Major interaction on record — check this product against your medications before combining. Check your meds →
Dietary supplement

Swedish Bitters Ingredients & Drug Interactions

by NatureWorks

Swedish Bitters label
See full label image
Liquid Category: Botanical
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Swedish Bitters against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy

The interaction bottom line Most serious interaction: Major

Swedish Bitters is a dietary supplement by NatureWorks with 14 active ingredients. Its ingredients are commonly taken for constipation, digestive upset, menopausal symptoms.Based on those ingredients, 1,510 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Valerian, Rhubarb, Black Snakeroot. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Swedish Bitters by NatureWorks

Ask about any prescription or over-the-counter medication and we check it for interactions with Swedish Bitters by NatureWorks — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
Prefer a human? Send your question to our licensed pharmacists — free, answered by email within 24 hours.

HelloPharmacist Scorecard of Swedish Bitters by NatureWorks

Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 11, 2026

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 14 of its 14 active ingredients.
  • No proprietary blends here — you can verify the dose of every single component.

Swedish Bitters is a 14-ingredient liquid blend with active herbal components. The formula includes rhubarb root (a stimulant laxative), senna (also a stimulant laxative), and aloe (a strong cathartic agent) — all traditionally used to promote bowel movement.

Valerian root supports relaxation and sleep. Cinnamon, cardamom, myrrh, and zedoary are warming digestive herbs.

Angelica, saffron, camphor, manna, carline thistle, and black cohosh round out the formula as traditional bitters and tonics. The product is delivered in a liquid form with water and alcohol as inactive ingredients.

Does it work?

Strong evidence
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Strong

Clinical evidence supports at least one of this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: promotes regularity for healthy digestive function.
  • We looked for evidence on: Constipation, Dyspepsia, Diarrhea, Bowel preparation, digestive regularity, bowel health — and 1 related terms.
  • The strongest evidence on file: Senna is rated "Likely Effective" for Constipation (Natural Medicines).
  • Also on file: Aloe is rated "Possibly Effective" for Constipation.
  • Also on file: Senna is rated "Possibly Effective" for Bowel preparation.

Evidence for this multi-ingredient formula as a whole is not established in the data we hold. Looking at individual ingredients: rhubarb is possibly effective for pancreatitis and menopausal symptoms, though the evidence for constipation is insufficient.

Senna is likely effective for constipation and possibly effective for bowel preparation. Aloe is possibly effective for constipation, diabetes, acne, burns, psoriasis, and obesity.

Camphor is likely effective for cough, pain, and itching. Black cohosh is possibly effective for menopausal symptoms.

Saffron is possibly effective for chemotherapy-related nerve pain and Alzheimer disease. The other ingredients either lack sufficient evidence or the data we hold does not include effectiveness ratings.

The evidence, ingredient by ingredient Rhubarb Cassia Cinnamon Ashitaba Cardamom Valerian Senna Aloe Zedoary

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 11 of the 14 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 14 of 14.
  • General safety write-ups exist for 14 of 14.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Rhubarb is generally well tolerated in food amounts and seems well tolerated in medicinal amounts, though it can cause cramping and should not be used long-term. Senna and aloe are also generally well tolerated short-term but carry warnings against long-term use.

Valerian is generally well tolerated short-term; common side effects include drowsiness, dizziness, mental slowness, and headache. Stopping valerian abruptly after long use may cause withdrawal symptoms like anxiety and insomnia, so taper slowly.

Aloe latex carries a higher risk of adverse effects than aloe gel and is associated with serious electrolyte loss with overuse. Camphor is unsafe if swallowed — it can cause significant toxicity — but is generally well tolerated for short-term topical use.

Black cohosh is generally well tolerated short-term but rare cases of liver problems have been reported. Saffron is generally well tolerated orally but high doses can be toxic, and allergic reactions including anaphylaxis are rare but documented.

Pregnancy and breastfeeding: rhubarb, aloe, zedoary, myrrh, and saffron are rated possibly or likely unsafe in pregnancy. Valerian, black cohosh, and carline thistle are also advised against in pregnancy due to insufficient safety data.

Camphor is unsafe in pregnancy and lactation. Cinnamon, cardamom, manna, and myrrh are advised against or have insufficient data for breastfeeding.

Senna and cinnamon are rated possibly or likely safe in pregnancy and lactation, respectively.

Side effects, ingredient by ingredient Rhubarb Cassia Cinnamon Ashitaba Cardamom Valerian Senna Aloe Zedoary

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

At least one ingredient has a documented Major-severity interaction. Check your medications for a personalized result.

Why this rating?
  • 12 of the 14 matched ingredients can interact with medications — Manna, Rhubarb, Zedoary, Myrrh, Aloe, among others.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; immunosuppressants / transplant drugs; diabetes medications; heart-rhythm medications.
  • For scale: 1,511 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Check with your pharmacist before using this product if you take digoxin (Lanoxin) or other heart medications, blood thinners like warfarin, diuretics, diabetes drugs, blood-pressure medicines, sedative or sleep medications, antidepressants (especially serotonin-based ones), chemotherapy agents, estrogen therapy, or any drug that stresses the liver. The product's laxative ingredients can alter how your body absorbs and processes many medications.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.

Swedish Bitters is a traditional digestive and laxative blend best used short-term under the guidance of a healthcare provider. If you take any medications — especially blood thinners, heart drugs, diabetes medications, blood-pressure drugs, sleep aids, or liver-metabolized drugs — you should check this product with your pharmacist or doctor before starting.

Pregnant or breastfeeding people should avoid it entirely.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 14 of 14 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Jan 23, 2015.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about Swedish Bitters, straight from the product label.

Brand NatureWorks
Net contents 8.45 fl. Oz.; 250 mL
Market status Off market
Date entered into DSLD Jan 23, 2015
DSLD ID 41089
Product type Botanical
Supplement form Liquid
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Children 4 or More Years of Age, Adult (18 - 50 Years)
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Swedish Bitters by NatureWorks, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
1 Teaspoon(s)
Maximum serving Sizes:
2 Teaspoon(s)
Servings per container
25
IngredientAmount% DV
Calories22 {Calories}--
Total Carbohydrates1 Gram(s)1%
Rhubarb67 mg--
Cinnamon7.4 mg--
Angelica89 mg--
Cardamon3.7 mg--
Valerian7.4 mg--
Senna67 mg--
Aloe67 mg--
Zedoary74 mg--
Camphor17 mg--
Manna117 mg--
Myrrh37 mg--
Carline Thistle33 mg--
Black Snakeroot15 mg--
Saffron1.3 mg--

Other ingredients: Water, Alcohol

Tap any ingredient to jump to its full detail below.

Label statements
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
General Statements

Swedish Bitters secret formula rediscovered. Lost for centuries, the secret herbal formula Swedish Bitters, created by Paracelsus in the 16th century, was rediscovered by a distinguished Austrian herbalist.

We make the extract and analyze it in our laboratory to assure you of unquestionable purity and optimum potency. Swedish Bitters is the most remarkable traditional European herbal extract.

Original Formula

The Traditional European Herbal Extract

Gentle and Stimulating Promotes Regularity For Healthy Digestive Function

Put Nature To Work For You

Brand IP Statement(s)

Since then, NatureWorks(R) Swedish Bitters has won enthusiastic praise from millions of Europeans as the definitive herbal elixir.

NatureWorks(R) Swedish Bittes is an artfully blended extract of selected herbs of unsurpassed quality.

NatureWorks(R)

FDA Statement of Identity

Dietary Supplement

FDA Disclaimer Statement

These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Suggested/Recommended/Usage/Directions

Suggested use: Adults and children over 15 years of age take 1-2 teaspoons daily for improved health and overall well being. For an exciting alternative way to take Swedish Bitters(TM), add to a cup of herbal tea, like Chamomile or Peppermint, or to a glass of your favorite fruit juice. Shake well before using.

Precautions

WARNING: Do not use this product if you are pregnant or nursing a baby.

Do not use this product when vomiting, nausea, diarrhea or abdominal pain are present.

Keep out of the reach of children.

Seals/Symbols

{Image}(R)

Is this label outdated? Report a formula or label change and our pharmacy team will review it.

See for yourself

Swedish Bitters by NatureWorks label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

Swedish Bitters label

Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.

View the full label (PDF)
What’s inside

The Ingredients in Swedish Bitters by NatureWorks

These are the 14 active ingredients this product is made of. Select any to open its full monograph.

Serving size1 Teaspoon(s) Dosage formLiquid Servings per container25 Amounts shown are per serving.

Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.

Rhubarb

Interacts with
658 drugs
67 mg per serving

Rhubarb root has a long history of use as a laxative and in traditional Chinese medicine, and its edible stalks are a common food. Most medicinal clai...

Rhubarb monograph & interactions

Cinnamon

Interacts with
442 drugs
7.4 mg per serving

Cassia cinnamon is the common, inexpensive cinnamon used in cooking, and it is also taken as a supplement, most often for blood sugar support. The evi...

Cinnamon monograph & interactions

Angelica

Interacts with
186 drugs
89 mg per serving

Ashitaba is a leafy plant from Japan that is eaten as a vegetable and taken as a supplement for general health, antioxidant, and heart benefits. Most...

Angelica monograph & interactions

Cardamon

No known
interactions
3.7 mg per serving

Cardamom is a popular cooking spice that has long been used in traditional medicine for digestion and fresh breath. As a food, it is generally safe fo...

Cardamon monograph & interactions

Valerian

Interacts with
902 drugs
7.4 mg per serving

Valerian is an herb whose root is widely used as a natural sleep aid and for calming nerves. The evidence is mixed and often weak, so it may help some...

Valerian monograph & interactions

Senna

Interacts with
140 drugs
67 mg per serving

Senna is a plant-based stimulant laxative that is widely used and generally effective for short-term relief of constipation. It is best used occasiona...

Senna monograph & interactions

Aloe

Interacts with
461 drugs
67 mg per serving

Aloe vera gel is widely used on the skin for minor burns and irritation, and some research suggests it may help. Aloe latex (the yellow part) is a str...

Aloe monograph & interactions

Zedoary

Interacts with
643 drugs
74 mg per serving

Zedoary is a ginger-family root used in traditional Asian and Indian medicine, mostly for digestion and as a spice. Scientific evidence in humans is v...

Zedoary monograph & interactions

Camphor

Interacts with
370 drugs
17 mg per serving

Camphor is a strong-smelling compound from the camphor tree (or made synthetically) that is used in many topical rub-on products for muscle aches, itc...

Camphor monograph & interactions

Manna

Interacts with
99 drugs
117 mg per serving

Manna is the dried, sweet sap of the flowering ash tree (Fraxinus ornus) and is best known as a gentle, mild laxative because it contains a sugar alco...

Manna monograph & interactions

Myrrh

Interacts with
88 drugs
37 mg per serving

Myrrh is a fragrant gum resin from Commiphora trees that has long been used in mouthwashes, throat remedies, and skin care. Modern evidence for most o...

Myrrh monograph & interactions

Carline Thistle

No known
interactions
33 mg per serving

Carlina (Carlina acaulis) is a thistle-like plant whose root has long been used in European folk medicine for digestive and skin complaints. Modern sc...

