Amazon A P by Raintree Nutrition, Inc.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Benign prostatic hyperplasia (BPH). Oral boldo has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with BPH, some of whom were already receiving conventional treatment such as alpha-1 blockers, shows that taking a specific product containing water-soluble extracts of boldo, goldenrod, chanca piedra, fireweed, and spiny restharrow (Fluxonorm, Omega Pharma) orally for 30 days improves lower urinary tract symptom scores by about 50% when compared with baseline. Maximum urinary flow rate and quality of life were also improved when compared with baseline (106432). The validity of these findings is limited by the lack of a comparator group.
• Gallbladder disease. Although there has been interest in using oral boldo for gallbladder disease, there is insufficient reliable information about the clinical effects of boldo for this purpose.
• Gonorrhea. Although there has been interest in using oral boldo for gonorrhea, there is insufficient reliable information about the clinical effects of boldo for this purpose.
• Kidney stones (nephrolithiasis). Oral boldo has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in children 6-18 years of age with upper ureteral tract kidney stones shows that taking a specific combination product containing boldo 200 mg, uva ursi 300 mg and Herniaria hirsuta 40 mg (Renalit-combi, Bio-Stilogit Pharmaceuticals) orally for 12 days each month for 3 months after undergoing lithotripsy, in addition to standard care, reduces presence of residual stone fragments by 58% when compared with standard care alone (109936).
• Joint pain. Although there has been interest in using oral boldo for joint pain, there is insufficient reliable information about the clinical effects of boldo for this purpose. More evidence is needed to rate boldo for these uses.

(Read more about BOLDO)

There is insufficient reliable information available about the effectiveness of carqueja.

(Read more about CARQUEJA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Intestinal parasite infection. Although there has been interest in using oral chenopodium oil for intestinal parasite infections, there is insufficient reliable information about the clinical effects of chenopodium oil for this purpose. More evidence is needed to rate chenopodium oil for this use.

(Read more about CHENOPODIUM OIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Although there has been interest in using oral cinchona for cancer, there is insufficient reliable information about the clinical effects of cinchona for this purpose.
• Hemorrhoids. Although there has been interest in using oral or topical cinchona for hemorrhoids, there is insufficient reliable information about the clinical effects of cinchona for this purpose.
• Influenza. Although there has been interest in using oral cinchona for influenza, there is insufficient reliable information about the clinical effects of cinchona for this purpose.
• Leg cramps. Although there has been interest in using oral cinchona for leg cramps, there is insufficient reliable information about the clinical effects of cinchona for this purpose.
• Malaria. Although there has been interest in using oral cinchona for malaria, there is insufficient reliable information about the clinical effects of cinchona for this purpose.
• Muscle cramps. Although there has been interest in using oral cinchona for muscle cramps, there is insufficient reliable information about the clinical effects of cinchona for this purpose.
• Respiratory tract infections. Although there has been interest in using oral cinchona for respiratory tract infections, there is insufficient reliable information about the clinical effects of cinchona for this purpose.
• Varicose veins. Although there has been interest in using oral or topical cinchona for varicose veins, there is insufficient reliable information about the clinical effects of cinchona for this purpose. More evidence is needed to rate cinchona for these uses.

