Table 11. Previously published case reports showing herbal adverse effects.
YO: Years Old, Hx: History, Bx: Biopsy, DM: Diabetes Mellitus, HTN: Hypertension, PHTN: Pulmonary Hypertension, CVA: Cerebrovascular Accident, AFib: Atrial Fibrillation, INR: International Normalized Ratio, HIV: Human Immunodeficiency Virus, OA: Osteoarthritis, SJW: St. John's Wort, M: Male, F: Female, ART: Antiretroviral Therapy, ZDV: Zidovudine, 3TC: Lamivudine, NVP: Nevirapine, CYP: Cytochrome P450, P-gp: P-glycoprotein 1, Pb: Lead, DILI: Drug-Induced Liver Injury, HILI: Herb-Induced Liver Injury, Lab: Laboratory, CT: Computed Tomography, SVT: Supraventricular Tachycardia, ECG: Electrocardiogram, HR: Heart Rate, ED: Emergency Department
| Author Name and Year of Publication | Case Description | Herb name, (Purpose of use) | Form / Dose / Duration of Herbal use causing the adverse effect | Interacted Drug | Mechanism of Adverse Effect |
| Alscher and Klotz (2003) [123] | 57 YO, M, a kidney transplant patient, developed a sudden drop in immunosuppressant (Cyclosporin). | SJW, (depression) | regular drinking as a tea form | Cyclosporine | CYP3A4 and P-gp induction |
| Leung et al., (2008) [124] | 80 YO, Chinese woman, with Hx of DM, HTN, CVA & AFib experienced two episodes of an elevated INR. | Goji berry / Lycium barbarum L (longevity) | After 1-2 days of use as tea | Warfarin | CYP2C9 inhibition & /or additive anticoagulation |
| Hamann et al., (2011) [125] | 46 YO, African American woman, with a Hx of stage 1 sarcoidosis, uterine fibroids, anemia, cardiomyopathy, & depression developed increased INR. | Cranberry juice, (constipation) | 2 quarts daily for 3-4 days | Warfarin | Unknown |
| Mateo-Carrasco et al., (2012) [126] | 56 YO, a White Caucasian man, with a Hx of HIV, developed generalized pruritus, scratching lesions, increased transaminase, visible jaundiced skin, & mucous membranes (Raltegravir-induced liver injury). | Ginseng, (sexual disability) | After 39 days of use as oral lozenges | Raltegravir | CYP3A4 inhibition |
| Sobieraj and Freyer, (2010) [127] | 58 YO, Mexican man, with a Hx of type 2 DM, OA, hyperlipidemia, HTN, & degenerative disc disease of the spine reported four hypoglycemic events. | Prickly Pear Cactus (PPC), (glucose control) | daily for two months as crude PPC pads | Glipizide, Metformin | Additive effect with antihyperglycemic agents |
| Cordova et al., (2017) [128] | 49 YO, F, HIV+ with excellent adherence and sustained (10 yrs) virologic suppression developed two consecutive detectable viral loads (96 & 57 copies/mL). | “horsetail” / Equisetum arvense, (analgesic & anti-kidney stone) | two months before the first detectable viral load | ZDV, 3TC & NVP | Limited data, probably negative interaction with ART |
| Sorbera et al., (2017) [129] | 70 YO, Haitian man, with AFib & PHTN, developed elevated INR. | Mauby, (Caribbean folk remedy) | recent use as a bitter liquid | Warfarin | No clear information |
| Prescott and Smereck, (2019) [130] | 49 YO, M, presented to ED with features of Hypertensive Urgency including palpitations & severely elevated BP uncontrolled with multiple doses of oral clonidine & IV labetalol (refractory HTN). | Yohimbine, (enhance male sexual performance & improve energy level) | two capsules the morning of presentation to the ED | Not mentioned | Selective ⍺2- adrenoceptor antagonist |
| Koenig et al., (2021) [131] | 53 YO, F, presented to the ED with features of HILI including marked hyperbilirubinemia with liver enzyme elevations (cholestatic jaundice); imaging revealed hepatomegaly & steatosis without biliary dilatation; Bx results consistent with DILI. | Scute root- Bupleurum- -Turmeric root Mix, ("Liver Detoxifier & Regenerator") & Valerian, ("Restful Sleep") | daily use for 3 to 4 weeks | Not mentioned | Hepatotoxicity |
| Mowafy et al., (2021) [132] | 56 YO, M, Hx of DM & bilateral knee OA presented to ED with features of acute pancreatitis including elevated lipase (Lab) & acute peripancreatic inflammatory changes (CT). | Fenugreek, (decrease blood sugar) | Extended regular use | Metformin (resorted) | Inflammatory effect on the pancreas |
| Fisher et al., (2021) [133] | 33 YO, F, with a reported Hx of depression developed SVT (Sweating, insomnia, frequent brief Palpitations, tachycardia of 150-160 & ECG revealing SVT with HR of 148 bpm). | SJW, (depression) | 300 mg tab daily for three weeks | Not mentioned | Neurotransmitter modulation |
| Kupiec and Raj, (2005) [134] | 55 YO, M, suffered a fatal breakthrough seizure while swimming, no evidence of noncompliance with his anticonvulsant medications. An autopsy report revealed subtherapeutic serum levels of anticonvulsants (valproic acid & phenytoin). | Ginkgo biloba, (CVA) | undisclosed use around one year before his death | Valproic acid (Depakote) & Phenytoin (Dilantin) | Potent neurotoxin from Ginkgo nuts & Induction of CYP enzyme system |
| Gardiner et al., (2013) [135] | A systematic review of 128 pediatric case reports (40 from the US), to evaluate herbal adverse events, in <18 YO cases, published during 44 yrs (1965-2008). Events include: Neurologic (45), Gastrointestinal (18), Liver toxicity & jaundice (14), Cardiovascular/hematological (13), Dermatological (12), Respiratory (9), Endocrine/reproductive/renal (8), Cyanosis (6), Neonatal withdrawal (2), Anaphylactic shock (1) | Various herbal products, (prenatal (8) vs. postnatal (118) exposure, unintentional exposure (47) vs intentional use (59) for pediatric health | Pregnancy use (prenatal exposure), ingestion, and skin exposure | Not mentioned | Organ damage, hormonal imbalance, Pb toxicity |