The Dietary Supplement Health and Education Act (DSHEA) of 1994 removed food and nutritional supplements (including herbs) from regulation by the FDA.  As a result herbal supplement manufacturers are not required to publicize evidence of efficacy, or possible adverse effects (even death), of their products.

The April 2009 issue of Psychopharm Review (vol. 44, no. 4, www.LWW.com), lists four common psycho-active herbal products, some of which have questionable efficacy and some of which must be taken with care because of possible adverse effects:

1.  Valerian (valeriana officinalis):  Often taken for insomnia, has shown little benefit for sleep in most placebo-controlled studies.

2.  Kava Kava (piper methysticum):  Often taken for anxiety, it is questionable still from controlled studies whether it helps anxiety.  It can also be hepatotoxic — nine people have died from liver failure from kava.

3.  Ginkgo (ginkgo biloba):  Taken to help prevent dementia, controlled studies have yet to verify this claim.  It also may cause intracranial and intraocular bleeding.  Patients taking blood thinning medications, such as aspirin, ibuprofen, warfarin, or valproate, should consult their doctor before taking ginkgo.

4.  St. John’s Wort (hypericum perforatum):  Often taken to help anxiety and depression, St. John’s Wort has been shown in double-blinded, placebo-controlled studies to be as effective as standard SSRI antidepressants, such as fluoxetine (Prozac) or Lexapro (escitalopram).  However, it induces the p450 liver enzyme system, and can lead to more rapid metabolism of some drugs (oral contraceptives, anticoagulants like warfarin, methadone maintenance for opioid dependence, statin drugs to reduce cholesterol, and cyclosporine to suppress rejection of  liver transplants).

If a patient takes St. John’s Wort (SJW) while on oral contraceptives, the contraceptive effect could be diminished, leading to possible conception.  Patients taking anticoagulants with SJW would be more likely to have a stroke.  Those taking methodone with SJW could experience acute opioid withdrawal.  Those taking statins for high cholesterol with SJW would be at greater risk for cardiovascular events, such as heart attacks.  Those taking cyclosporine for liver transplants with SJW would be at greater risk for acute liver transplant rejection.

Anyone considering taking the herbal products above should consult with their doctor prior to doing so.  In particular, those taking the above medications which are metabolized by the p450 liver enzyme system should be careful not to take St. John’s Wort unless they have first discussed it with their doctor.