(Read more about CINCHONA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bladder cancer. Oral graviola has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Low-quality, observational research in adults with intermediate to high-risk non-muscular invasive bladder cancer has found that taking graviola 100 mg and ellagic acid 100 mg daily for 6 months is associated with 83% higher recurrence-free survival when compared with no intervention. However, taking graviola and ellagic acid was only associated with higher recurrence-free rates at 6 months, not at 12 months. All subjects included in this study were also unable to receive standard recurrence prevention therapy with Bacillus Calmette-Guerin (BCG) (106054).
• Cancer. Although there has been interest in using oral graviola for cancer, there is insufficient reliable information about the clinical effects of graviola for this purpose.
• Cough. Although there has been interest in using oral graviola for cough, there is insufficient reliable information about the clinical effects of graviola for this purpose.
• Diabetes. Although there has been interest in using oral graviola for diabetes, there is insufficient reliable information about the clinical effects of graviola for this purpose.
• Headache. Although there has been interest in using oral graviola for headache, there is insufficient reliable information about the clinical effects of graviola for this purpose.
• Human papillomavirus (HPV). Oral graviola has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adult females with HPV and low-grade squamous intraepithelial lesions (L-SIL) shows that taking a combination of graviola 100 mg and ellagic acid 16 mg orally twice daily for 6 months increases viral clearance of high-risk HPV by 3-fold when compared with placebo. Graviola treatment also prevented the progression of L-SIL to high-grade squamous intraepithelial lesions (H-SIL) in all patients, whereas 12% of subjects taking placebo progressed to H-SIL (96297). A small observational study in females with HPV suggests that taking graviola 100 mg and ellagic acid 16 mg (Oasit-K, BioSTILOGIT Pharmaceuticals) once daily for 12 months is not associated with improved detection of HPV DNA high-risk genotypes or E6 and E7 oncogene mRNA when compared with nonavalent HPV vaccination, but is linked with reduced cytological abnormalities observed on Pap test when compared to baseline (112855). Additionally, a small observational study in males with HPV and infertility suggests that taking graviola 100 mg and ellagic acid 100 mg daily for 3 months is associated with a reduced percentage of patients with persistent HPV DNA in seminal fluid and improved sperm concentration, motility, and morphology when compared with control (112853). However, for these studies, it is unclear if these effects are from graviola, ellagic acid, or the combination.
• Insect repellent. Although there has been interest in using topical graviola as an insect repellent, there is insufficient reliable information about the clinical effects of graviola for this purpose.
• Interstitial cystitis. Although there has been interest in using oral graviola for interstitial cystitis, there is insufficient reliable information about the clinical effects of graviola for this purpose.
• Leishmania lesions. Although there has been interest in using topical graviola for leishmania lesions, there is insufficient reliable information about the clinical effects of graviola for this purpose.
• Male infertility. Oral graviola has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small observational study in males with human papilloma virus (HPV) and infertility suggests that taking graviola 100 mg and ellagic acid 100 mg daily for 3 months is associated with a reduced percentage of patients with persistent HPV DNA in seminal fluid and improved sperm concentration, motility, and morphology when compared with control (112853). More evidence is needed to rate graviola for these uses.

(Read more about GRAVIOLA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Lice. Preliminary clinical research shows that a single application of quassia tincture can kill head lice. However, the single application of quassia tincture resulted in 0.6% reinfestation rate after a week (17492). Researchers suggest that two applications with a one-week interval between them might be more effective.
• Rosacea. Preliminary clinical research in patients with rosacea shows that applying quassia 4% gel twice daily for 45 days reduces flushing, redness, and telangiectasia by approximately 74%, 56%, and 50%, respectively, compared with baseline. A moderate to complete overall improvement occurred in 89% of patients (99995). The validity of these results is limited by a lack of control group.
• Seborrheic dermatitis. Preliminary clinical research shows that applying quassia 4% gel twice daily for 28 days results in complete remission in 29.4% of patients with seborrheic dermatitis. This response rate is higher than the 5.6% and 7.1% response rate for patients using 1% ciclopirox olamine or 2% ketoconazole. At one-month post-treatment, quassia was more effective than the other two treatments for avoiding relapse (99994). However, the lack of placebo group makes conclusions difficult. More evidence is needed to rate quassia for these uses.

(Read more about QUASSIA)

There is insufficient reliable information available about the effectiveness of simaruba.

(Read more about SIMARUBA)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Boldo has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).

POSSIBLY UNSAFE ...when used orally in medicinal amounts. The volatile oil (2.5% in the leaf) contains the liver toxin ascaridole (4). Boldo has also been linked to a documented case of liver damage (13178). If boldo preparations are taken for medicinal purposes, only ascaridole-free preparations should be used. There is insufficient reliable information available about the safety of boldo when used topically.

