Hepatotoxic Botanicals - An Evidence-based Systematic Review

Abdualmjid, Reem J; Sergi, Consolato

doi:10.18433/j36g6x

Cited by 60 publications

(44 citation statements)

References 216 publications

(480 reference statements)

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“…[126,127]). These traditional or herbal medicines can contain a vast array of biologically active ingredients, either identified or unidentified [128], sometimes in conjunction with conventional APIs [129].…”

Section: Discussionmentioning

confidence: 99%

Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries

Kookana

Williams

Boxall

et al. 2014

Phil. Trans. R. Soc. B

137

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Active pharmaceutical ingredients (APIs) can enter the natural environment during manufacture, use and/or disposal, and consequently public concern about their potential adverse impacts in the environment is growing. Despite the bulk of the human population living in Asia and Africa (mostly in low- or middle-income countries), limited work relating to research, development and regulations on APIs in the environment have so far been conducted in these regions. Also, the API manufacturing sector is gradually shifting to countries with lower production costs. This paper focuses mainly on APIs for human consumption and highlights key differences between the low-, middle- and high-income countries, covering factors such as population and demographics, manufacture, prescriptions, treatment, disposal and reuse of waste and wastewater. The striking differences in populations (both human and animal), urbanization, sewer connectivity and other factors have revealed that the environmental compartments receiving the bulk of API residues differ markedly between low- and high-income countries. High sewer connectivity in developed countries allows capture and treatment of the waste stream (point-source). However, in many low- or middle-income countries, sewerage connectivity is generally low and in some areas waste is collected predominantly in septic systems. Consequently, the diffuse-source impact, such as on groundwater from leaking septic systems or on land due to disposal of raw sewage or septage, may be of greater concern. A screening level assessment of potential burdens of APIs in urban and rural environments of countries representing low- and middle-income as well as high-income has been made. Implications for ecological risks of APIs used by humans in lower income countries are discussed.

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Section: Discussionmentioning

confidence: 99%

Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries

Kookana

Williams

Boxall

et al. 2014

Phil. Trans. R. Soc. B

137

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show abstract

“…94 An estimated 500 herbal products are distributed worldwide, and are represented as harmless healthy products without side effects 95,96 Over 60% of patients in the U.S. being seen by a physician report use of herbal remedies. 97 Because herbal products are considered dietary supplements in many countries including the U.S., proof of efficacy and safety does not have to be provided by the manufacturer.…”

Section: Exposure To Herbal Toxinsmentioning

confidence: 99%

“…102 Because botanicals are self-prescribed, self-administered, and widely available, they are difficult to control and difficult to document. 94 Unspecified mixed formulations are common. The point should be made that severe hepatotoxicity, including SOS, may be quite rare, given the massive use of herbal products and the relative infrequency of severe clinical presentations.…”

Section: Exposure To Herbal Toxinsmentioning

confidence: 99%

Sinusoidal Obstruction Syndrome (Hepatic Veno-Occlusive Disease)

Fan

Crawford

2014

Journal of Clinical and Experimental Hepatology

228

178

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“…Risks should be identified, 1, 3-10 not ignored, 2,13 and communicated on websites 4,5 and in peer reviewed English language journals. 1,3,[6][7][8][9][10][11][12]14 ACKNOWLEDGEMENT The authors' declarations of personal and financial interests are unchanged from those in the original article. …”

mentioning

confidence: 99%