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NEWS ROUNDUP: Roger Dobson Combining anticoagulant drugs with herbal medicines is risky, report says BMJ 2001; 323: 1270c [Full text]

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Primum non nocere.

Yann Barguil   (2 December 2001)

One standard for all drugs

Steven Zeitzew   (6 December 2001)

Human kidneys suffer in the hands of herbal medicines

ANIL K. SAXENA, MD; MRCP (Dublin)   (12 May 2003)

Primum non nocere. 2 December 2001
Yann Barguil, Director, Pathology Laboratory New-Caledonia Territorial Hospital,98849 Nouméa. Send response to journal: Re: Primum non nocere.	Editor-In the last BMJ's News roundup(1), it is discussed the interactions between herbal remedies and anticoagulant drugs emphasising the need to conduct studies demonstrating clear evidence of such interactions. Times are to natural products. More and more remedies or herbal beverages are tempting the consumer, the new "fashion victim", multiplying the risks of possible interactions or even accidents (for instance : recent accidents concerning kava extracts and hepatitis). "Primum non nocere"-first, do not hurt-prior selling an herbal remedy, manufacturers should conduct serious studies or should be helped or financialy encourage to conduct such studies, demonstrating that what they are about to sell is exempt of any dangerous effect. 1- Roger Dobson,BMJ 2001; 323: 1270c. Combining anticoagulant drugs with herbal medicine is risky, report say.
One standard for all drugs 6 December 2001
Steven Zeitzew, Chief, Orthopaedic Surgery, West L.A. V.A. Healthcare Center Los Angeles, CA 90073 Send response to journal: Re: One standard for all drugs	Why should we continue to allow some drugs, such as herbals and homeopathics, to be sold without first requiring the evidence of safety and efficacy we require for other drugs? There is no incentive for someone who can now profit from selling drugs without such evidence to spend money to seek that evidence. Regulations requiring evidence of safety and efficacy were adopted in response to marketing of unsafe and ineffective drugs. The mounting evidence for the lack of safety and efficacy of "alternative" drugs provides a reason to extend these regulations to encompass those drugs as well. Steve Zeitzew, M.D. Chief, Orthopaedic Surgery West Los Angeles Veterans Administration Healthcare Center, "The contents of this message are mine personally and do not reflect any position of the Government or the Department of Veterans Affairs."
Human kidneys suffer in the hands of herbal medicines 12 May 2003
ANIL K. SAXENA, MD; MRCP (Dublin), Consultant Nephrologist & Deputy Chief Division of Nephrology, King Fahad Hospital & Tertiary Care Center, Hofuf, 31982, Saudi Arabia Send response to journal: Re: Human kidneys suffer in the hands of herbal medicines	Currently nephropathy after ingestion of Chinese herbs is well recognized. A survey in Brussels in 1992-93, for the first time identified nearly 100 patients who suffered from rapidly progressive renal failure after taking herbal slimming pills (1). This rapidly progressive interstitial renal fibrosis was recognized among young females after ingestion of a potentially nephrotoxic ingredient aristolochic acid present in the herbal product that had been erroneously substituted for a nontoxic substance. As a consequence a third of these had to go through a renal transplant; another third were on hemodialysis and the last third had gradually progressive renal failure. After the outbreak, thin-layer chromatography of the preparation revealed Aristolochia manshuriensis rich in aristolochic acid (Radix Aristolochiae fangchi, Guang fangji) instead of Stephenia tetrandra (Radix Stephaniae tetrandrae, Fangji). Renal biopsy specimens of the patients showed remarkably similar histological patterns: widespread paucicellular interstitial fibrosis and tubular atrophy; however the glomeruli were apparently intact (2). In 1994, two cases of end-stage renal failure related to Chinese herbs similar to those incriminated in the case series reported from Belgium, led to an epidemiologic investigation in France (3). In 1999, cases with Chinese herb-induced nephropathy were encountered in the UK and in 2000 Chinese herb-induced Fanconi syndrome in Japan (4,5). Likewise, development of renal tubular acidosis with hypokalemic paralysis, rhabdomyolysis and subsequent acute renal failure was reported from Taiwan, as an atypical presentation of nephrotoxicity of Chinese mixed herbal medicine. Evidently the use of herbal products is not free from risk to human kidneys. The accurate documentation of incidence of adverse effects of herbal products on renal system calls for further research for precise toxicology information, in order to maximize safety of countless consumers. References 1.Vanherweghem JL, Depierreux M, Tielemans C et al. Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs. Lancet 1993; 341: 387-391. 2.Chung-Hsin Chang, Yi-Ming Wang, An-Hang Yang, Shou-Shan Chiang. Rapidly Progressive Interstitial Renal Fibrosis Associated with Chinese Herbal Medications. American Journal of Nephrology 2001; 21:441-448. 3.Stengel B, Jones E. End-stage renal insufficiency associated with Chinese herbal consumption in France. Nephrologie. 1998; 19(1):15-20. 4.Lord GM, Tagore R, Cook T, Gower P, Pusey CD. Nephropathy caused by Chinese herbs in the UK. Lancet 1999; 354(9177):481-482. 5.Tanaka A, Nishida R, Maeda K, Sugawara A, Kuwahara T. Chinese herb nephropathy in Japan presents adult-onset Fanconi syndrome: could different components of aristolochic acids cause a different type of Chinese herb nephropathy? Clin Nephrol 2000; 53 (4):301-306. Competing interests:   None declared