Carline Thistle monograph & interactions

Black Snakeroot

Interacts with
652 drugs
15 mg per serving

Black cohosh is a North American plant most often used to ease menopause symptoms like hot flashes, but the research is mixed and far from settled. It...

Black Snakeroot monograph & interactions

Saffron

Interacts with
521 drugs
1.3 mg per serving

Saffron is a costly spice that has shown promise in early studies for mild-to-moderate depression and some mood and PMS symptoms, but most research us...

Saffron monograph & interactions

Other (inactive) ingredients: Water, Alcohol. These complete the product’s ingredient list but are not active constituents.

Interaction report

Swedish Bitters by NatureWorks Drug Interactions

Want to check YOUR meds against Swedish Bitters?

Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.

 Go to the checker
1,510Drugs
1 Major 1,503 Moderate 6 Minor

Ingredients driving the most interactions

Valerian 902
Rhubarb 658
Black Snakeroot 652
Zedoary 643
Saffron 521

Individual Drug Interactions

The ingredients in Swedish Bitters interact with 1,510 drugs. Click any drug to see the details.

12 of the 14 ingredients in Swedish Bitters interact with drugs. Each result below shows which ingredient is responsible. Valerian Rhubarb Black Snakeroot Zedoary Saffron Aloe Cinnamon Camphor Angelica Senna Manna Myrrh

Each ingredient & the kinds of drugs it affects

For each ingredient in Swedish Bitters with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.

Valerian6 drug types · 902 drugs

Alcohol (Ethanol)

Valerian can have additive sedative effects when used concomitantly with alcohol.
Valerian has sedative effects. Theoretically, valerian might have an additive sedative effect when combined with alcohol. Excessive sedation has been reported in an alcohol-abusing individual who took valerian and Gingko biloba. However, the potential interaction between valerian and alcohol has been disputed in other research. Limited evidence suggests that a combination of valerian 160 mg and lemon balm 80 mg (Euvegal) does not cause further deterioration in reaction ability and reaction rate when taken with alcohol as compared to the effects of alcohol alone.

Likelihood Possible Evidence B
Alprazolam (Xanax)

Valerian can have additive sedative effects when used with alprazolam. Also, valerian in high doses might modestly increase alprazolam levels, though this is not likely to be clinically significant.
Valerian has sedative effects. Theoretically, valerian might cause additive sedation when combined with alprazolam. Also, a small pharmacokinetic study shows that taking valerian extract 1000 mg daily (providing 11 mg valerenic acid) might increase alprazolam levels by about 19%. This might be due to valerian's mild inhibition of cytochrome P450 3A4 (CYP3A4). Despite being statistically significant, this increase is not likely to be clinically significant.

Likelihood Possible Evidence B
Cns Depressants

Valerian can have additive sedative effects when used concomitantly with CNS depressant drugs.
Theoretically, concomitant use of valerian and drugs with sedative and anesthetic properties may cause additive therapeutic and adverse effects.

Likelihood Possible Evidence D
Glucuronidated Drugs

Valerian might weakly inhibit glucuronidation and increase concentrations of drugs metabolized by UGT1A1 and UGT2B7.
In vitro research shows that methanolic valerian extract and valerenic acid might competitively inhibit UDP-glucuronosyltransferase (UGT) 1A1 (UGT1A1) and UGT2B7.

Likelihood Possible Evidence D
Cytochrome P450 2D6 (Cyp2D6) Substrates

Valerian does not seem to have a clinically relevant effect on levels of drugs metabolized by CYP2D6.
Although some in vitro evidence suggests that valerian affects CYP2D6, clinical pharmacokinetic (PK) studies show that valerian is unlikely to affect the CYP2D6 enzyme. In one PK study, taking valerian 1000 mg (providing about 11 mg valerenic acid) nightly for 14 days did not affect the metabolism of dextromethorphan, a CYP2D6 substrate. In another PK study, taking valerian 125 mg three times daily for 28 days did not affect metabolism of debrisoquine, an accepted CYP2D6 probe-substrate.

Likelihood Unlikely Evidence B
Cytochrome P450 3A4 (Cyp3A4) Substrates

Valerian does not seem to have a clinically relevant effect on levels of drugs metabolized by CYP3A4.
Although some in vitro evidence suggests that valerian extract might inhibit or induce CYP3A4, clinical pharmacokinetic (PK) studies show that valerian does not have a clinically significant effect on the CYP3A4 enzyme. In one PK study, taking valerian 125 mg three times daily for 28 days did not affect metabolism of midazolam, an accepted CYP3A4 probe-substrate. In another PK study, taking valerian 1000 mg (providing about 11 mg valerenic acid) nightly for 14 days modestly increases levels of alprazolam, a CYP3A4 substrate, suggesting mild inhibition of CYP3A4. However, this mild inhibition is unlikely to be clinically relevant.

Likelihood Possible Evidence B
Valerian full monograph & interactions

Rhubarb8 drug types · 658 drugs

Corticosteroids

Theoretically, frequent and high doses of rhubarb might increase the risk of hypokalemia when taken with corticosteroids.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might compound corticosteroid-induced potassium loss.

Likelihood Possible Evidence D
Cyclosporine (Neoral, Sandimmune)

Theoretically, taking rhubarb with cyclosporine might reduce cyclosporine levels.
Animal research shows that co-administration of rhubarb decoction 0.25 or 1 gram/kg with cyclosporine 2.5 mg/kg, decreases cyclosporine maximum plasma concentration and overall exposure levels when compared with taking cyclosporine alone. The authors theorize that rhubarb might reduce cyclosporine bioavailability by inducing of P-glycoprotein and/or cytochrome P450 3A4. However, since rhubarb was administered as a single oral dose and enzyme induction usually occurs after multiple doses, it is possible that cyclosporine absorption was actually reduced via rhubarb's stimulant laxative effects. Also, the composition of the rhubarb decoction was not described.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, overuse of rhubarb might increase the risk of adverse effects when taken with digoxin.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might cause potassium depletion, increasing the risk of digoxin toxicity.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, frequent and high doses of rhubarb might increase the risk of hypokalemia.
Rhubarb has stimulant laxative effects. Overuse of rhubarb might cause potassium depletion and compound diuretic-induced potassium loss.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, concomitant use of rhubarb with potentially hepatotoxic drugs might increase the risk of developing liver damage.
Some animal research suggests that anthraquinones in rhubarb might have hepatotoxic effects. Also, rhubarb use has been linked to at least 24 cases of liver injury, although details on the dose of rhubarb and duration of use in these cases is unclear.

Likelihood Possible Evidence D
Nephrotoxic Drugs

Theoretically, long-term use of anthraquinones from rhubarb might increase the risk of nephrotoxicity when used with nephrotoxic drugs.
The anthraquinone constituents of rhubarb have been shown to induce nephrotoxicity in animal research. Additionally, in a case report, a 23-year old female presented with kidney failure after taking 6 tablets of a proprietary slimming agent (found to contain the anthraquinones emodin and aloe-emodin from rhubarb) daily for 6 weeks and then adding diclofenac 25 mg 4 times daily for 2 days. The authors postulate that the anthraquinone constituents of rhubarb contributed to the renal dysfunction, and the addition of diclofenac, a nephrotoxic drug, led to renal failure. Until more is known, advise patients to avoid taking rhubarb if they are taking other potentially nephrotoxic drugs.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, rhubarb might increase the risk for fluid and electrolyte loss when taken with other stimulant laxatives.
Rhubarb has stimulant laxative effects. Concomitant use with stimulant laxatives might compound fluid and electrolyte loss.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, excessive use of rhubarb might increase the risk of bleeding when taken with warfarin.
Rhubarb has stimulant laxative effects and can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of rhubarb.

Likelihood Possible Evidence D
Rhubarb full monograph & interactions

Black Snakeroot7 drug types · 652 drugs

Atorvastatin (Lipitor)

Taking black cohosh with atorvastatin might increase the risk for elevated liver function tests.
In one case report, a patient taking atorvastatin (Lipitor) developed significantly elevated liver function enzymes after starting black cohosh 100 mg four times daily. Liver enzymes returned to normal when black cohosh was discontinued. It is unclear whether the elevated liver enzymes were due to black cohosh itself or an interaction between atorvastatin and black cohosh.

Likelihood Possible Evidence D
Cisplatin (Platinol-Aq)

Theoretically, black cohosh may reduce the clinical effects of cisplatin.
Animal research suggests that black cohosh might decrease the cytotoxic effect of cisplatin on breast cancer cells.

Likelihood Possible Evidence D
Cytochrome P450 2D6 (Cyp2D6) Substrates

Some research suggests that black cohosh might inhibit CYP2D6, but there is conflicting evidence.
Some clinical research suggests that black cohosh might modestly inhibit CYP2D6 and increase levels of drugs metabolized by this enzyme. However, contradictory clinical research shows a specific black cohosh product (Remifemin, Enzymatic Therapy) 40 mg twice daily does not significantly inhibit metabolism of a CYP2D6 substrate in healthy study volunteers. Until more is known, use black cohosh cautiously in patients taking drugs metabolized by CYP2D6.

Likelihood Possible Evidence B
Estrogens

Theoretically, black cohosh may alter the effects of estrogen therapy.
Some research suggests that black cohosh has estrogenic effects. This may enhance or inhibit the effects of estrogen therapy.

Likelihood Possible Evidence D
Hepatotoxic Drugs

Theoretically, taking black cohosh with hepatotoxic drugs may increase the risk of liver damage.
There is concern that black cohosh might be linked to cases of liver failure and autoimmune hepatitis.

Likelihood Possible Evidence D
Serotonergic Drugs

Combining serotonergic drugs with black cohosh might cause additive serotonergic effects.
Black cohosh might increase the risk of serotonin syndrome when combined with other serotonergic drugs. Black cohosh acts as an agonist at several serotonin receptor subtypes and might interact with other serotonergic medications. In one case, a 55-year-old female who had been on stable treatment with sertraline 50 mg and duloxetine 60 mg daily developed serotonin syndrome after taking black cohosh extract 40 mg daily for 3 days.

Likelihood Possible Evidence D
Organic Anion-Transporting Polypeptide Substrates (Oatp)

Black cohosh may inhibit one form of OATP, OATP2B1, which could reduce the bioavailability and clinical effects of OATP2B1 substrates.
In vitro research shows that black cohosh modestly inhibits OATP2B1. OATPs are expressed in the small intestine and liver and are responsible for the uptake of drugs and other compounds into the body. Inhibition of OATP may reduce the bioavailability of oral drugs that are substrates of OATP.

Likelihood Possible Evidence D
Black Snakeroot full monograph & interactions

Zedoary1 drug type · 643 drugs

Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, zedoary might increase levels of drugs metabolized by CYP3A4.
In-vitro research shows that a methanol extract of zedoary strongly inhibits the CYP3A4 metabolism of the tyrosine kinase inhibitors lapatinib and sorafenib, and to a lesser extent, gefitinib.

Likelihood Possible Evidence D
Zedoary full monograph & interactions

Saffron4 drug types · 521 drugs

Antidiabetes Drugs

Theoretically, concomitant use of saffron with antidiabetes drugs might increase the risk of hypoglycemia.
Some clinical research shows that taking saffron extract reduces fasting levels of glucose when used in addition to hypoglycemic agents. However, saffron powder itself has not been shown to reduce fasting glucose levels.