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally in medicinal amounts. In animals, boldo and the constituent boldine have abortive and teratogenic effects (100302). Also, the ascaridole constituent of boldo is a liver toxin (4).

(Read more about BOLDO)

There is insufficient reliable information available about the safety of carqueja.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CARQUEJA)

UNSAFE ...when used orally due to toxicity (11).

PREGNANCY AND LACTATION: UNSAFE
when used orally due to toxicity (11).

(Read more about CHENOPODIUM OIL)

LIKELY SAFE ...when used orally as a flavoring in tonic water and alcoholic beverages. The US Code of Federal Regulations allows not more than 83 parts per million (ppm) of total cinchona alkaloids in finished beverages (93229).

POSSIBLY UNSAFE ...when used orally in medicinal amounts. Cinchona derivatives marketed as over-the-counter (OTC) medicines are required to carry the warning, "Caution - discontinue use if ringing in the ears, deafness, skin rash, or visual disturbances occur" (93231). Cinchona contains the alkaloid quinine that was previously available OTC in the US for treatment and prevention of nocturnal leg muscle cramps. In 1994 the US Food and Drug Administration (FDA) determined that quinine was not generally recognized as safe and effective for this indication, citing serious adverse reactions and its narrow therapeutic index (93232,93233). A final ban on marketing of OTC quinine products was implemented by the FDA in 2007, and a Risk Evaluation and Mitigation Strategy (REMS) to reduce off-label use of prescription quinine products for night-time leg cramps was introduced in 2010 (93232).

LIKELY UNSAFE ...when excessive amounts are used orally. Cinchona contains the alkaloids quinine and quinidine, which are used as prescription medicines and have been associated with significant adverse effects at doses of 2 grams per day or more (505). The amount of these constituents in cinchona products is variable (13).

PREGNANCY: LIKELY UNSAFE
when used orally. Cinchona is reported to have uterine stimulant and abortifacient activity, and to be fetotoxic and teratogenic, causing visual and auditory defects (12,19). Avoid using.

LACTATION: POSSIBLY UNSAFE
when used orally. The cinchona alkaloids quinine and quinidine are reported to be excreted in breast milk and may be toxic to infants (19).

(Read more about CINCHONA)

POSSIBLY UNSAFE ...when used orally. Some research has found that consumption of large amounts of graviola fruit and/or tea made from graviola leaves (e.g., daily) is associated with an increased odds of having movement disorders that resemble Parkinson disease (7854).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally (7854).

(Read more about GRAVIOLA)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Quassia has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used topically and appropriately. A 4% quassia gel has been safely used twice daily for up to 45 days (99995).

POSSIBLY UNSAFE ...when used orally in medicinal amounts. Quassia wood contains cardioactive glycosides (4), but toxicity is likely limited by emetic effects of large doses (4). There is insufficient reliable information available about the safety of rectal use of quassia.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally; avoid using. Quassia has cytotoxic and emetic properties (4,18,19). There is insufficient reliable information available about the safety of rectal or topical use during pregnancy or lactation; avoid using.

(Read more about QUASSIA)

There is insufficient reliable information available about the safety of simaruba.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally during pregnancy due to apparent abortifacient effects (18,4500); avoid using. There is insufficient reliable information available about the safety of simaruba during lactation.

(Read more about SIMARUBA)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking boldo with anticoagulant/antiplatelet drugs might increase the risk of bleeding.  Details Animal and in vitro research shows that boldine, a constituent of boldo, has antiplatelet activity (5191,36789). In one case report, an adult taking a combination of boldo and fenugreek with warfarin experienced an increase in international normalized ratio (INR); however, it is unclear if this effect was due to boldo, fenugreek, the combination, or another factor (5191).

HEPATOTOXIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking boldo with hepatotoxic drugs might increase the risk of hepatic injury and disease.  Details Boldo leaf contains ascaridole, a known liver toxin. Many cases of hepatotoxicity, including elevated liver transaminase levels and jaundice, have been reported in patients taking boldo (13178,100304,106431).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking boldo with lithium might increase the levels and clinical effects of lithium.  Details Boldo is believed to have diuretic effects (4). Theoretically, these diuretic effects might reduce the excretion of lithium. The dose of lithium might need to be decreased.

TACROLIMUS (Prograf) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Taking boldo with tacrolimus may decrease the levels and clinical effects of tacrolimus, potentially increasing the risk of transplant rejection.  Details In one case report, a patient with a long-term history of stable tacrolimus levels developed subtherapeutic levels after taking boldo 300 mg twice daily orally for several weeks. Tacrolimus levels returned to normal after discontinuing boldo. However, the mechanism of this interaction is unclear (92601).

(Read more about BOLDO)

(Read more about CARQUEJA)

PHOTOSENSITIZING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, concomitant use of chenopodium oil with other photosensitizing drugs can increase the risk of adverse effects.  Details Chenopodium species are also associated with photosensitivity (19).

(Read more about CHENOPODIUM OIL)

ANTACIDS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking cinchona might decrease the effectiveness of antacids. Theoretically, taking antacids might also increase the risk of adverse effects from cinchona.  Details Some research shows that taking cinchona lowers stomach acid pH (19). In addition, some research shows that taking antacids might increase urinary pH. Theoretically, this may increase the amount of quinidine, a constituent of cinchona, reabsorbed in the renal tubules and increase the risk of quinidine toxicity (3046).

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking cinchona might increase the drug effects and risk of bleeding with anticoagulant and antiplatelet drugs.  Details In vitro evidence shows that the alkaloids quinine, quinidine, and cinchonine, constituents of cinchona, inhibit platelet aggregation (19,93228).

CARBAMAZEPINE (Tegretol) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Theoretically, taking cinchona might increase the adverse effects of carbamazepine.  Details Clinical research shows that taking quinine, a constituent of cinchona, increases the peak plasma concentration and area under the curve of carbamazepine (11016).

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking cinchona might inhibit cytochrome P450 2D6 (CYP2D6) and increase levels of drugs metabolized by this enzyme.  Details Quinidine, a constituent of cinchona, inhibits CYP2D6-mediated metabolism in humans (3046,95687).

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking cinchona might increase serum levels of digoxin.  Details Quinine and quinidine, which are constituents of cinchona, decrease clearance of digoxin and increase serum digoxin levels in humans (3046).

H2-BLOCKERS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking cinchona might decrease the effectiveness of H2-blockers.  Details Some research shows that taking cinchona lowers stomach acid pH (19).

PHENOBARBITAL (Luminal) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking cinchona might increase the adverse effects of phenobarbital.  Details Clinical research shows that taking quinine, a constituent of cinchona, increases the peak plasma concentration and area under the curve of phenobarbital (504,11016).

PROTON PUMP INHIBITORS (PPIs) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking cinchona might decrease the effectiveness of PPIs.  Details Some research shows that taking cinchona lowers stomach acid pH (19).

QT INTERVAL-PROLONGING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking cinchona with other QT interval-prolonging drugs might cause an additive effect and increase the risk of ventricular arrhythmias.  Details Quinidine and quinine, which are constituents of cinchona, prolong the QT interval (3046).

QUINIDINE Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking cinchona might increase plasma levels and adverse effects of quinidine.  Details Cinchona contains quinidine (505).

QUININE Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking cinchona might increase plasma levels and adverse effects of quinine.  Details Cinchona contains quinine (505).

(Read more about CINCHONA)

CARBAMAZEPINE (Tegretol) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, graviola might decrease concentrations of carbamazepine when used concomitantly.  Details A study in rats shows that graviola extract reduces the area under the curve of carbamazepine by 46% and maximum concentration by 35% when compared with carbamazepine alone (112852).

(Read more about GRAVIOLA)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D In animals, quassia extract reduced levels of fasting glucose (99998). Theoretically, quassia might have additive effects when used with antidiabetes drugs. This might increase the risk of hypoglycemia in some patients. Monitor blood glucose levels closely.  Details Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others.

