Table 1.

Use and mechanism of specific HDS products

Herbals	Common use	Mechanism and comments	References
Anabolic steroids	bodybuilding, weight training, or athletics	unknown	(40)
Black cohosh (Cimicifuga/Actaea racemosa)	joint aches, myalgia and menopausal symptoms	unknown possibly adultrated with Actaea pachypoda Ell. (white cohosh) and Actaea podocarpa DC. (yellow cohosh)	(46)
Chaparral (Larrea tridentata)	antioxidant properties, anti- inflammatory, liver disease, skin disorders	unknown possibly, interference with cyclo- oxygenase or CYP450, estrogen-like activity	(84)
Green tea extracts (Camellia sinensis)	weight loss	epigallocatechin gallate (EGCG) toxicity is possibly heightened in individuals with a genetic predisposition	(54)
Pyrrolizidine alkaloids/Comfrey (Senecio, Symphytum)	natural home remedy	hepatic sinusoidal cells are damaged, ultimately resulting in sinusoidal obstruction syndrome	(55, 64)
Germander (Teucrium chamaedrys)	dyspepsia, obesity, diabetes and abdominal colic	CYP3A4 dependent alkylation of microsomal protein leading to autoantibody formation	(47-49)
Greater celandine (Chelidonium majus)	dyspepsia	unknown	(85)
Kava Kava (Piper methysticum)	gall bladder disease, biliary colic, cholelithiasis, and jaundice	immunoallergic and idiosyncratic factors, including CYP2D6 deficiency	(65, 66)
Mistletoe (Viscum Album)	asthma, infertility, hypertension	mistletoe lectins have immunostimulating properties and a strong dose-dependent cytotoxic activity	(86)
Pennyroyal (Mentha pulegium, Hedeoma pulegoides)	abortifacient	oxidation of pulegone by cytochrome P450 into menthofuran, depletion of glutathione	(87)
Skullcap (Scutellaria baicalensis)	arthritic symptoms	CYP3A dependent apoptosis demonstrated in isolated rat hepatocytes	(80-82)
Jin Bu Huan	sedation, analgesic	adulteration with other plant genera	(38)
Ma huang	stimulant, weight loss	idiosyncratic ephidrine alkaloid toxicity	(88)