Likelihood Possible Evidence B
Antihypertensive Drugs

Theoretically, concomitant use of saffron with antihypertensive drugs might have additive effects.
Animal and human research suggests that saffron extract can decrease blood pressure.

Likelihood Possible Evidence D
Caffeine

Theoretically, saffron might inhibit the metabolism of caffeine.
A small clinical study suggests that taking saffron powder 300 mg in 150 mL water daily for 5 days and then taking caffeine 200 mg seems to reduce caffeine metabolite levels in the saliva and urine in males, but not females. Theoretically, this may be due to the inhibition of cytochrome P450 1A2 by saffron.

Likelihood Possible Evidence B
Cns Depressants

Theoretically, concomitant use of saffron and CNS depressants might have additive sedative effects.
Clinical research shows that taking saffron extract 60 mg orally daily for 26 weeks can cause drowsiness and sedation. Animal research suggests that adding saffron to hexobarbital further increases sleeping and slows motor activity.

Likelihood Possible Evidence D
Saffron full monograph & interactions

Aloe7 drug types · 461 drugs

Digoxin (Lanoxin)

Theoretically, aloe latex might increase the risk of adverse effects when taken with cardiac glycosides.
Overuse of aloe latex can increase the risk of adverse effects from cardiac glycoside drugs, such as digoxin, due to potassium depletion. Overuse of aloe, along with cardiac glycoside drugs, can increase the risk of toxicity.

Likelihood Probable Evidence D
Anticoagulant/Antiplatelet Drugs

Theoretically, aloe gel might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.
In vitro research shows that aloe gel can inhibit platelet aggregation. This inhibition was greater than that seen with celecoxib, but less than that seen with aspirin.

Likelihood Possible Evidence D
Antidiabetes Drugs

Aloe might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Preliminary clinical research suggests aloe gel might lower blood glucose levels and have additive effects when used with antidiabetes drugs. Monitor blood glucose levels closely.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, aloe latex might increase the risk of hypokalemia when taken with diuretic drugs.
Overuse of aloe latex might compound diuretic-induced potassium loss, increasing the risk of hypokalemia.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, aloe latex might increase the risk for fluid and electrolyte loss when taken with stimulant laxatives.
Due to cathartic laxative effects of aloe latex, concomitant use with other stimulant laxatives might compound fluid and electrolyte loss.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, aloe latex might increase the risk of bleeding when taken with warfarin.
Aloe latex has stimulant laxative effects. In some people aloe latex can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of aloe vera.

Likelihood Possible Evidence D
Cytochrome P450 1A2 (Cyp1A2) Substrates

Theoretically, aloe might decrease the levels and clinical effects of CYP1A2 substrates.
In vitro research shows that aloe extract induces CYP1A2 enzymes.

Likelihood Possible Evidence D
Aloe full monograph & interactions

Cinnamon2 drug types · 442 drugs

Antidiabetes Drugs

Theoretically, cassia cinnamon may have additive effects with antidiabetes drugs.
Cassia cinnamon may lower blood glucose levels, and have additive effects in patients treated with antidiabetic agents. Dose adjustments to diabetes medications might be necessary.

Likelihood Possible Evidence B
Hepatotoxic Drugs

Theoretically, large doses of cassia cinnamon might cause additive effects when used with hepatotoxic drugs.
There is some concern that ingesting large amounts of cassia cinnamon for an extended duration might cause hepatotoxicity in some people. Cassia cinnamon contains coumarin, which can cause hepatotoxicity in animal models. In humans, very high doses of coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin use is discontinued. Lower amounts might also cause liver problems in sensitive people, such as those with liver disease or those taking potentially hepatotoxic agents.

Likelihood Possible Evidence D
Cinnamon full monograph & interactions

Camphor1 drug type · 370 drugs

Hepatotoxic Drugs

Theoretically, concomitant use of camphor with other hepatotoxic drugs might increase the risk of liver damage.
There have been a few case reports of transient elevations in liver enzymes in adults after oral or topical use of camphor. There has also been one case of hepatotoxicity in an infant after topical camphor use.

Likelihood Possible Evidence D
Camphor full monograph & interactions

Angelica1 drug type · 186 drugs

Cytochrome P450 1A2 (Cyp1A2) Substrates

In vitro research shows that ashitaba extract inhibits cytochrome P450 (CYP) 1A2. Theoretically, concomitant use of ashitaba with CYP1A2 substrates might decrease the clearance of these substrates and increase the risk for adverse effects. However, this interaction has yet to be reported in humans. Until more is known, use with caution.

Likelihood Possible Evidence D
Angelica full monograph & interactions

Senna5 drug types · 140 drugs

Digoxin (Lanoxin)

Theoretically, senna might increase the risk of adverse effects when taken with digoxin.
Overuse/abuse of senna increases the risk of adverse effects from cardiac glycosides, such as digoxin, due to potassium depletion.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, senna might increase the risk of hypokalemia when taken with diuretic drugs.
Overuse of senna might compound diuretic-induced potassium loss and increase the risk for hypokalemia.

Likelihood Possible Evidence D
Estrogens

Theoretically, taking senna may interfere with the absorption of exogenous estrogens.
Some preliminary clinical evidence suggests that senna reduces the absorption of estradiol and decreases serum concentrations of estrone and estrone sulfate by decreasing intestinal transit time.

Likelihood Possible Evidence B
Stimulant Laxatives

Theoretically, senna might increase the risk for fluid and electrolyte loss when taken with other stimulant laxatives.
Senna is a stimulant laxative; concomitant use with other stimulant laxatives might compound fluid and electrolyte loss.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, excessive use of senna might increase the effects of warfarin.
Senna has stimulant laxative effects and can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. In one case report, excessive use of senna for 3 weeks resulted in diarrhea, bloody stools, and an elevated INR of 11.9.

Likelihood Possible Evidence D
Senna full monograph & interactions

Manna4 drug types · 99 drugs

Digoxin (Lanoxin)

Theoretically, manna might increase the risk of adverse effects when taken with cardiac glycosides.
Manna contains mannitol, which acts as an osmotic laxative. Overuse or abuse of manna might increase the risk of adverse effects from cardiac glycoside drugs.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, manna might increase the risk of hypokalemia when taken with diuretic drugs.
Manna contains mannitol, which acts as an osmotic laxative. Overuse of manna might compound diuretic-induced potassium loss, increasing the risk of hypokalemia.

Likelihood Possible Evidence D
Stimulant Laxatives

Theoretically, manna might increase the risk for fluid and electrolyte loss when taken with stimulant laxatives.
Due to the osmotic laxative effects of manna, concomitant use with stimulant laxatives might compound fluid and electrolyte loss.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, manna might increase the risk of bleeding when taken with warfarin.
Manna has osmotic laxative effects. In some people manna can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding.

Likelihood Possible Evidence D
Manna full monograph & interactions

Myrrh2 drug types · 88 drugs

Antidiabetes Drugs

Theoretically, myrrh might increase the risk of hypoglycemia when taken with antidiabetes drugs.
In vitro and animal research suggests that myrrh has hypoglycemic effects.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, myrrh might decrease the effectiveness of warfarin.
In one case, a patient who was previously stable on warfarin had a significant decline in international normalized ratio (INR) following consumption of an aqueous extract of myrrh.

Likelihood Possible Evidence D
Myrrh full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Swedish Bitters, from the product label.

NatureWorks

See all NatureWorks products
Name
NatureWorks(R) a Division of ABKIT, INC.
City
New York
State
NY
ZipCode
10006
Web Address
www.natureworks.com
Pharmacist Counseling Corner

Swedish Bitters by NatureWorks: Common Questions

Does Swedish Bitters by NatureWorks interact with any medications?
Yes. Based on its ingredients, Swedish Bitters has a known interaction with 1,510 medications, including 1 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Swedish Bitters contains 14 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Can I use this if I take warfarin or another blood thinner?
No — not without checking with your doctor or pharmacist first. Multiple ingredients in Swedish Bitters (rhubarb, senna, aloe, and manna) can cause diarrhea, which increases the effects of blood thinners and raises your bleeding risk. Your prescriber may need to adjust your dose or you may need to skip this product.
Is it safe to use long-term?
No. The label and safety data both advise against long-term daily use of the laxative ingredients — rhubarb, senna, and aloe. Long-term use can lead to serious electrolyte loss, especially potassium, and harm to your kidneys and heart. Use it only short-term and under medical guidance.
Can I take this while pregnant?
No. Rhubarb, aloe, zedoary, myrrh, saffron, and camphor in the formula are rated unsafe or possibly unsafe in pregnancy because they may stimulate the uterus or act as strong laxatives. Talk with your doctor about safe alternatives.
Will this help with digestion or constipation?
Senna is likely effective for constipation. Rhubarb is possibly effective for it, though the evidence is not strong. Aloe is also possibly effective. The digestive herbs in the blend — cinnamon, cardamom, myrrh — have not been shown to work well for these conditions based on the data we hold.
What are the most common side effects?
The main ones are cramps, diarrhea, nausea, and abdominal discomfort from the laxative ingredients. Valerian may cause drowsiness, dizziness, and headache. If you stop valerian after long use, you may experience withdrawal symptoms like anxiety and insomnia — taper slowly instead of quitting abruptly.
Can I take this with my diabetes medication?
Check with your doctor or pharmacist first. Aloe, cinnamon, saffron, and myrrh all may lower blood sugar, so combining them with your diabetes drug could increase the risk of low blood sugar (hypoglycemia). Your prescriber may need to monitor your levels or adjust your medication.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Not sure if Swedish Bitters is safe with your meds?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

Swedish Bitters label
Go deeper

The Full Monographs Behind Swedish Bitters’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

Rhubarb

Interacts with 658 drugs

Rhubarb root has a long history of use as a laxative and in traditional Chinese medicine, and its edible stalks are a common food. Most medicinal claims are backed by limited or low-quality...

Read the full Rhubarb monograph → Herb & supplement monograph

Cassia Cinnamon

Interacts with 442 drugs

Cassia cinnamon is the common, inexpensive cinnamon used in cooking, and it is also taken as a supplement, most often for blood sugar support. The evidence for its health benefits is mixed a...

Read the full Cassia Cinnamon monograph → Herb & supplement monograph

Ashitaba

Interacts with 186 drugs

Ashitaba is a leafy plant from Japan that is eaten as a vegetable and taken as a supplement for general health, antioxidant, and heart benefits. Most of the supporting research comes from la...

Read the full Ashitaba monograph → Herb & supplement monograph

Cardamom

Cardamom is a popular cooking spice that has long been used in traditional medicine for digestion and fresh breath. As a food, it is generally safe for most people, but high-dose supplements...

Read the full Cardamom monograph → Herb & supplement monograph

Valerian

Interacts with 902 drugs

Valerian is an herb whose root is widely used as a natural sleep aid and for calming nerves. The evidence is mixed and often weak, so it may help some people sleep but does not work reliably...

Read the full Valerian monograph → Herb & supplement monograph

Senna

Interacts with 140 drugs

Senna is a plant-based stimulant laxative that is widely used and generally effective for short-term relief of constipation. It is best used occasionally and for only a few days at a time, s...

