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Sethi SS, Bhardwaj T, Sethi SK, Kaur S, Rimpi, Baldi A. Advancing herbal medicine safety: the need for a global pharmacovigilance approach. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2025:10.1007/s00210-025-04066-2. [PMID: 40338319 DOI: 10.1007/s00210-025-04066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 03/17/2025] [Indexed: 05/09/2025]
Abstract
Herbal and traditional medicines (H&TMs) form a significant part of healthcare practices worldwide, often perceived as safe alternatives to conventional treatments. However, this perception has led to challenges in ensuring the safety and efficacy of these products, highlighting the critical importance of pharmacovigilance for herbal medicines. Over the past two decades, concerted efforts have been made globally to establish robust regulatory frameworks, leading to the emergence of phytovigilance systems. This review provides a comprehensive overview of the pharmacovigilance mechanisms in various countries, emphasizing recent developments, persistent challenges, and international perspectives in the field. The study underscores the need for systematic monitoring of adverse events (AEs) associated with herbal medicines to safeguard patient health. A key focus is placed on comparing the processes and mechanisms employed by different nations in building up safety monitoring systems, identifying gaps in knowledge and practices, and evaluating stakeholder awareness and involvement. The findings highlight the necessity of harmonizing global regulations under the guidance of the World Health Organization (WHO) to ensure uniformity and efficacy in reporting systems. This article advocates for a collaborative international approach, inclusive of all regulatory agencies, to enhance the safety of herbal therapies. By proposing comprehensive, standardized guidelines, it aims to bridge existing gaps and strengthen the pharmacovigilance infrastructure for herbal medicines globally, paving the way for improved patient safety and trust in traditional medical practices.
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Affiliation(s)
- Sumeet Singh Sethi
- Pharma Innovation Lab, Department of Pharmaceutical Sciences & Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, 151001, India
| | - Tejaswani Bhardwaj
- Pharma Innovation Lab, Department of Pharmaceutical Sciences & Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, 151001, India
| | | | | | - Rimpi
- Department of Clinical Hematology, Haemato-Oncology & Bone Marrow (Stem Cell) Transplantation, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Ashish Baldi
- Pharma Innovation Lab, Department of Pharmaceutical Sciences & Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, Punjab, 151001, India.
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Choi Y, Shin HK. Adverse events associated with herbal medicine products reported in the Korea Adverse Event Reporting System from 2012 to 2021. Front Pharmacol 2024; 15:1378208. [PMID: 39498343 PMCID: PMC11532164 DOI: 10.3389/fphar.2024.1378208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 10/10/2024] [Indexed: 11/07/2024] Open
Abstract
Introduction Systematic collection of diverse adverse events during herbal medicine administration is crucial. The Korea Adverse Event Reporting System (KAERS) compiles spontaneously reported adverse event data for medicinal products including herbal medicines. This study focused on extracting and analyzing adverse event data specifically related to herbal medicine products from the KAERS database. Methods Individual case safety reports (ICSRs) encompassing 84 types of herbal medicine products, identified by item codes from 2012 to 2021, were extracted from the KAERS database. Descriptive statistics were employed to analyze the characteristics of the extracted reports, and adverse event information was systematically categorized and analyzed based on the MedDRA System Organ Class and preferred term classification. Results In total, 1,054 ICSRs were extracted, with some documenting multiple adverse events in a single ICSR, resulting in 1,629 extracted adverse events. When categorized by the MedDRA System Organ Class, gastrointestinal disorders were the most prevalent (28.7%), followed by skin and subcutaneous tissue disorders (20.1%). Based on the preferred terms, the most frequently reported adverse events were diarrhea (5.8%), urticaria (5.3%), pruritus (4.7%), rash (4.4%), and abdominal discomfort (4.2%). The most frequently reported herbal medicines were Bangpungtongseong-san (297 cases), Kyeongok-go (144 cases), and Eunkyo-san (108 cases). Conclusion Spontaneously reported adverse events associated with herbal medicine products were systematically documented using the KAERS database. This study, which focused on voluntarily reported adverse reactions, underscores the need for additional research to estimate the incidence rate of adverse events and assess causality.
