytochrome P450 3A4 (CYP3A4) enzymes (6450). Theoretically, wild cherry might increase levels of drugs metabolized by CYP3A4. However, so far, this interaction has not been reported in humans.  Details Some drugs metabolized by CYP3A4 include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and others.

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General ...Topically, occupational exposure to basil has resulted in contact dermatitis (95140).

Immunologic ...Allergic contact dermatitis has been reported in a 45-year old woman with occupational exposure to basil (95140).

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General ...No adverse effects have been reported in adults. However, a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Gastrointestinal adverse effects, such as necrotizing enterocolitis, when recombinant human bile salt-stimulated lipase is used in premature infants.

Gastrointestinal ...Orally, when added to the formula or pasteurized breast milk consumed by premature infants, recombinant human bile salt-stimulated lipase (rhBSSL) can cause gastrointestinal adverse effects, including abdominal distension, flatulence, constipation, colic, abdominal pain, gastroenteritis, vomiting, regurgitation, and rectal bleeding (101940). Premature infants receiving rhBSSL also had a slightly higher rate of necrotizing enterocolitis (NEC) when compared with those receiving placebo. After review by a panel of experts, it was determined that the rate of confirmed or suspected NEC in infants consuming rhBSSL was 3.3%, compared with 0.5% in those receiving placebo. Although this rate of NEC is lower than the historical rate of occurrence in premature infants (11%), a possible increased risk for NEC cannot be ruled out (101940).

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

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

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General ...Orally, proteolytic enzymes are generally well tolerated. See specific monographs for detailed safety information related to individual proteolytic enzymes.
Most Common Adverse Effects:
Orally: Gastrointestinal upset.
Serious Adverse Effects (Rare):
Topically: Allergic reactions.

Gastrointestinal ...Orally, some patients taking proteolytic enzymes may have gastrointestinal complaints (101517).

Immunologic ...Proteolytic enzymes are commonly found in laundry detergents and pre-spotter products. Rarely, protease specific IgE positive tests possibly related to these products have occurred. Exposure may be airborne or topical (102705). In addition, in case reports, occupational exposure to the airborne proteolytic enzyme pepsin has resulted in allergic rhinoconjunctivitis or asthma (102706,102707).

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General ...Orally, radish seems to be well tolerated when used in moderate amounts.

Gastrointestinal ...Large amounts of radish may cause irritation of the gastrointestinal mucus membrane (18). Mild indigestion has also been associated with use of a specific product containing radish, camu camu, acerola, honey, and tapioca in clinical research. However, it is unclear if this adverse event is due to radish, other ingredients in the product, or the combination (94290).

Immunologic ...A case of allergy to oral intake of radish has been reported. Symptoms included throat tightness and generalized urticaria (94289).

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

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

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

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

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

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

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

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General ...Orally, sarsaparilla seems to be well tolerated.

Gastrointestinal ...Orally, there is some concern that sarsaparilla may cause GI irritation when used in large amounts (11,18). However, these claims cannot be substantiated.

Pulmonary/Respiratory ...Occupational exposure to sarsaparilla root dust can cause rhinitis and asthma symptoms (4111).

Renal ...Orally, there is some concern that sarsaparilla may cause temporary kidney impairment and diuresis, possibly leading to shock, when used in large amounts (11,18). However, these claims cannot be substantiated.

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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).

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General ...Orally, white horehound may cause nausea, dry mouth, excessive salivation, loss of appetite, and dizziness in some patients (86369). Large amounts of white horehound (exact dose is unclear) may cause purgative effects (4,12).
Topically, skin contact with the plant juice may cause contact dermatitis (4).

Dermatologic ...Topically, skin contact with the plant juice may cause contact dermatitis (4).

Gastrointestinal ...Orally, clinical research shows that drinking one cup of tea prepared with white horehound 1 gram three times daily for 3 weeks may cause nausea, dry mouth, excessive salivation, and loss of appetite in some patients (86369). Intake of large amounts of white horehound (exact dose is unclear) may cause purgative effects (4,12).

Neurologic/CNS ...Orally, clinical research shows that drinking one cup of tea prepared with white horehound 1 gram three times daily for 3 weeks may cause dizziness in some patients (86369).

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General ...Orally, large amounts of wild cherry can lead to cyanide toxicity, which can be fatal (18,41565).

Neurologic/CNS ...Orally, large amounts of wild cherry can lead to cyanide toxicity, which can be fatal (18,41565). A case of accidental poisoning has been reported for a 56-year old women who consumed approximately 300 grams of wild cherries that had been steeped in alcohol the evening before symptom onset. The patient presented to the hospital the following day with symptoms including headache, nausea, vomiting, confusion, and severe dyspnea. Eventually the patient became comatose and hypotonic. After regaining consciousness the following day, the patient continued to experience severe sinus bradycardia, as well as disorientation, hallucinations, delusions, and agitation. After about 3 weeks, the patient began to experience blurred vision and tingling sensation of the lower limbs. The symptoms were eventually attributed to cyanide intoxication; the wild cherries the patient had consumed contained 4.7-15 mg/kg cyanide (41565).

(Read more about WILD CHERRY)