Dietary supplements and herbal medicine toxicities—when to anticipate them and how to manage them

BACKGROUND: Dietary supplements and herbal medicines are gaining popularity in many developed countries. AIMS: Although most can be used without any problem, serious toxicities do occur. METHODS: Problems can be anticipated when they are used for non-traditional indications, at excessive dose, for prolonged duration, or by patients who are also on multiple modern pharmaceuticals. Problems should also be anticipated when these products claim to be able to relieve symptoms rapidly or when herbs with pronounced pharmacological effects or toxic components are used. RESULTS: Resuscitation, symptomatic and supportive care are the most important aspects of management of toxicities from these products. CONCLUSION: This article reviews when problems with these products can be anticipated and outlines a practical approach to management.