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Overuse of quassia might compound diuretic-induced potassium loss (13). There is some concern that people taking quassia along with potassium depleting diuretics might have an increased risk for hypokalemia. Initiation of potassium supplementation or an increase in potassium supplement dose may be necessary for some patients.  Details Some diuretics that can deplete potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), and hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), and others.

(Read more about QUASSIA)

(Read more about SIMARUBA)

General ...Orally, boldo is generally well tolerated when used in amounts commonly found in foods. However, when used in medicinal amounts, boldo can cause significant adverse effects such as hepatotoxicity. There is currently a limited amount of information on the adverse effects of topical boldo; however, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Abdominal pain, nausea, vomiting.
Topically: Dermatitis.
Severe Adverse Effects (Rare):
Orally: Hepatotoxicity, jaundice.

Cardiovascular ...In one report, a 39-year-old obese female developed palpitations and syncope after taking a weight loss supplement containing a combination of boldo, dandelion, and bladderwrack for 3 weeks. The patient was found to have prolonged QT-interval on ECG and frequent episodes of sustained polymorphic ventricular tachycardia (14321). It is not clear whether boldo, another ingredient, or the combination of ingredients is responsible for this adverse effect. The product was not analyzed to determine the presence of any potential toxic contaminants.

Dermatologic ...Topically, boldo can be irritating when applied to the skin (4). In one case report, a healthy 64-year-old patient experienced allergic contact dermatitis in an airborne pattern on the face, arms, and dorsum of both hands following airborne exposure to boldo. After exposure to boldo was avoided, the dermatitis resolved (106433).

Gastrointestinal ...In one case report, a manufacturer of an herbal laxative reformulated their product to contain boldo. Within 5 months of switching to this reformulated product, an 82-year-old male developed abdominal discomfort with gastrointestinal upset including heartburn (13178). In another case, a 72-year-old female reported nausea, vomiting, and anorexia, which were thought to be associated with hepatotoxic effects of a boldo infusion (100304).

Hepatic ...Orally, boldo is thought to potentially cause hepatotoxicity. The volatile oil from the boldo leaf contains the liver toxin, ascaridole. In one case report, a manufacturer of an herbal laxative reformulated their product to contain boldo. Within 5 months of switching to this reformulated product, an 82-year-old male with mild hepatic steatosis and very small gallbladder stones developed elevated liver transaminase levels. Levels normalized following discontinuation of the herbal product (13178). Several other cases of hepatotoxicity have been reported in elderly patients who received infusions of boldo leaves. These patients presented with elevated liver transaminase and bilirubin levels, sometimes up to 200 times the upper limit of normal, as well as nausea, vomiting, anorexia, asthenia, and jaundice. Lab tests and symptoms normalized a few days after stopping boldo (100304,106431).

Immunologic ...Boldo intake has been linked to one case of IgE-mediated anaphylactic allergic reaction (13185).

(Read more about BOLDO)

General ...No adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about CARQUEJA)

General ...Orally, chenopodium oil is unsafe.
Most Common Adverse Effects:
Orally: Dizziness, headache, mucous membrane irritation, skin irritation, vertigo, vomiting.
Serious Adverse Effects (Rare):
Orally: Circulatory collapse, convulsions, deafness, death, kidney and liver damage, paralysis.

Dermatologic ...Orally, chenopodium oil can cause skin and mucous membrane irritation (11).

Gastrointestinal ...Orally, chenopodium oil can cause vomiting (11).

Hepatic ...Orally, chenopodium oil can cause liver damage (11).

Neurologic/CNS ...Orally, chenopodium oil affects the nervous system and can cause headache, vertigo/dizziness, temporary deafness, convulsions, circulatory collapse, paralysis, and death (11).

Renal ...Orally, chenopodium oil can cause kidney damage (11).

