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Dietary supplements, which include substances known as botanical and herbal medications, are available without prescription and, unlike over-the-counter medications, are considered to be nutritional supplements rather than drugs.* These substances are marketed in the United States without FDA or other governmental premarketing review of efficacy or safety, and with little government oversight of purity, variations in potency, or adverse effects. Purified nonherbal nutritional supplements such as dehydroepiandrosterone (DHEA) and melatonin are also used widely by the general public in pursuit of “alternative medicine.” For many herbal products and nutritional supplements, evidence from controlled clinical studies for their medical effectiveness is incomplete or nonexistent. A summary of the intended uses of some herbal products and nutritional supplements is presented in Table 60–1.

TABLE 60–1Common intended uses of some botanical or nutritional supplements.

*Manufacturers will replace the term “medications” with “dietary supplement” to avoid legal liability.


A. Echinacea

1. Nature

Leaves and roots of echinacea species (eg, Echinacea purpurea) contain flavonoids, polyacetylenes, and caffeoyl conjugates.

2. Pharmacology

In vitro studies have shown that echinacea has cytokine activation and anti-inflammatory properties. There is some evidence for the efficacy of aerial (above-ground) parts of E purpurea plants in the early treatment of colds.

3. Toxicity and drug interactions

Unpleasant taste and gastrointestinal effects may occur, sometimes with dizziness or headache. Some preparations have a high alcohol content, but no drug interactions have been reported.

B. Ephedra (Ma Huang)

1. Nature

Ma huang is one of many names given to various plants of the genus Ephedra, the major chemical constituents of which are ephedrine and pseudoephedrine (see Chapter 9). Ephedrine is a prescription drug in the United States; pseudoephedrine is available in over-the-counter decongestants. In the United States, the FDA has banned the marketing of dietary ...

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