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Mssusa AK, Holst L, Kagashe G, Maregesi S. Safety profile of herbal medicines submitted for marketing authorization in Tanzania: a cross-sectional retrospective study. J Pharm Policy Pract 2023; 16:149. [PMID: 37986124 PMCID: PMC10658996 DOI: 10.1186/s40545-023-00661-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The popular use of herbal medicines necessitates national regulatory authorities to have efficient mechanisms for the control of these products including marketing authorization (MA) and safety follow-up. Herbal medicines like conventional medicines require assessment of efficacy, safety and quality information before MA can be granted. However, the complete proof of safety is mainly based on the history of the long-term traditional use. Herbal medicines can cause adverse reactions due to various factors and thus require clinical trials to ensure their safety. Herbal medicines treatment practices involve combinations of different plants to achieve the desired effect while multiple herbal components have been known to cause herbal-herbal toxicity and interactions due to variety of complex active ingredients in plants. Compliance with regulatory requirements on herbal medicines has been shown to be difficult for manufacturers since different countries have different regulatory requirements with wide variations which results in the MA of very few herbal medicines. Limited studies on dossiers of marketing authorization of herbal medicines have been performed in other countries, with no studies in African regulatory system settings. The aim of this study is to determine the type of safety documentation that is submitted on herbal medicines application dossiers to support MA in Tanzania. METHODS A cross-sectional retrospective study of herbal medicines dossiers submitted at the Tanzania Medicines and Medical Devices Authority from 2009 to 2020 was conducted. RESULTS As many as 75% of the herbal products applications were combination products made by more than one herbal substance or plant. Out of 84 dossiers subjected to analysis the majority did not provide evidence of preclinical (55%) and clinical safety data (68%). Evidence of safety data in humans was mostly from the literature (70%) and not manufacturers' clinical studies. Quality parameters with safety implications were not included in 48% and 23% of the active herbal substance and finished product specifications, respectively. CONCLUSION Analysis of the herbal medicine dossiers submitted showed major deficiencies of safety data to support MA. Manufactures need to provide evidence to support the safety of their products for evidence-based regulatory decisions and to avoid multiple reviews of the applications.
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Affiliation(s)
- Alambo K Mssusa
- Tanzania Medicines and Medical Devices Authority, EPI External Mabibo, P.O. Box 77150, Dar Es Salaam, Tanzania.
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, Block D, 5009, Bergen, Norway.
| | - Lone Holst
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, Block D, 5009, Bergen, Norway
| | - Godeliver Kagashe
- Muhimbili University of Health and Allied Sciences, School of Pharmacy, P.O. Box 65013, Dar Es Salaam, Tanzania
| | - Sheila Maregesi
- Muhimbili University of Health and Allied Sciences, School of Pharmacy, P.O. Box 65013, Dar Es Salaam, Tanzania
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van Hunsel FPAM, van der Kooi D, van de Koppel S, Kroes BH, Woerdenbag HJ. Analysis of Reports on Adverse Drug Reactions Related to Herbal Medicinal Products and Herbal Supplements in the Netherlands Received by the National Pharmacovigilance Centre Lareb. Drug Saf 2022; 45:651-661. [PMID: 35608783 DOI: 10.1007/s40264-022-01180-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The inclusion of herbal medicinal products and herbal supplements in pharmacovigilance systems is important because a systematic approach of collecting and analyzing adverse drug reactions related to these products will help practitioners, patients, and regulators to gain more knowledge and prevent harm. OBJECTIVE We aimed to categorize the adverse drug reaction reports on herbal medicinal products and herbal supplements submitted to the Pharmacovigilance Centre Lareb between 1991 and February 2021 on the basis of their regulatory status, herbs included, and adverse drug reactions involved. METHODS We categorized products on the basis of their registration status and herbal ingredients. The products were then categorized according to the Herbal Anatomical Therapeutic Chemical Classification System. We used descriptive statistics in Microsoft Excel 2019. Pivot tables were used for the analysis and presentation of the data. RESULTS Until February 2021, a total of 789 reports of herbal medicinal products and herbal supplements were received by Lareb. In these reports, a total of 823 herbal products were labeled as suspect. These products caused a total of 1727 adverse drug reactions. Of the 823 products, 229 were registered as a medicine, and 594 were on the market as a herbal supplement. Of the 823 herbal products, 522 reports concerned single-herb products, 256 reports concerned combination products, 27 reports concerned vitamin products containing herbal ingredients, and 18 reports concerned product issues. Approximately 15% of reports concerned serious adverse drug reactions, and adulterated products harbored a high risk of causing serious adverse drug reactions. CONCLUSIONS Analysis of the herbal medicinal products and herbal supplements in the Dutch pharmacovigilance database revealed a variety of suspected herbal ingredients. The reports provide insight into the variety of herbal products used in the Netherlands and the adverse reactions associated with their use. Pharmacovigilance of herbal products is essential to ensure their safe use.