Read the full Senna monograph → Herb & supplement monograph

Aloe

Interacts with 461 drugs

Aloe vera gel is widely used on the skin for minor burns and irritation, and some research suggests it may help. Aloe latex (the yellow part) is a strong laxative that can cause cramping and...

Read the full Aloe monograph → Herb & supplement monograph

Zedoary

Interacts with 643 drugs

Zedoary is a ginger-family root used in traditional Asian and Indian medicine, mostly for digestion and as a spice. Scientific evidence in humans is very limited, so its benefits are not wel...

Read the full Zedoary monograph → Herb & supplement monograph

Camphor

Interacts with 370 drugs

Camphor is a strong-smelling compound from the camphor tree (or made synthetically) that is used in many topical rub-on products for muscle aches, itching, and chest congestion. It can be he...

Read the full Camphor monograph → Herb & supplement monograph

Manna

Interacts with 99 drugs

Manna is the dried, sweet sap of the flowering ash tree (Fraxinus ornus) and is best known as a gentle, mild laxative because it contains a sugar alcohol called mannitol. It is generally con...

Read the full Manna monograph → Herb & supplement monograph

Myrrh

Interacts with 88 drugs

Myrrh is a fragrant gum resin from Commiphora trees that has long been used in mouthwashes, throat remedies, and skin care. Modern evidence for most of its uses is limited and comes mostly f...

Read the full Myrrh monograph → Herb & supplement monograph

Carlina

Carlina (Carlina acaulis) is a thistle-like plant whose root has long been used in European folk medicine for digestive and skin complaints. Modern scientific evidence in humans is very limi...

Read the full Carlina monograph → Herb & supplement monograph

Black Cohosh

Interacts with 652 drugs

Black cohosh is a North American plant most often used to ease menopause symptoms like hot flashes, but the research is mixed and far from settled. It is generally well tolerated for short-t...

Read the full Black Cohosh monograph → Herb & supplement monograph

Saffron

Interacts with 521 drugs

Saffron is a costly spice that has shown promise in early studies for mild-to-moderate depression and some mood and PMS symptoms, but most research uses small trials, so results are not defi...

Read the full Saffron monograph →
Sources

Sources & How We Checked

Swedish Bitters's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

The 292 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Rhubarb 20 references
  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  2. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  3. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  5. Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
  6. Kwan TH, Tong MK, Leung KT, et al. Acute renal failure associated with prolonged intake of slimming pills containing anthraquinones. Hong Kong Med J 2006;12:394-7.
  7. Fairbairn JW. The anthraquinone laxatives. Biological assay and its relation to chemical structure. Pharmacology 1976;14:48-61. PubMed
  8. Siegers, C. P., Hertzberg-Lottin, E., Otte, M., and Schneider, B. Anthranoid laxative abuse--a risk for colorectal cancer? Gut 1993;34(8):1099-1101. PubMed
  9. Fan, J. G. Evaluating the efficacy and safety of Danning Pian in the short-term treatment of patients with non-alcoholic fatty liver disease: a multicenter clinical trial. Hepatobiliary.Pancreat.Dis.Int 2004;3(3):375-380.
  10. Yan, M., Zhang, L. Y., Sun, L. X., Jiang, Z. Z., and Xiao, X. H. Nephrotoxicity study of total rhubarb anthraquinones on Sprague Dawley rats using DNA microarrays. J Ethnopharmacol. 4-15-2006; PubMed
  11. Zhang, J. H., Li, L. S., and Zhang, M. Clinical effects of rheum and captopril on preventing progression of chronic renal failure. Chin Med J (Engl.) 1990;103(10):788-793.
  12. Mitsuma, T., Yokozawa, T., Oura, H., and Terasawa, K. [Rhubarb therapy in patients with chronic renal failure (Part 2)]. Nippon Jinzo Gakkai Shi 1987;29(2):195-207.
  13. Wu, C. X. [A preliminary study on the effect of a single Rheum officinale in heavy doses in the treatment of acute icteric hepatitis]. Zhong.Xi.Yi.Jie.He.Za Zhi.(Chinese Journal of Modern Developments in Traditional Medicine) 1984;4(2):88-89.
  14. Jiao, D. H. [Clinical research on the hemostatic effect of rhubarb on peptic ulcer with acute bleeding]. Zhong.Xi.Yi.Jie.He.Za Zhi.(Chinese Journal of Modern Developments in Traditional Medicine) 1984;4(10):597-600, 579.
  15. Jiao, D. H., Ma, Y. H., Chen, S. J., Liu, C. T., Shu, H. N., and Chu, C. M. Resume of 400 cases of acute upper digestive tract bleeding treated by rhubarb alone. Pharmacology 1980;20 Suppl 1:128-130.
  16. Zhang, JH, Yao, XD, Song, Y, and et al. [Long-term treating effects of rhubarb and captopril in delaying the progression of renal failure]. Chinese Kidney Disease Journal 1993;9(4):197-201.
  17. Rehman H, Begum W, Anjum F, Tabasum H, Zahid S. Effect of rhubarb (Rheum emodi) in primary dysmenorrhoea: a single-blind randomized controlled trial. J Complement Integr Med. 2015 Mar;12(1):61-9.
  18. Yu CP, Lin HJ, Lin SP, Shia CS, Chang PH, Hou YC, Hsieh YW. Rhubarb decreased the systemic exposure of cyclosporine, a probe substrate of P-glycoprotein and CYP 3A. Xenobiotica. 2016 Aug;46(8):677-82. PubMed
  19. Byeon JH, Kil JH, Ahn YC, Son CG. Systematic review of published data on herb induced liver injury. J Ethnopharmacol 2019;233:190-6. PubMed
  20. Zhao D, Feng SX, Zhang HJ, et al. Pharmacokinetics, tissue distribution and excretion of five rhubarb anthraquinones in rats after oral administration of effective fraction of anthraquinones from rheum officinale. Xenobiotica. 2021;51(8):916-925. PubMed

See these in context on the Rhubarb monograph →

Cassia Cinnamon 20 references
  1. Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=182
  2. Khan A, Safdar M, Ali Khan M, et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care 2003;26:3215-8. PubMed
  3. De Benito V, Alzaga R. Occupational allergic contact dermatitis from cassia (Chinese cinnamon) as a flavouring agent in coffee. Contact Dermatitis 1999;40:165. PubMed
  4. Drake TE, Maibach HI. Allergic contact dermatitis and stomatitis caused by a cinnamic aldehyde-flavored toothpaste. Arch Dermatol 1976;112:202-3.
  5. Press release. Cinnamon capsules to reduce blood sugar are medicinal products! Efficacy has not been scientifically proven - some products contain high levels of coumarin. Federal Institute of Risk Assessment (BfM), Germany, November 11, 2006. Available a
  6. Felter SP, Vassallo JD, Carlton BD, Daston GP. A safety assessment of coumarin taking into account species-specificity of toxicokinetics. Food Chem Toxicol 2006;44:462-75. PubMed
  7. Crawford P. Effectiveness of cinnamon for lowering hemoglobin A1C in patients with type 2 diabetes: a randomized, controlled trial. J Am Board Fam Med 2009;22:507-12. PubMed
  8. Akilen, R., Tsiami, A., Devendra, D., and Robinson, N. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic Type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Diabet.Med. 2010; PubMed
  9. Lu T, Sheng H Wu J Cheng Y Zhu J Chen Y. Cinnamon extract improves fasting blood glucose and glycosylated hemoglobin level in Chinese patients with type 2 diabetes. Nutr Res. 2012;32(6):408-412. PubMed
  10. Choi, J., Lee, K. T., Ka, H., Jung, W. T., Jung, H. J., and Park, H. J. Constituents of the essential oil of the Cinnamomum cassia stem bark and the biological properties. Arch Pharm Res 2001;24(5):418-423.
  11. Altschuler JA, Casella SJ, MacKenzie TA, Curtis KM. The effect of cinnamon on A1C among adolescents with type 1 diabetes. Diabetes Care 2007;30(4):813-6. PubMed
  12. Stoecker BR, Zhan Z, Luo R, et al. Cinnamon extract lowers blood glucose in hyperglycemic subjects. FASEB J. 2010;22:722.1 (Abstract only). DOI
  13. Admani S, Hill H, Jacob SE. Cinnamon Sugar Scrub Dermatitis: "Natural" Is Not Always Best. Pediatr Dermatol. 2017;34(1):e42-e43. PubMed
  14. Isaac-Renton M, Li MK, Parsons LM. Cinnamon spice and everything not nice: many features of intraoral allergy to cinnamic aldehyde. Dermatitis. 2015;26(3):116-21. PubMed
  15. Vandersall A, Katta R. Eyelid dermatitis as a manifestation of systemic contact dermatitis to cinnamon. Dermatitis. 2015 Jul-Aug;26(4):189. PubMed
  16. Wickenberg J, Lindstedt S, Nilsson J, Hlebowicz J. Cassia cinnamon does not change the insulin sensitivity or the liver enzymes in subjects with impaired glucose tolerance. Nutr J 2014 Sep 24;13:96. PubMed
  17. Brancheau D, Patel B, Zughaib M. Do cinnamon supplements cause acute hepatitis? Am J Case Rep 2015;16:250-4. PubMed
  18. Shekarchizadeh-Esfahani P, Heydarpour F, Izadi F, Jalili C. The effect of cinnamon supplementation on liver enzymes in adults: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2021;58:102699. PubMed
  19. Bernaola J, Valverde-Monge M, Otal-Buesa M, Cullen D, Heras-Mendaza F. Cinnamon allergic contact cheilitis. Contact Dermatitis 2023;88(5):418-419. PubMed
  20. Patel K, Howard M, Tate B. Cheilitis caused by allergic contact dermatitis to cinnamon in chai tea: A case report. Contact Dermatitis 2023;88(3):239-240. PubMed

See these in context on the Cassia Cinnamon monograph →

Ashitaba 2 references
  1. Kwon D, Yoon S, Carter O, Bailey GS, Dashwood RH. Antioxidant and antigenotoxic activities of Angelica keiskei, Oenanthe javanica and Brassica oleracea in the Salmonella mutagenicity assay and in HCT116 human colon cancer cells. Biofactors. 2006;26(4):231
  2. Noh HM, Ahn EM, Yun JM, Cho BL, Paek YJ. Angelica keiskei Koidzumi extracts improve some markers of liver function in habitual alcohol drinkers: a randomized double-blind clinical trial. J Med Food. 2015;18(2):166-72.

