Posted by SalArmy4me on July 10, 2001, at 3:57:34
From: Psychosomatic Medicine. Volume 61(5) September/October 1999 p 712 Dietary Supplements and Natural Products as Psychotherapeutic Agents
Fugh-Berman, Adriane MD; Cott, Jerry M. PhD:Saint John's Wort
Side effects reported for SJW are generally mild. Gastrointestinal symptoms and fatigue have been reported (7). The most predictable effect seems to be photosensitization, especially in fair-skinned people. First noted in light-skinned cows that grazed in pastures in which SJW grew, photosensitization has been demonstrated in a controlled clinical trial involving hypericin and exposure to metered doses of UVA and UVB irradiation (13). Using LI 160, a standardized extract from Lichtwer Pharma (Berlin, Germany), these authors found a measurable increase in erythema in light-sensitive volunteers exposed to UVA irradiation after receiving 600 mg of SJW three times daily for 15 days. This effect has also been seen in humans taking high doses of synthetic hypericin (14). Photosensitization is generally mild and transient, disappearing within a few days of drug discontinuation. Although this effect is usually associated with higher than recommended doses of hypericum, it can occur at lower doses and generally appears on the package labeling as a precaution. No other adverse effects were observed in the high-dose studies.
There are two unpublished case reports of possible mild “serotonin syndrome,” characterized by mental confusion, muscle twitching, sweating, flushing, and ataxia, in patients consuming SJW (17). In one case, the patient was taking SJW alone; in the other, the patient had also been taking trazodone.
Gingko Biloba
In humans, side effects are rare. In a German postmarketing surveillance study of 10,815 patients treated with LI 1370 (another brand of standardized ginko), only 183 reported side effects. These included nausea (37), headache (24), stomach problems (15), diarrhea (15), allergy (10), anxiety or restlessness (8), sleep disturbances (6), and other (68).
Although it may be a component of its therapeutic activity, ginkgo does have anticoagulant effects and, in rare cases, has been associated with serious bleeding problems. There have been five reports of bleeding associated with ginkgo treatment. These include two subdural hematomas, one with a documented increase in bleeding time (52, 53); one intracerebral hemorrhage (54); and one subarachnoid hemorrhage (55). There was also one case of hyphema (56). In most cases, patients were receiving concurrent anticoagulant drugs. All patients seem to have recovered with no sequelae. Ginkgo reduces platelet aggregation by inhibiting PAF, and concurrent use of anticoagulants and ginkgo extracts should probably be avoided. It should also be avoided in patients with clotting problems.
Kava
Therapeutic doses may result in mild gastrointestinal complaints or allergic skin reactions (incidence, 1.5%) (59). Chronic use of kava up to 100 times the therapeutic dose (73) results in an ichthyosiform eruption known as kava dermopathy, which is often accompanied by eye irritation (74). This scaly dermatitis is similar to that seen in pellagra, but niacin deficiency is apparently not the mechanism, because a randomized controlled trial of administration of 100 mg of nicotinamide in 29 habitual kava drinkers with dermopathy showed no difference between the treatment and placebo groups (75). Abstaining from kava results in complete resolution of symptoms.
Interaction studies with alcohol found differing effects in humans and animals. A synergistic effect was reported in mice using hypnotic doses of kava and alcohol (76). However, a clinical trial in 20 volunteers (77) given 100 mg of kava extract three times per day for 8 days tested the added effects of alcohol by adding ethanol on days 1, 4, and 8 (doses of alcohol were sufficient to achieve blood alcohol levels of 0.05%). This study showed no additive effects of alcohol with kava.
Ginseng
Ginseng can cause estrogenic effects even though it does not actually contain phytoestrogens. Two cases of postmenopausal uterine bleeding have been reported. One occurred in a patient who ingested a geriatric formula containing ginseng (86); another occurred in a 44-year-old postmenopausal woman after use of a face cream that contained ginseng (87). Follicle-stimulating hormone levels rose to normal postmenopausal levels after use of the face cream was discontinued. Three weeks after rechallenge, the level of follicle-stimulating hormone dropped from 70 to 27 mIU; 1 week later another episode of uterine bleeding occurred. One case of swollen breasts and diffuse nodularity was reported in a 70-year-old woman (88). The symptoms disappeared on discontinuation of the ginseng and recurred on rechallenge. Another report of five cases of mastalgia lacks detail and thus is unevaluable (89
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