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Affiliation(s)
| | - Djurre van der Kooi
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands.,Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Sonja van de Koppel
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Burt H Kroes
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Herman J Woerdenbag
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
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Chang HH, Chiang SY, Chen PC, Tsai CH, Yang RC, Tsai CL, Wu TH, Hsieh YW, Lin YC, Kuo YT, Chen KC, Chu HT. A system for reporting and evaluating adverse drug reactions of herbal medicine in Taiwan from 1998 to 2016. Sci Rep 2021; 11:21476. [PMID: 34728662 PMCID: PMC8564513 DOI: 10.1038/s41598-021-00704-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
The Taiwan Adverse Drug Reaction Reporting System for Herbal Medicine (TADRRS-HM) has systematically documented suspected adverse events from adverse drug reaction (ADR) reports from 1998 (prior to its formal establishment in 2001) and evaluates safety profiles of herbal medicines. This article describes findings from 2079 ADR reports filed between 1998 and 2016: 941 reports involved single herbs and 87 involved folk herbals; 842 were generated from clinical trials, while 209 ADR reports involving foods, health foods, dietary supplement foods and herbal cuisine were grouped as Other. Severity assessments using the Modified Hartwig and Siegel scale classified 72.4% of ADRs as mild, 17.4% as moderate and 6.5% as severe. System Organ Class classification of the ADRs identified gastrointestinal system disorders as the most common (33.4%), followed by skin and subcutaneous tissue disorders (21.2%). The TADRRS-HM records indicate that herbal medicines may cause a wide range of ADRs. Aconiti Radix, Xiao-Qing-Long-Tang, and Datura suaveolens were the most commonly reported single herb, herbal formula, and folk herbal, respectively. The data indicate that herbal medicines may cause a wide range of ADRs. This system will confer long-term benefits for the development of Taiwan’s herbal medicines adverse reaction database and facilitate epidemiological analysis.
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Affiliation(s)
- Hen-Hong Chang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Chinese Medicine Research Center, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan, ROC. .,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Su-Yin Chiang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Han Tsai
- Division of Chinese Internal Medicine, Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Rong-Chi Yang
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiu-Lin Tsai
- Traditional Chinese Medicine Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Hsiu Wu
- Traditional Chinese Medicine Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Yow-Wen Hsieh
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan.,School of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan
| | - Yu-Chun Lin
- Department of Traditional Chinese Medicine, Chinese Medicine Department, China Medicine University Hospital, Taichung, Taiwan
| | - Yung-Te Kuo
- Traditional Chinese Medicine Pharmacy, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Chung Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Chinese Medicine Research Center, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan, ROC
| | - Hsueh-Ting Chu
- Department of Computer Science and Information Engineering, College of Computer Science, Asia University, No. 500, Lioufeng Road, Wufeng, Taichung, 41354, Taiwan, ROC.
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Complementary and alternative medicine. SIDE EFFECTS OF DRUGS ANNUAL 2021. [PMCID: PMC8488687 DOI: 10.1016/bs.seda.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Complementary and alternative medicine is used worldwide. The use of plant-based medicines for the prevention or treatment of disease is prevalent but not regulated or studied. Multiple countries are implementing pharmacovigilance systems to monitor the use and safety of dietary supplements. Reporting mechanisms continue to be sporadic and inconsistent, based mainly on consumer or healthcare provider reports outlining individual adverse effects (AEs) from dietary supplements. Supplement product ingredient lists may be inaccurate, claims biased, and Evidence-Based information regarding risks and benefits lacking. Healthcare providers should familiarize themselves with complementary medicine practices, the benefits and associated risks to best care for their patient populations. A global pandemic marked 2020 with the emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A short review of vitamin and plant-based prevention, treatment, and associated ramifications with use of these products for coronavirus disease 2019 (COVID-19) is provided. Another world-wide dilemma is food security. Nutrieconomics and the socioeconomic ramifications of food are reviewed from a wider timeframe. Reports and reviews from 2020 describe AEs of complementary and alternative medicine and herbal dietary supplements. These are listed alphabetically by plant or supplement name.
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