See these in context on the Ashitaba monograph →

Cardamom 2 references
  1. Mobacken, H. and Fregert, S. Allergic contact dermatitis from cardamom. Contact Dermatitis 1975;1(3):175-176. PubMed
  2. Aghasi M, Koohdani F, Qorbani M, et al. Beneficial effects of green cardamom on serum SIRT1, glycemic indices and triglyceride levels in patients with type 2 diabetes mellitus: a randomized double-blind placebo controlled clinical trial. J Sci Food Agri PubMed

See these in context on the Cardamom monograph →

Valerian 37 references
  1. Willey LB, Mady SP, Cobaugh DJ, Wax PM. Valerian overdose: a case report. Vet Hum Toxicol 1995;37:364-5.
  2. Kuhlmann J, Berger W, Podzuweit H, Schmidt U. The influence of valerian treatment on "reaction time, alertness and concentration" in volunteers. Pharmacopsychiatry 1999;32:235-41. PubMed
  3. Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm 1999;56:125-38. PubMed
  4. Houghton PJ. The scientific basis for the reputed activity of Valerian. J Pharm Pharmacol 1999;51:505-12. PubMed
  5. Garges HP, Varia I, Doraiswamy PM. Cardiac complications and delirium associated with Valerian root withdrawal. [Letter to the Editor]. JAMA 1998;280:1566-7. PubMed
  6. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed
  7. MacGregor FB, Abernethy VE, Dahabra S, et al. Hepatotoxicity of herbal remedies. BMJ 1989;299:1156-7. PubMed
  8. Leathwood PD, Chauffard F. Aqueous extract of valerian reduces latency to fall asleep in man. Planta Med 1985;2:144-8. PubMed
  9. Hadley S, Petry JJ. Valerian. Am Fam Physician 2003;67:1755-8..
  10. Glass JR, Sproule BA, Herrmann N, et al. Acute pharmacological effects of temazepam, diphenhydramine, and valerian in healthy elderly subjects. J Clin Psychopharmacol 2003;23:260-8. PubMed
  11. Lefebvre T, Foster BC, Drouin CE, et al. In vitro activity of commercial valerian root extracts against human cytochrome P450 3A4. J Pharm Pharmaceut Sci 2004;7:265-73.
  12. Yuan CS, Mehendale S, Xiao Y, et al. The gamma-aminobutyric acidergic effects of valerian and valerenic acid on rat brainstem neuronal activity. Anesth Analg 2004;98:353-8. PubMed
  13. Donovan JL, DeVane CL, Chavin KD, et al. Multiple night-time doses of valerian (Valeriana officinalis) had minimal effects on CYP3A4 activity and no effect on CYP2D6 activity in healthy volunteers. Drug Metab Dispos 2004;32:1333-6. PubMed
  14. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. PubMed
  15. Gutierrez S, Ang-Lee MK, Walker DJ, Zacny JP. Assessing subjective and psychomotor effects of the herbal medication valerian in healthy volunteers. Pharmacol Biochem Behav 2004;78:57-64. PubMed
  16. Jacobs BP, Bent S, Tice JA, et al. An internet-based randomized, placebo-controlled trial of kava and valerian for anxiety and insomnia. Medicine (Baltimore) 2005;84:197-207. PubMed
  17. National Toxicology Program, US Department of Health and Human Services. Chemical Information Review Document for Valerian (Valeriana officinalis L.) [CAS No. 8057-49-6] and Oils [CAS No. 8008-88-6]. Supporting Nomination for Toxicological Evaluation by t
  18. Fernández-San-Martín MI, Masa-Font R, Palacios-Soler L, et al. Effectiveness of Valerian on insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep Med. 2010 Jun;11:505-11. PubMed
  19. Coxeter PD, Schluter PJ, Eastwood HL, et al. Valerian does not appear to reduce symptoms for patients with chronic insomnia in general practice using a series of randomised n-of-1 trials. Complement Ther Med. 2003 Dec;11:215-22. PubMed
  20. Diaper A, Hindmarch I. A double-blind, placebo-controlled investigation of the effects of two doses of a valerian preparation on the sleep, cognitive and psychomotor function of sleep-disturbed older adults. Phytother Res. 2004 Oct;18:831-6. PubMed
  21. Cuellar NG, Ratcliffe SJ. Does valerian improve sleepiness and symptom severity in people with restless legs syndrome? Altern Ther Health Med 2009;15:22-8.
  22. Chen D, Klesmer J, Giovanniello A, et al. Mental status changes in an alcohol abuser taking valerian and gingko biloba. Am J Addict. 2002 Winter;11:75-7. PubMed
  23. Albrecht M, Berger W, Laux P, Schmidt U, et al. Psychopharmaka und Verkehrssicherheit. Der Einfluß von Euvegal® - Dragees forte auf die Fahrtüchtigkeit und Kombinationswirkungen mit Alkohol Z Allg Med 1995;71:1215-25.
  24. Carrasco MC, Vallejo JR, Pardo-de-Santayana M, et al. Interactions of Valeriana officinalis L. and Passiflora incarnata L. in a patient treated with lorazepam. Phytother Res. 2009 Dec;23:1795-6.
  25. Hellum BH, Nilsen OG. The in vitro inhibitory potential of trade herbal products on human CYP2D6-mediated metabolism and the influence of ethanol. Basic Clin Pharmacol Toxicol. 2007 Nov;101:350-8.
  26. Hellum BH, Hu Z, Nilsen OG. The induction of CYP1A2, CYP2D6 and CYP3A4 by six trade herbal products in cultured primary human hepatocytes. Basic Clin Pharmacol Toxicol. 2007 Jan;100:23-30. PubMed
  27. Alkharfy, K. M. and Frye, R. F. Effect of valerian, valerian/hops extracts, and valerenic acid on glucuronidation in vitro. Xenobiotica 2007;37(2):113-123.
  28. Vassiliadis, T., Anagnostis, P., Patsiaoura, K., Giouleme, O., Katsinelos, P., Mpoumponaris, A., and Eugenidis, N. Valeriana hepatotoxicity. Sleep Med 2009;10(8):935. PubMed
  29. Muller, Z., Sarkany, A., Altorjay, A., Szilagyi, A., Tura, T., and Ozsvar, Z. [Liver failure a la Eastern Europe]. Orv.Hetil. 3-22-2009;150(12):555-557. PubMed
  30. National Toxicology Program, US Department of Health and Human Services. Chemical Information Review Document for Valerian (Valeriana officinalis L.) [CAS No. 8057-49-6] and Oils [CAS No. 8008-88-6]. 2009;
  31. Wells SR. International intravenous administration of a crude valerian root extract. NACCT 1995;33:542.
  32. Aydinoglu U, Özcan H, Yücel A, Yücel N, Mutlu M. Valerian induced hypomania: a case report. Bull Clin Psychopharma 2012;22(Suppl. 1):S63.
  33. Mirabi P, Mojab F. The effects of valerian root on hot flashes in menopausal women. Iran J Pharm Res 2013;12(1):217-22.
  34. Thomas K, Canedo J, Perry PJ, et al. Effects of valerian on subjective sedation, field sobriety testing and driving simulator performance. Accid Anal Prev. 2016 Jul;92:240-4. PubMed
  35. Kia YH, Alexander S, Dowling D, Standish R. A case of steroid-responsive valerian-associated hepatitis. Intern Med J. 2016 Jan;46(1):118-9. PubMed
  36. Burke H, Jiang S, Chatham P, Stern TA. Delirium After Withdrawal From Valerian Root: A Case Report. Psychosomatics. 2020;61(6):787-790. PubMed
  37. Hajizadeh I, Jamshidi M, Kazemi M, Kargar H, Sadeghi T. Comparison the effect of valerian and gabapentin on RLS and sleep quality in hemodialysis patients: A randomized clinical trial. Ther Apher Dial 2023.

See these in context on the Valerian monograph →

Senna 42 references
  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  3. American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776-89. PubMed
  4. Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
  5. Seybold U, Landauer N, Hillebrand S, Goebel FD. Senna-induced hepatitis in a poor metabolizer. Ann Intern Med 2004;141:650-1. PubMed
  6. Vanderperren B, Rizzo M, Angenot L, et al. Acute liver failure with renal impairment related to the abuse of senna anthraquinone glycosides. Ann Pharmacother 2005;39:1353-7. PubMed
  7. Xing JH, Soffer EE. Adverse effects of laxatives. Dis Colon Rectum 2001;44:1201-9. PubMed
  8. Prior J, White I. Tetany and clubbing in patient who ingested large quantities of senna. Lancet 1978;2:947. PubMed
  9. Langmead L, Rampton DS. Review article: herbal treatment in gastrointestinal and liver disease--benefits and dangers. Aliment Pharmacol Ther 2001;15:1239-52. PubMed
  10. Joo JS, Ehrenpreis ED, Gonzalez L, et al. Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited. J Clin Gastroenterol 1998;26:283-6. PubMed
  11. Godding EW. Laxatives and the special role of senna. Pharmacology 1988;36:230-6. PubMed
  12. van Os FH. Anthraquinone derivatives in vegetable laxatives. Pharmacology 1976;14:7-17. PubMed
  13. Sondheimer JM, Gervaise EP. Lubricant versus laxative in the treatment of chronic functional constipation of children: a comparative study. J Pediatr Gastroenterol Nutr 1982;1:223-6. DOI
  14. Perkin JM. Constipation in childhood: a controlled comparison between lactulose and standardized senna. Curr Med Res Opin 1977;4:540-3. PubMed
  15. Shelton MG. Standardized senna in the management of constipation in the puerperium: A clinical trial. S Afr Med J 1980;57:78-80.
  16. [No authors listed] Senna in the puerperium. Pharmacology 1992;44:23-5. PubMed
  17. Passmore AP, Davies KW, Flanagan PG, et al. A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Pharmacology 1993;47:249-52. PubMed
  18. Passmore AP, Wilson-Davies K, Stoker C, Scott ME. Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. BMJ 1993;307:769-71. PubMed
  19. MacLennan WJ, Pooler AFWM. A comparison of sodium picosulphate ("Laxoberal") with standardised senna ("Senokot") in geriatric patients. Curr Med Res Opin. 1974;2:641-7. PubMed
  20. Kittisupamongkol W, Nilaratanakul V, Kulwichit W. Near-fatal bleeding, senna, and the opposite of lettuce. Lancet 2008;371:784. PubMed
  21. Prather CM. Pregnancy-related constipation. Curr Gastroenterol Rep 2004;6:402-4. PubMed
  22. Werthmann WM Jr, Krees SV. Quantitative excretion of Senokot in human breast milk. Med Ann Dist Columbia 1973;42:4-5.
  23. Hagemann TM. Gastrointestinal medications and breastfeeding. J Hum Lact 1998;14:259-62. PubMed
  24. Faber P, Strenge-Hesse A. Senna-containing laxatives: excretion in the breast milk? Geburtshilfe Frauenheilkd 1989;49:958-62.
  25. Faber P, Strenge-Hesse A. Relevance of rhein excretion into breast milk. Pharmacology 1988;36 Suppl 1:212-20. PubMed
  26. Duncan AS. Standardized senna as a laxative in the puerperium; a clinical assessment. Br Med J 1957;1:439-41. PubMed
  27. Stickel, F. and Schuppan, D. Herbal medicine in the treatment of liver diseases. Dig.Liver Dis. 2007;39(4):293-304. PubMed
  28. BALDWIN, W. F. CLINICAL STUDY OF SENNA ADMINISTRATION TO NURSING MOTHERS: ASSESSMENT OF EFFECTS ON INFANT BOWEL HABITS. Can.Med Assoc.J 9-14-1963;89:566-568. DOI
  29. Sonmez, A., Yilmaz, M. I., Mas, R., Ozcan, A., Celasun, B., Dogru, T., Taslipinar, A., and Kocar, I. H. Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation. Acta Gastroenterol.Belg. 2005;68(3):385-387.
  30. Beuers, U., Spengler, U., and Pape, G. R. Hepatitis after chronic abuse of senna. Lancet 2-9-1991;337(8737):372-373. PubMed
  31. Lim, A. K., Hooke, D. H., and Kerr, P. G. Anorexia nervosa and senna misuse: nephrocalcinosis, digital clubbing and hypertrophic osteoarthropathy. Med J Aust. 1-21-2008;188(2):121-122. PubMed
  32. McLaughlin, A. F. Anorexia nervosa and senna misuse: nephrocalcinosis, digital clubbing and hypertrophic osteoarthropathy. Med J Aust. 9-15-2008;189(6):348. PubMed
  33. Soyuncu, S., Cete, Y., and Nokay, A. E. Portal vein thrombosis related to Cassia angustifolia. Clin.Toxicol.(Phila) 2008;46(8):774-777.
  34. Levine, D., Goode, A. W., and Wingate, D. L. Purgative abuse associated with reversible cachexia, hypogammaglobulinaemia, and finger clubbing. Lancet 4-25-1981;1(8226):919-920. PubMed
  35. Malmquist, J., Ericsson, B., Hulten-Nosslin, M. B., Jeppsson, J. O., and Ljungberg, O. Finger clubbing and aspartylglucosamine excretion in a laxative-abusing patient. Postgrad.Med J 1980;56(662):862-864. PubMed
  36. Lewis, S. J., Heaton, K. W., Oakey, R. E., and McGarrigle, H. H. Lower serum oestrogen concentrations associated with faster intestinal transit. Br.J Cancer 1997;76(3):395-400. PubMed
  37. Lewis, S. J., Oakey, R. E., and Heaton, K. W. Intestinal absorption of oestrogen: the effect of altering transit-time. Eur.J Gastroenterol.Hepatol. 1998;10(1):33-39. PubMed
  38. Vilanova-Sanchez A, Gasior AC, Toocheck N, et al. Are Senna based laxatives safe when used as long term treatment for constipation in children? J Pediatr Surg 2018;53(4):722-7. PubMed
  39. Cogley K, Echevarria A, Correa C, De la Torre-Mondragón L. Contact Burn with Blister Formation in Children Treated with Sennosides. Pediatr Dermatol 2017;34(2):e85-e88. PubMed
  40. Coskun Y, Yuksel I. Polyethylene glycol versus split high-dose senna for bowel preparation: A comparative prospective randomized study. J Gastroenterol Hepatol 2020;35(11):1923-1929.
  41. Haoudar A, Chekhlabi N, El Kettani C, Dini N. Acute Hepatitis and Pancytopenia in a Child With Chronic Abuse of Senna. Cureus 2021;13(1):e12436. PubMed
  42. Irazábal B, Sánchez de Vicente J, Galán C, et al. Anaphylaxis Due to Senna (Cassia angustifolia). J Investig Allergol Clin Immunol 2021;31(1):71-73. PubMed

