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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." In the case of 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 60–1 Common Intended Uses of Some Botanical or Nutritional Supplements.
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Alternative medicineTreatments that are not generally recognized by the medical community as standard or conventional medical approaches
Controlled clinical trialA clinical trial that compares a group of subjects who are receiving a treatment with a closely matched group of individuals who are not receiving a treatment. Chapter 5 describes clinical trials in more detail
Herbal medicationPlants or plant extracts that people use to improve their health
Nutritional supplementA substance that is added to the diet to improve health and which usually contains dietary ingredients such as vitamins, minerals, amino acids, and enzymes
PlaceboAn inactive medication made to resemble the investigational formulation as much as possible



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


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.

Toxicity and Drug Interactions

Unpleasant taste and gastrointestinal effects may occur, sometimes with dizziness or headache. Some preparations ...

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