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