See these in context on the Senna monograph →

Aloe 41 references
  1. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  2. Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 1994.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  4. Nusko G, Schneider B, Schneider I, et al. Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Gut 2000;46:651-5. PubMed
  5. Luyckx VA, Ballantine R, Claeys M, et al. Herbal remedy-associated acute renal failure secondary to Cape aloes. Am J Kidney Dis 2002;39:E13. PubMed
  6. Rajasekaran S, Sivagnanam K, Ravi K, Subramanian S. Hypoglycemic effect of Aloe vera gel on streptozotocin-induced diabetes in experimental rats. J Med Food 2004;7:61-6.
  7. Williams MS, Burk M, Loprinzi CL, et al. Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys 1996;36:345-9. PubMed
  8. Vogler BK, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999;49:823-8.
  9. Bottenberg MM, Wall GC, Harvey RL, Habib S. Oral aloe vera-induced hepatitis. Ann Pharmacother 2007;41:1740-3. PubMed
  10. Rabe C, Musch A, Schirmacher P, et al. Acute hepatitis induced by an Aloe vera preparation: a case report. World J Gastroenterol 2005;11:303-4. PubMed
  11. Kanat O, Ozet A, Ataergin S. Aloe vera-induced acute toxic hepatitis in a healthy young man. Eur J Int Med 2006;17:589. PubMed
  12. Mueller SO, Stopper H. Characterization of the genotoxicity of anthraquinones in mammalian cells. Biochim Biophys Acta 1999;1428:406-14. PubMed
  13. Schorkhuber M, Richter M, Dutter A, et al. Effect of anthraquinone laxatives on the proliferation and urokinase secretion of normal, premalignant and malignant colonic epithelial cells. Eur J Cancer 1998;34:1091-8. PubMed
  14. Yang HN, Kim DJ, Kim YM, et al. Aloe-induced toxic hepatitis. J Korean Med Sci 2010;25:492-5. PubMed
  15. Choonhakarn C, Busaracome P, Sripanidkulchai B, et al. A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J.Eur.Acad.Dermatol.Venereol. 2010;24:168-72. PubMed
  16. Ishii Y, Tanizawa H, Takino Y. Studies of aloe. IV. Mechanism of cathartic effect. (3). Biol Pharm Bull. 1994;17:495-7. PubMed
  17. Ishii Y, Tanizawa H, Takino Y. Studies of aloe. V. Mechanism of cathartic effect. (4). Biol Pharm Bull. 1994;17:651-3. PubMed
  18. Nelemans FA. Clinical and toxicological aspects of anthraquinone laxatives. Pharmacology. 1976;14 Suppl 1:73-7. PubMed
  19. Paulsen E, Korsholm L, Brandrup F. A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2005;19:326-31.
  20. Huseini HF, Kianbakht S, Hajiaghaee R, et al. Anti-hyperglycemic and anti-hypercholesterolemic effects of Aloe vera leaf gel in hyperlipidemic type 2 diabetic patients: a randomized double-blind placebo-controlled clinical trial. Planta Med. 2012;78:311-6
  21. Ferreira, M., Teixeira, M., Silva, E., and Selores, M. Allergic contact dermatitis to Aloe vera. Contact Dermatitis 2007;57(4):278-279.
  22. Choonhakarn, C., Busaracome, P., Sripanidkulchai, B., and Sarakarn, P. The efficacy of aloe vera gel in the treatment of oral lichen planus: a randomized controlled trial. Br J Dermatol 2008;158(3):573-577. PubMed
  23. Baretta, Z., Ghiotto, C., Marino, D., and Jirillo, A. Aloe-induced hypokalemia in a patient with breast cancer during chemotherapy. Ann.Oncol. 2009;20(8):1445-1446. PubMed
  24. Hunter, D. and Frumkin, A. Adverse reactions to vitamin E and aloe vera preparations after dermabrasion and chemical peel. Cutis 1991;47(3):193-196.
  25. Alvarez-Perea, A., Garcia, A. P., Hernandez, A. L., de, Barrio M., and Baeza, M. L. Urticaria due to aloe vera: a new sensitizer? Ann.Allergy Asthma Immunol. 2010;105(5):404-405. PubMed
  26. Hogan, D. J. Widespread dermatitis after topical treatment of chronic leg ulcers and stasis dermatitis. CMAJ. 2-15-1988;138(4):336-338.
  27. Savchak VI. Acute bullous allergic dermatitis due to local application of aloe leaves. Vestnik Dermatologii i Venerologii 1977;12:44-45.
  28. Nakamura, T. and Kotajima, S. Contact dermatitis from aloe arborescens. Contact Dermatitis 1984;11(1):51. PubMed
  29. Shoji, A. Contact dermatitis to Aloe arborescens. Contact Dermatitis 1982;8(3):164-167. PubMed
  30. Morrow, D. M., Rapaport, M. J., and Strick, R. A. Hypersensitivity to aloe. Arch Dermatol. 1980;116(9):1064-1065. DOI
  31. Cosmetic Ingredient Review Expert Panel. Final report on the safety assessment of AloeAndongensis Extract, Aloe Andongensis Leaf Juice,aloe Arborescens Leaf Extract, Aloe Arborescens Leaf Juice, Aloe Arborescens Leaf Protoplasts, Aloe Barbadensis Flower E
  32. Bhalang K, Thunyakitpisal P, Rungsirisatean N. Acemannan, a polysaccharide extracted from Aloe vera, is effective in the treatment of oral aphthous ulceration. J Altern Complement Med 2013;19(5):429-34.
  33. Hajheydari Z, Saeedi M, Morteza-Semnani K, Soltani A. Effect of Aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris: a randomized, double-blind, prospective trial. J Dermatolog Treat 2014;25(2):123-9.
  34. Jiménez-Encarnación E, Ríos G, Muñoz-Mirabal A, Vilá LM. Euforia-induced acute hepatitis in a patient with scleroderma. BMJ Case Rep 2012;2012. PubMed
  35. Lee J, Lee MS, Nam KW. Acute toxic hepatitis caused by an aloe vera preparation in a young patient: a case report with a literature review. Korean J Gastroenterol 2014;64(1):54-8. PubMed
  36. Guo X, Mei N. Aloe Vera - A Review of Toxicity and Adverse Clinical Effects. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 2016;34(2):77-96.
  37. Hoogenboom TCH, Patel N, Cook NA, Williams R, Taylor-Robinson SD, Lim AKP. The effect of Aloe vera juice on liver enzymes and hepatic structure in a healthy population. Integr Med (Encinitas) 2020;19(3):30-4.
  38. Mushtaq S, Mushtaq Z, Sarfraz J, et al. Comparison of effect of aloe vera gel with aspirin and celecoxib on platelet aggregation. Professional Med J. 2020; 27(5):973-978. DOI
  39. Haron MH, Dale O, Martin K, et al. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022. PubMed
  40. Sabbaghzadegan S, Soltani MH, Kamalinejad M, Bahrami M, Kabir A, Dadmehr M. The effect of a standardized capsule of Aloe vera gel on the quality of life in patients with systolic heart failure: A randomized double-blind placebo-controlled clinical trial.
  41. Lewis ED, Crowley DC, Guthrie N, Evans M. Healthy adults supplemented with a nutraceutical formulation containing Aloe vera gel, rosemary and Poria cocos enhances the effect of influenza vaccination in a randomized, triple-blind, placebo-controlled trial. PubMed

See these in context on the Aloe monograph →

Zedoary 5 references
  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  3. Tariq S, Imran M, Mushtaq Z, Asghar N. Phytopreventive antihypercholesterolemic and antilipidemic perspectives of zedoary (Curcuma Zedoaria Roscoe) herbal tea. Lipids Health Dis 2016;15:39. doi: 10.1186/s12944-016-0210-y.
  4. Rodseeda C, Yamanont P, Pinthong D, Korprasertthaworn P. Inhibitory effects of Thai herbal extracts on the cytochrome P450 3A-mediated the metabolism of gefitinib, lapatinib and sorafenib. Toxicol Rep 2022;9:1846-1852. PubMed
  5. Niu LQ, Xiao L, Cai QH, et al. Comparative effectiveness of Chinese herbal injections treating for rotavirus enteritis in children: A systematic review and Bayesian network meta-analysis. Integr Med Res 2023;12(2):100944. PubMed

