1;Preface;8<br />2;Contents;10<br />3;1 Commonly used herbal supplements;14<br />3.1;1.1 Introduction;14<br />3.2;1.2 Regulation of the sale of herbal supplements;14<br />3.3;1.3 Sale of herbal supplements and demographics of use;17<br />3.4;1.4 Commonly used relatively safe herbal supplements;18<br />3.5;1.5 Commonly used toxic herbs;27<br />3.6;1.6 Conclusions;28<br />4;2 Abnormal liver function tests due to use of herbal supplements;32<br />4.1;2.1 Introduction;32<br />4.2;2.2 Abnormal liver function tests and herbal supplements;32<br />5;3 Kelp and thyroid panel tests;42<br />5.1;3.1 Introduction;425.2;3.2 Kelp and iodine content;42<br />5.3;3.3 Kelp as a herbal supplement;43<br />5.4;3.4 Case report;44<br />5.5;3.5 Role of iodine in thyroid function;44<br />5.6;3.6 Kelp and abnormal thyroid function;46<br />5.7;3.7 Kelp and arsenic;47<br />5.8;3.8 Dietary iodine intake;47<br />5.9;3.9 Conclusions;48<br />6;4 Interferences in digoxin immunoassays by various herbal supplements;50<br />6.1;4.1 Introduction;50<br />6.2;4.2 Herbal supplements that interfere with digoxin immunoassays;50<br />6.3;4.3 Conclusions;54<br />7;5 Interaction of St. John's wort with various drugs;58<br />7.1;5.1 Introduction;58<br />7.2;5.2 Mechanism of interaction between St. John's wort and Western drugs;58<br />7.3;5.3 Interaction between immunosuppressants and St. John's wort;61<br />7.4;5.4 Interaction between antiretrovirals and St. John's wort;62<br />7.5;5.5 Interaction between warfarin and St. John's wort;63<br />7.6;5.6 Interaction between anticancer drugs and St. John's wort;63<br />7.7;5.7 Interaction between cardiovascular drugs and St. John's wort;63<br />7.8;5.8 Interaction between theophylline and St. John's wort;64<br />7.9;5.9 Interaction between antiepileptic drugs and St. John's wort;64<br />7.10;5.10 Interaction between other central nervous system (CNS)-acting drugs and St. John's wort;65<br />7.11;5.11 Interaction between oral contraceptives and St. John's wort;65<br />7.12;5.12 Interaction between opioids and St. John's wort;66<br />7.13;5.13 Other clinically signifi cant drug interactions with St. John's wort;66<br />7.14;5.14 Drug interactions of St. John's wort: impact on therapeutic drug monitoring;66<br />7.15;5.15 Conclusions;68<br />8;6 Herbs to avoid with warfarin therapy;72<br />8.1;6.1 Introduction;72<br />8.2;6.2 Interaction between warfarin and herbal supplements;72<br />8.3;6.3 Herbal supplements that increase warfarin efficacy;72<br />8.4;6.4 Herbal supplements that reduce warfarin efficacy;75<br />8.5;6.5 Fruits, vegetables, vitamins and mineral supplements, and other agents that interact with warfarin;76<br />8.6;6.6 Conclusions;78<br />9;7 Interaction of ginseng, ginkgo, garlic and ginger supplements with various drugs;80<br />9.1;7.1 Introduction;80<br />9.2;7.2 Ginseng: efficacy and toxicity;81<br />9.3;7.3 Ginkgo biloba: efficacy and toxicity;81<br />9.4;7.4 Garlic and ginger: efficacy and toxicity;82<br />9.5;7.5 Drug interactions with ginseng;83<br />9.6;7.6 Drug interactions with ginkgo biloba;83<br />9.7;7.7 Drug interactions with garlic;84<br />9.8;7.8 Drug interactions with ginger;84<br />9.9;7.9 Conclusions;85<br />10;8 Interactions between fruit juices and drugs: clinical impact;88<br />10.1;8.1 Introduction;88<br />10.2;8.2 Drug interactions with grapefruit juice;88<br />10.3;8.3 Drug classes that interact with grapefruit juice;89<br />10.4;8.4 Drug interactions with orange juice;91<br />10.5;8.5 Drug interactions with other fruit juices;92<br />10.6;8.6 Role of therapeutic drug monitoring in identifying fruit juice-drug interaction;93<br />10.7;8.7 Conclusions;94<br />11;9 Heavy metal toxicity due to use of Oriental and Ayurvedic medicines;96<br />11.1;9.1 Introduction;96<br />11.2;9.2 Heavy metal toxicity in man;96<br />11.3;9.3 Percentage of herbal supplements contaminated with heavy metals;97<br />11.4;9.4 Case studies;100<br />11.5;9.5 How herbal supplements become contaminated with heavy metals;101<br />11.6;9.6 Pesticide contamination of herbal supplements;102<br />11.7;9.7 Toxicity associated with misidentifi ed herbal supplements;102<br />11.8;9.8 Contamination of herbal supplements: unintentional versus intentional;103<br />11.9;9.9 Role of the clinical laboratory;104<br />11.10;9.10 Conc