Introduction

• Specify the estimated number of Americans who simultaneously use both herbal supplements and conventional drugs.
• State rules of the 1994 Dietary Supplement Health and Education Act that govern how herbal supplements are sold in the United States.
• Identify the role of the US Food and Drug Administration (FDA) related to the safety and efficacy of these supplements.

Issues with Variable Active Ingredients and Poor Manufacturing Practices

• Describe problems encountered with herbal supplements related to variations in their active ingredients.
• List poor manufacturing practices found in about 50% of herbal supplement manufacturing facilities in the United States from 2008-2012.

FDA Action When Toxic Herbs are Identified

• Identify action FDA is authorized to take if an herbal supplement product is found to be toxic.

Herbal Supplements and Abnormal Liver Function Tests

• List herbal supplements associated with liver toxicity.
• Specify the mechanisms by which herbal supplements cause liver damage.
• Name the herb that may cause hepatotoxicity in a manner similar to that caused by overdose of acetaminophen.
• Compare toxicity of green tea to that of concentrated extracts of green tea.
• Identify the substance in ma huang that may be responsible for its severe cardiotoxic and hepatotoxic effects.

Herbal Supplements Associated with Kidney Damage

• Specify the substance in herbal supplements that has been shown to cause progressive fibrosing interstitial nephritis leading to renal failure and severe anemia.

Herbal Supplements and Hypoglycemia

• List herbal supplements that have been investigated for their use in controlling diabetes.
• Name the trace element required for maintenance of normal glucose metabolism.

Licorice and Hypokalemia

• Relate the possible effects of excessive intake of licorice and the conditions under which these effects may occur.

Kelp and Abnormal Thyroid Function Tests

• Identify individuals who may experience the Wolff-Chaikoff effect from ingesting kelp supplement with high levels of iodine.  

Drug-Herb Interactions

• Identify the mechanisms by which St. John’s wort decreases the effectiveness of many drugs.
• Identify the most clinically important drug interactions with St. John’s wort.

Drug-Herb Interactions

• Specify the prescription medication that when taken with St. John’s wort can result in serotonin syndrome.
• Distinguish between herbal supplements that affect the prothrombin time INR, increasing or decreasing the efficacy of warfarin in patients.
• Specify the pharmacodynamic interaction between ginkgo biloba and certain prescription drugs.

Grapefruit Juice-Drug Interactions

• Identify the drug whose efficacy decreases when consumed with grapefruit juice.