(Read more about CHENOPODIUM OIL)

General ...Information on the adverse effects of cinchona is limited. Orally, prolonged use of high doses of cinchona can cause severe adverse effects. Topically, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Diarrhea, nausea, ringing ears, vomiting.
Topically: Contact dermatitis, urticaria.
Serious Adverse Effects (Rare):
Orally: Arrhythmias, cinchonism syndrome, hemolytic uremic syndrome, QT prolongation, thrombotic thrombocytopenic purpura.

Cardiovascular ...Cinchona contains the alkaloids quinidine and quinine that can prolong the QT interval on the electrocardiogram, and cause potentially fatal cardiac arrhythmias such as torsades de pointes (3046,93232)

Dermatologic ...Topical use of cinchona bark extracts and occupational exposure to cinchona bark dust can cause contact dermatitis and other urticarial reactions (11,93234). A 31-year old man developed itching, erythema, and edema of the face and upper chest after occupational exposure to dust from cinchona bark. Skin testing produced reactions to ethanol and ether extracts of the bark, but not to the individual alkaloids quinine and quinidine (93234).

Gastrointestinal ...Cinchona stimulates secretion of stomach acid and has been associated with nausea, vomiting, and diarrhea (6,19).

Hematologic ...Quinine, which is present in cinchona, has been associated with serious, sometimes fatal, hematological disorders including thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (hemolytic anemia, acute renal failure, and thrombocytopenia) (93232,93233). Initial symptoms may include bleeding from the gums, nose or gastrointestinal tract, easy bruising, and petechiae (93233). Bone marrow depression and thrombocytopenia have also been associated with quinidine (505).

Immunologic ...Oral use of quinine, an alkaloid present in cinchona, has been associated with severe allergic skin reactions, as well as anaphylaxis (19,93232).

Ocular/Otic ...Cinchona contains quinine that can cause dose-related adverse effects on hearing and vision, including tinnitus, deafness, vision changes, and blindness (6,8,12,93232).

Other ...Orally, prolonged use of high doses of cinchona or its alkaloids, or a single dose of 3 grams or more of the alkaloid quinine are associated with a toxicity syndrome known as cinchonism. Symptoms include headache, dizziness, nausea and vomiting, diarrhea, hemolysis, hypotension, cardiac arrhythmias, tinnitus, deafness, vision changes, blindness, abdominal pain, delirium, convulsions, paralysis, and collapse (6,12,19,505,93232). Doses of 10-15 grams of quinine may be fatal (18).

(Read more about CINCHONA)

General ...Orally, regular consumption of graviola may be unsafe.
Most Common Adverse Effects:
Orally: Epigastrium pain, nausea.
Serious Adverse Effects (Rare):
Orally: Movement disorders, myeloneuropathy.

Gastrointestinal ...In one clinical study, some patients reported nausea and burning pain in the epigastrium after taking graviola leaf extract 300 mg daily (95045).

Neurologic/CNS ...Orally, regular consumption of graviola fruit may cause movement disorders and myeloneuropathy. The symptoms of these disorders are similar to Parkinson disease (7854). In addition, a large observational study in patients with Parkinson disease suggests that even low cumulative consumption of graviola fruit, juice, or any amount of herbal tea containing graviola is associated with worsened motor and cognitive symptoms (112854).

(Read more about GRAVIOLA)

General ...Orally, quassia can cause mucous membrane irritation, nausea, and vomiting when used in medicinal amounts (4,18). Long-term use can cause vision changes and blindness (18).
Topically, quassia seems to be well tolerated (99995). No adverse effects have been reported.

Gastrointestinal ...Orally, quassia has been reported to cause mucous membrane irritation, nausea, and vomiting when used in medicinal amounts (4,18).

Ocular/Otic ...Orally, long-term use of quassia can cause vision changes and blindness (18).

(Read more about QUASSIA)

General ...Orally, ingesting large amounts of simaruba can cause vomiting (18).

Gastrointestinal ...Orally, ingesting large amounts of simaruba can cause vomiting (18).

(Read more about SIMARUBA)