Table 1.

When adverse effects and toxicities may arise

Factors predisposing to adverse effects and toxicities	When to anticipate them
Inappropriate usage and inherent toxicity of herbs	Inappropriate indications (non-traditional indications)—weight loss, athletic performance, recreational use
	Inappropriate duration—use for prolonged periods of time, usually several weeks to months
	Inappropriate dosage—excessive dose in order to achieve some particular results
	Inadequate processing—herbs that are usually consumed in a certain way in a particular herbal tradition being processed in other non-recommended ways
	Herbs with pronounced pharmacological effects or toxic components
Adulteration with modern pharmaceuticals (NSAIDs, steroids, antihistamines, Sildenafil, sulfonylurea)	Finished products claiming fast relief of symptoms or sexual enhancement
Drug interaction	Patients on multiple modern pharmaceuticals, especially drugs with a narrow therapeutic index, such as warfarin, and taking dietary supplements and herbal products
	Patients taking multiple dietary supplements or herbal medicines
Heavy metal toxicities	Finished products from TCM, Ayurvedic traditions, or Mexican folk remedies