See these in context on the Zedoary monograph →

Camphor 20 references
  1. Uc A, Bishop WP, Sanders KD. Camphor hepatotoxicity. South Med J 2000;93:596-8. DOI
  2. Love JN, Sammon M, Smereck J. Are one or two dangerous? Camphor exposure in toddlers. J Emerg Med 2004;27:49-54.. PubMed
  3. Ruha AM, Graeme KA, Field A. Late seizure following ingestion of Vicks VapoRub. Acad Emerg Med 2003;10:691. . PubMed
  4. Gouin S, Patel H. Unusual cause of seizure. Pediatr Emerg Care 1996;12:298-300. DOI
  5. Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol 2000;143:923-9. PubMed
  6. Fung AE, Oxford KW. Microwave-superheated Vics Vapo Rub: an ocular public health danger. Am J Ophthalmol 2004;137:379-80. PubMed
  7. Emery, D. P. and Corban, J. G. Camphor toxicity. J.Paediatr.Child Health 1999;35(1):105-106.
  8. Rampini, S. K., Schneemann, M., Rentsch, K., and Bachli, E. B. Camphor intoxication after cao gio (coin rubbing). JAMA 7-3-2002;288(1):45.
  9. SMITH, A. G. and MARGOLIS, G. Camphor poisoning; anatomical and pharmacologic study; report of a fatal case; experimental investigation of protective action of barbiturate. Am.J.Pathol. 1954;30(5):857-869.
  10. Ragucci, K. R., Trangmar, P. R., Bigby, J. G., and Detar, T. D. Camphor ingestion in a 10-year-old male. South.Med.J. 2007;100(2):204-207. PubMed
  11. Agarwal, A. and Malhotra, H. S. Camphor ingestion: an unusual cause of seizure. J.Assoc.Physicians India 2008;56:123-124.
  12. Weiss, J. and Catalano, P. Camphorated oil intoxication during pregnancy. Pediatrics 1973;52(5):713-714. DOI
  13. Vasey, R. H. and Karayannopoulos, S. J. Camphorated oil. Br.Med.J. 1-8-1972;1(5792):112.
  14. Mascie-Taylor, B. H., Widdop, B., and Davison, A. M. Camphor intoxication treated by charcoal haemoperfusion. Postgrad.Med.J. 1981;57(673):725-726. PubMed
  15. Theis, J. G. and Koren, G. Camphorated oil: still endangering the lives of Canadian children. CMAJ. 6-1-1995;152(11):1821-1824.
  16. Skoglund, R. R., Ware, L. L., Jr., and Schanberger, J. E. Prolonged seizures due to contact and inhalation exposure to camphor. A case report. Clin.Pediatr.(Phila) 1977;16(10):901-902. PubMed
  17. Cordoba Torres IT, Marino-Nieto J, Barkin HB, Fort AC, Cobas M. Vicks VapoRub intoxication: an unusual presentation of multiorgan failure. J Clin Anesth 2018;48:46-7. PubMed
  18. Rahimi M, Shokri F, Hassanian-Moghaddam H, et al. Severe camphor poisoning, a seven-year observational study. Environ Toxicol Pharmacol 2017;52:8-13. PubMed
  19. Mathew T, John SK, Kamath V, et al. Essential oil related seizures (EORS): A multi-center prospective study on essential oils and seizures in adults. Epilepsy Res. 2021;173:106626. PubMed
  20. Camphor (synthetic): Immediately Dangerous to Life or Health Concentrations (IDLH). National Institute for Occupational Safety and Health. 1994. https://www.cdc.gov/niosh/idlh/76222.html. Assessed 5/6/2021.

See these in context on the Camphor monograph →

Manna 3 references
  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

See these in context on the Manna monograph →

Myrrh 8 references
  1. Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
  2. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  3. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.
  5. Al Faraj S. Antagonism of the anticoagulant effect of warfarin caused by the use of Commiphora molmol as a herbal medication: a case report. Ann Trop Med Parasitol 2005;99:219-20.
  6. Al-Jaroudi D, Kaddour O, Al-Amin N. Risks of myrrh use in pregnancy. JBRA Assist Reprod 2016;20(4):257-8.
  7. Xu YY, Li L, Xuan L, Guan K. Patch test diagnosis of non-immediate cutaneous reaction to myrrh following oral intake of a traditional Chinese medicine decoction. Contact Dermatitis. 2019;80(2):135-136. PubMed
  8. Al-Romaiyan A, Huang GC, Jones P, Persaud S. Commiphora myrrha stimulates insulin secretion from mouse and human islets of Langerhans. J Ethnopharmacol. 2021 Jan 10;264:113075. PubMed

See these in context on the Myrrh monograph →

Carlina 2 references
  1. Dietary Supplements: What You Need to Know — NIH Office of Dietary Supplements Source
  2. Herbs at a Glance — NIH NCCIH Source

See these in context on the Carlina monograph →

Black Cohosh 68 references
  1. McFarlin BL, Gibson MH, O'Rear J, Harman P. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. J Nurse Midwifery 1999;44:205-16. PubMed
  2. Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-3. PubMed
  3. Pepping J. Black cohosh: Cimicifuga racemosa. Am J Health Syst Pharm 1999;56:1400-2. PubMed
  4. Liske E. Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders. Adv Ther 1998;15:45-53.
  5. Kruse SO, Lohning A, Pauli GF, et al. Fukiic and piscidic acid esters from the rhizome of Cimicifuga racemosa and the in vitro estrogenic activity of fukinolic acid. Planta Med 1999;65:763-4.
  6. Jacobson JS, Troxel AB, Evans J, et al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001;19:2739-45. PubMed
  7. Gunn TR, Wright IM. The use of black and blue cohosh in labour. N Z Med J 1996;109:410-1.
  8. Baillie N, Rasmussen P. Black and blue cohosh in labour. N Z Med J 1997;110:20-1.
  9. Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2003;179:390-1.. DOI
  10. Wuttke W, Seidlova-Wuttke D, Gorkow C. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers. Maturitas 2003;44:S67-77. PubMed
  11. Huntley A, Ernst E. A systematic review of the safety of black cohosh. Menopause 2003;10:58-64.. DOI
  12. Cohen SM, O'Connor AM, Hart J, et al. Autoimmune hepatitis associated with the use of black cohosh: a case study. Menopause 2004;11:575-7. PubMed
  13. Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2003;178:411-2.. PubMed
  14. Thomsen M, Vitetta L, Schmidt M, Sali A. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust 2004;180:598-600.. DOI
  15. Cohen B, Schardt D. Center for Science in the Public Interest. Letter to Food and Drug Administration. Commissioner Mark McClellan, MD, PhD. March 4, 2004.
  16. Seidlova-Wuttke D, Hesse O, Jarry H, et al. Evidence for selective estrogen receptor modulator activity in a black cohosh (Cimicifuga racemosa) extract: comparison with estradiol-17beta. Eur J Endocrinol 2003;149:351-62. PubMed
  17. Rockwell S, Liu Y, Higgins SA. Alteration of the effects of cancer therapy agents on breast cancer cells by the herbal medicine black cohosh. Breast Cancer Res Treat 2005;90:233-9. PubMed
  18. Levitsky J, Alli TA, Wisecarver J, Sorrell MF. Fulminant liver failure associated with the use of black cohosh. Dig Dis Sci 2005;50:538-9. PubMed
  19. Cheong JL, Bucknall R. Retinal vein thrombosis associated with a herbal phytoestrogen preparation in a susceptible patient. Postgrad Med J 2005;81:266-7.. PubMed
  20. Nappi RE, Malavasi B, Brundu B, Facchinetti F. Efficacy of Cimicifuga racemosa on climacteric complaints: a randomized study versus low-dose transdermal estradiol. Gynecol Endocrinol 2005;20:30-5.
  21. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. PubMed
  22. Minciullo PL, Saija A, Patafi M, et al. Muscle damage induced by black cohosh (Cimicifuga racemosa). Phytomedicine 2006;13:115-8. PubMed
  23. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Men PubMed
  24. MHRA. Black cohosh (Cimicifuga racemosa) - risk of liver problems. Herbal Safety News July 2006. Available at: http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary= true&ssDocName=CON2024131&ssTargetNodeId=663.
  25. Dugoua JJ, Seely D, Perri D, et al. Safety and efficacy of black cohosh (cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol 2006;13:e257-61.
  26. Raus K, Brucker C, Gorkow C, Wuttke W. First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055. Menopause 2006;13:678-91. PubMed
  27. Lynch CR, Folkers ME, Hutson WR. Fulminant hepatic failure associated with the use of black cohosh: a case report. Liver Transpl 2006;12:989-92. PubMed
  28. Bai W, Henneicke-von Zepelin HH, Wang S, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic black cohosh extract in Chinese women with menopausal symptoms: A randomized, double blind, parallel-controlled study versus tibol
  29. Meyer S, Vogt T, Obermann EC, et al. Cutaneous pseudolymphoma induced by Cimicifuga racemosa. Dermatology 2007;214:94-6.
  30. Gori L, Firenzuoli F. Is black cohosh a hepatotoxic medicinal herb? Forsch Komplementarmed 2007;14:109-10. PubMed
  31. Assessment of case reports connected to herbal medicinal products containing cimicifugae racemosa rhizoma (black cohosh, root). Doc. Ref. EMEA/269259/2006. Available at: www.emea.eu.int/pdfs/human/hmpc/26925806en.pdf (Accessed 30 November 2007).
  32. Chung DJ, Kim HY, Park KH, et al. Black cohosh and St. John's wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J 2007;48:289-94. PubMed
  33. Chow ECY, Teo M, Ring JA, Chen JW. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust 2008;188:420-2. PubMed
  34. Mahady GB, Low Dog T, Barrett ML, et al. United States Pharmacopeia review of the black cohosh case reports of hepatotoxicity. Menopause 2008;15:628-38. PubMed
  35. Hepatotoxicity with black cohosh. Australian Adv Drug Reactions Bull 2006;25:6. Available at: www.tga.gov.au/adr/aadrb/aadr0604.htm#a1.
  36. Dunbar K, Solga SF. Black cohosh, safety, and public awareness. Liver Int 2007;27:1017. PubMed
  37. Patel NM, Derkits RM. Possible increase in liver enzymes secondary to atorvastatin and black cohosh administration. J Pharm Pract 2007;20:341-6. DOI
  38. Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests. Climacteric 2008;11:84-8. PubMed
  39. Australian Adverse Drug Reactions Advisory Committee. Black cohosh and liver toxicity - an update. Aust Adv Drug Reactions Bull 2007;26:11.
  40. Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessement of CYP2D6-mediated herb-drug interactions in humans: Effects of milk-thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Mol Nutr Food Res 2008;52:755-63.
  41. Spangler L, Newton KM, Grothaus LC, et al. The effects of black cohosh therapies on lipids, fibrinogen, glucose and insulin. Maturitas 2007;57:195-204. PubMed
  42. Teschke R, Bahre R, Genthner A, et al. Suspected black cohosh hepatotoxicity - challenges and pitfalls of causality assessment. Maturitas 2009;63:302-14. PubMed
  43. Brasky TM, Lampe JW, Potter JD, et al. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) cohort. Cancer Epidemiol Biomarkers Prev 2010;19:1696-708. PubMed
  44. Fuchikami H, Satoh H, Tsujimoto M, Ohdo S, Ohtani H, Sawada Y. Effects of herbal extracts on the function of human organic anion-transporting polypeptide OATP-B. Drug Metab Dispos 2006;34:577-82. PubMed
  45. Vermes G, Bánhidy F, Acs N. The effects of remifemin on subjective symptoms of menopause. Adv Ther 2005;22:148-54. PubMed
  46. Nuntanakorn, P., Jiang, B., Einbond, L. S., Yang, H., Kronenberg, F., Weinstein, I. B., and Kennelly, E. J. Polyphenolic constituents of Actaea racemosa. J Nat Prod 2006;69(3):314-318.
  47. Oktem M, Eroglu D, Karahan HB, Taskintuna N, Kuscu E, Zeyneloglu HB. Black cohosh and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized trial. Adv Ther 2007;24:448-61. PubMed
  48. Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas 2007;57:405-14. PubMed
  49. Naser, B. and Liske, E. Liver failure associated with the use of black cohosh for menopausal symptoms. Med J Aust. 1-19-2009;190(2):99. PubMed
  50. van de Meerendonk, H. W., van Hunsel, F. P., and van der Wiel, H. E. [Autoimmune hepatitis induced by Actaea racemosa. Side affects of an herb extract]. Ned.Tijdschr.Geneeskd. 2-7-2009;153(6):246-249.
  51. Wong, V. C., Lim, C. E., Luo, X., and Wong, W. S. Current alternative and complementary therapies used in menopause. Gynecol.Endocrinol. 2009;25(3):166-174. PubMed
  52. Pierard, S., Coche, J. C., Lanthier, P., Dekoninck, X., Lanthier, N., Rahier, J., and Geubel, A. P. Severe hepatitis associated with the use of black cohosh: a report of two cases and an advice for caution. Eur J Gastroenterol Hepatol. 2009;21(8):941-945 PubMed
  53. Vannacci, A., Lapi, F., Gallo, E., Vietri, M., Toti, M., Menniti-Ippolito, F., Raschetti, R., Firenzuoli, F., and Mugelli, A. A case of hepatitis associated with long-term use of Cimicifuga racemosa. Altern.Ther Health Med 2009;15(3):62-63.
  54. Zimmermann, R., Witte, A., Voll, R. E., Strobel, J., and Frieser, M. Coagulation activation and fluid retention associated with the use of black cohosh: a case study. Climacteric. 2010;13(2):187-191. PubMed
  55. Amsterdam JD, Yao Y, Mao JJ, Soeller I, Rockwell K, Shults J. Randomized, double-blind, placebo-controlled trial of Cimicifuga racemosa (black cohosh) in women with anxiety disorder due to menopause. J Clin Psychopharmacol 2009;29:478-83. PubMed
  56. Bai WP, Wang SY, Liu JL, Geng L, Hu LN, Zhang ZL, Chen SL, Zheng SR. [Efficacy and safety of remifemin compared to tibolone for controlling of perimenopausal symptoms]. Zhonghua Fu Chan Ke Za Zhi 2009;44:597-600.
  57. McKenzie, S. C. and Rahman, A. Bradycardia in a patient taking black cohosh. Med J Aust. 10-18-2010;193(8):479-481. PubMed
  58. Stolze H. [An alternative to treat menopausal complaints]. Gynecologie 1982;1:14-16.
  59. Guzman G, Kallwitz ER, Wojewoda C, et al. Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh. Case Rep Med. 2009;2009:918156. PubMed
  60. Enbom ET, Le MD, Oesterich L, Rutgers J, French SW. Mechanism of hepatotoxicity due to black cohosh (Cimicifuga racemosa): histological, immunohistochemical and electron microscopy analysis of two liver biopsies with clinical correlation. Exp Mol Pathol. PubMed
  61. Sen A. Orobuccolingual dyskinesia after long-term use of black cohosh and ginseng. J Neuropsychiatry Clin Neurosci 2013 Fall;25(4):E50. PubMed
  62. Hoban CL, Byard RW, Musgrave IF. Analysis of spontaneous adverse drug reactions to echinacea, valerian, black cohosh and ginkgo in Australia from 2000 to 2015. J Integr Med. 2019;17(5):338-343. PubMed
  63. Pkhaladze L, Davidova N, Khomasuridze A, Shengelia R, Panossian AG. Actaea racemosa L. is more effective in combination with Rhodiola rosea L. for relief of menopausal symptoms: a randomized, double-blind, placebo-controlled study. Pharmaceuticals (Basel) PubMed
  64. Yalçin M, Oguz A, Bestepe EE, Saglam NGU, Ergelen M. Black cohosh associated mania in a patient with unipolar depression. Int J Psychiatry Med 2020 Sep 21:91217420961185. doi: 10.1177/0091217420961185. PubMed
  65. Brar HS, Marathi R. Case of cholestatic drug-induced liver injury (DILI) associated with black cohosh. BMJ Case Rep 2021;14(5):e240408. PubMed
  66. Castelo-Branco C, Navarro C, Beltrán E, Losa F, Camacho M; on the behalf of the Natural Products Study Group of the Spanish Menopause Society. Black cohosh efficacy and safety for menopausal symptoms. The Spanish Menopause Society statement. Gynecol Endoc PubMed
  67. Trant AA, Chagpar A, Wei W, et al. The Effect of Black Cohosh on Ki67 expression and Tumor Volume: A Pilot Study of Ductal Carcinoma in Situ Patients. Integr Cancer Ther 2022;21:15347354221137290. PubMed
  68. Dernbach MR, Carpenter JE, Shah N, Carter GB. Black Cohosh Interactions with Prescription Medications Associated with Serotonin Toxicity and Rhabdomyolysis: A Case Report. J Emerg Med 2024;66(5):e592-e596. PubMed

See these in context on the Black Cohosh monograph →

Saffron 22 references
  1. Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein. Boston, MA: American Botanical Council, 1998.
  2. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  3. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  4. Feo F, Martinez J, Martinez A, et al. Occupational allergy in saffron workers. Allergy 1997;52:633-41. PubMed
  5. Wuthrich B, Schmid-Grendelmeyer P, Lundberg M. Anaphylaxis to saffron. Allergy 1997;52:476-7. PubMed
  6. Akhondzadeh S, Tahmacebi-Pour N, Noorbala AA, et al. Crocus sativus L. in the treatment of mild to moderate depression: a double-blind, randomized and placebo-controlled trial. Phytother Res 2005;19:148-51.
  7. Safarinejad MR, Shafiei N, Safarinejad S. A prospective double-blind randomized placebo-controlled study of the effect of saffron (Crocus sativus Linn.) on semen parameters and seminal plasma antioxidant capacity in infertile men with idiopathic oligoasth
  8. Fatehi, M., Rashidabady, T., and Fatehi-Hassanabad, Z. Effects of Crocus sativus petals' extract on rat blood pressure and on responses induced by electrical field stimulation in the rat isolated vas deferens and guinea-pig ileum. J Ethnopharmacol. 2003; PubMed
  9. Modaghegh, M. H., Shahabian, M., Esmaeili, H. A., Rajbai, O., and Hosseinzadeh, H. Safety evaluation of saffron (Crocus sativus) tablets in healthy volunteers. Phytomedicine. 2008;15(12):1032-1037. PubMed
  10. Imenshahidi, M., Hosseinzadeh, H., and Javadpour, Y. Hypotensive effect of aqueous saffron extract (Crocus sativus L.) and its constituents, safranal and crocin, in normotensive and hypertensive rats. Phytother.Res 12-9-2009;
  11. Zhang, Y., Shoyama, Y., Sugiura, M., and Saito, H. Effects of Crocus sativus L. on the ethanol-induced impairment of passive avoidance performances in mice. Biol.Pharm Bull. 1994;17(2):217-221. PubMed
  12. Wuthrich, B., Schmid-Grendelmeyer, P., and Lundberg, M. Anaphylaxis to saffron. Allergy 1997;52(4):476-477. PubMed
  13. Akhondzadeh S, Sabet MS, Harirchian MH, Togha M, Cheraghmakani H, Razeghi S, Hejazi SSh, Yousefi MH, Alimardani R, Jamshidi A, Zare F, Moradi A. Saffron in the treatment of patients with mild to moderate Alzheimer's disease: a 16-week, randomized and plac
  14. Kashani L, Eslatmanesh S, Saedi N, Niroomand N, Ebrahimi M, Hosseinian M, Foroughifar T, Salimi S, Akhondzadeh S. Comparison of Saffron versus Fluoxetine in Treatment of Mild to Moderate Postpartum Depression: A Double-Blind, Randomized Clinical Trial. Ph PubMed
  15. Kianbakht S, Ghazavi A. Immunomodulatory effects of saffron: a randomized double-blind placebo-controlled clinical trial. Phytother Res. 2011 Dec;25(12):1801-5. PubMed
  16. Mazidi M, Shemshian M, Mousavi SH, Norouzy A, Kermani T, Moghiman T, Sadeghi A, Mokhber N, Ghayour-Mobarhan M, Ferns GA. A double-blind, randomized and placebo-controlled trial of Saffron (Crocus sativus L.) in the treatment of anxiety and depression. J C
  17. Safarinejad MR, Shafiei N, Safarinejad S. An open label, randomized, fixed-dose, crossover study comparing efficacy and safety of sildenafil citrate and saffron (Crocus sativus Linn.) for treating erectile dysfunction in men naïve to treatment. Int J Impo PubMed
  18. Talaei A, Hassanpour Moghadam M, Sajadi Tabassi SA, Mohajeri SA. Crocin, the main active saffron constituent, as an adjunctive treatment in major depressive disorder: a randomized, double-blind, placebo-controlled, pilot clinical trial. J Affect Disord. 2 PubMed
  19. Azimi P, Ghiasvand R Feizi A, Hariri M, Abbasi B. Effects of cinnamon, cardamom, saffron, and ginger consumption on markers of glycemic control, lipid profile, oxidative stress, and inflammation in type 2 diabetes. Rev Diabet Stud. 2014 Fall-Winter;11(3-4
  20. Begas E, Bounitsi M, Kilindris T, et al. Effects of short-term saffron (Crocus sativus L.) intake on the in vivo activities of xenobiotic metabolizing enzymes in healthy volunteers. Food Chem Toxicol. 2019;130:32-43. PubMed
  21. Moravej Aleali A, Amani R, Shahbazian H, Namjooyan F, Latifi SM, Cheraghian B. The effect of hydroalcoholic Saffron (Crocus sativus L.) extract on fasting plasma glucose, HbA1c, lipid profile, liver, and renal function tests in patients with type 2 diabet
  22. Abbaszadeh-Mashkani S, Hoque SS, Banafshe HR, Ghaderi A. The effect of crocin (the main active saffron constituent) on the cognitive functions, craving, and withdrawal syndrome in opioid patients under methadone maintenance treatment. Phytother Res. 2021; PubMed

See these in context on the Saffron monograph →

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Supplement interaction checker › Check any supplement or product against your medications Drug–drug interactions › Check two or more of your medications against each other Browse medications A–Z › Every drug we've checked against herbs & supplements NDC & pricing lookup › Find a drug’s NDCs, packaging and costs Ask a pharmacist › Free, personal answer from our licensed team