Sinutol Extra Strength [Discontinued] by EuroMedica

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Although there is interest in using topical eucalyptus for acne, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Asthma. A small clinical study suggests that taking the eucalyptol constituent of eucalyptus orally might have a steroid-sparing effect in some patients with asthma. Details: Preliminary clinical research in patients with steroid-dependent asthma shows that taking eucalyptol, a constituent of eucalyptus oil, 200 mg three times daily orally for 12 weeks, allows for an average reduction in prednisolone doses of 36%, compared with a 7% reduction in those taking placebo (13302).
• Bronchitis. Oral eucalyptol has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Some clinical research in patients with chronic bronchitis shows that taking a specific combination product containing eucalyptol and extracts of pine and lime (Myrtol standardized, MYS, Gelomyrtol forte) 900 mg daily orally for at least 1 month decreases the proportion of patients with acute exacerbations by 72%, compared with 53% for those taking placebo (48925). In patients with acute bronchitis, receiving the same product in a dose of 1200 mg daily for 14 days is associated with a reduction in symptoms in all but 1% of patients, compared with 32% of patients receiving placebo (48932).
• Burns. Although there is interest in using topical eucalyptus for burns, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Cancer. Although there is interest in using oral eucalyptus for cancer, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Chronic obstructive pulmonary disease (COPD). A small clinical study suggests that the eucalyptol constituent of eucalyptus might reduce acute exacerbations in patients with stable COPD. Details: Clinical research in adults with stable, moderate to severe COPD shows that adding eucalyptol, 200 mg three times daily, to conventional therapy for 6 months, including the winter season, reduces the proportion of patients experiencing acute exacerbations from 46% to 28% when compared with placebo (104960).
• Cough. Oral eucalyptus oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of four clinical studies in patients with cough associated with bronchitis or upper respiratory tract infection shows that taking eucalyptus oil, either in combination with pine and lime essential oils (Myrtol or Gelomyrtol) or with Origanum syriacum, peppermint, and rosemary essential oils, daily for up to 6 months increases the likelihood of improvement or resolution of cough symptoms by 45% when compared with placebo (110095).
• Dental plaque. Using chewing gum containing eucalyptus extract might reduce dental plaque. Details: Preliminary clinical research shows that chewing gum containing 0.3% to 0.6% eucalyptus extract 3-5 times daily for 4 days to 12 weeks reduces dental plaque when compared with placebo (49010,92863).
• Diabetes. Although there is interest in using oral eucalyptus for diabetes, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Endotracheal intubation-associated adverse effects. It is unclear if nebulized eucalyptus oil is beneficial for prevention of complications associated with endotracheal intubation. Details: A small clinical study in Iranian patients intubated and receiving care in the intensive care unit shows that nebulizing 4 mL of eucalyptus 5% oil in 6 mL of normal saline every 8 hours for 3 days increases oxygen saturation and decreases peak inspiratory pressure, but does not affect the level of consciousness as measured using the Glasgow Coma Scale, when compared with nebulized normal saline (110096).
• Fever. Inhaled eucalyptus oil has only been evaluated in combination with other ingredients for fever following vaccination; its effect when used alone is unclear. Details: A large clinical study in adults shows that inhaling aromatherapy with eucalyptus oil 0.05 mL in combination with topical application of tea tree oil 0.05 mL on the affected arm every 2 hours while awake for 3 days after COVID-19 vaccination reduces the frequency of self-reported fever when compared with control during the first 48 hours after vaccination (113141). The interpretation of these results is limited by baseline group differences in receipt of various COVID-19 vaccine products, which may differ in side effect frequency. Also, it is unclear if these effects are due to eucalyptus, tea tree oil, or the combination.
• Genital herpes. Although there is interest in using topical eucalyptus for genital herpes, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Gingivitis. Using chewing gum containing eucalyptus extract might improve gingivitis. Details: Preliminary clinical research shows that chewing gum containing 0.4% to 0.6% eucalyptus extract five times daily for 4 days improves gingivitis when compared with placebo (92863).
• Gonorrhea. Although there is interest in using oral eucalyptus for gonorrhea, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Halitosis. Using chewing gum containing eucalyptus extract might improve halitosis. Details: Preliminary clinical research shows that chewing gum containing 0.4% to 0.6% eucalyptus extract five times daily for 12 weeks significantly improves halitosis and coating of the tongue when compared with placebo (92863).
• Headache. Topical eucalyptus has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that applying a combination of peppermint oil, eucalyptus oil, and ethanol topically to the forehead and temples does not affect headache pain, but improves cognitive performance and produces relaxation, when compared with placebo (3801).
• Influenza. Although there is interest in using oral or inhaled eucalyptus for influenza, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Injection site reaction. Inhaled eucalyptus oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large clinical study in adults shows that inhaling aromatherapy with eucalyptus oil 0.05 mL in combination with topical application of tea tree oil 0.05 mL on the affected arm every 2 hours while awake for 3 days after COVID-19 vaccination improves self-reported muscle ache, localized swelling, pain, and fever, but not erythema, joint pain, or headache when compared with control in the first 24 hours after vaccination. However, at 24-48 hours, only localized swelling and fever were improved in the group using eucalyptus and tea tree oil (113141). The interpretation of these results is limited by baseline group differences in receipt of various COVID-19 vaccine products, which may differ in side effect frequency. Also, it is unclear if these effects are due to eucalyptus, tea tree oil, or the combination.
• Lice. Topical eucalyptus oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with head lice shows that applying eucalyptus oil 11% and lemon tea tree oil 1% (MOOV Head Lice Solution, Ego Pharmaceuticals Pty Ltd.) reduces the ex-vivo egg hatching rate by only 3%, compared with a 44% reduction with tea tree oil and lavender oil (NeutraLice Natural Lotion), and a 68% reduction with benzyl alcohol, mineral oil, and triethanolamine (NeutraLice Advance) (19188). However, other research in elementary school aged children shows that applying the MOOV Head Lice Solution combination product to the scalp for 10 minutes, once weekly for 3 weeks, is more effective than applying pyrethrins and piperonyl butoxide once weekly for 2 weeks. At 7 days after the last application, 71% of children treated with the eucalyptus formulation were still free of lice, compared with 33% of children in the control group (98492).
• Onychomycosis. Although there is interest in using topical eucalyptus for onychomycosis, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Oral mucositis. Although there is interest in using topical or oral eucalyptus for oral mucositis, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Osteoarthritis. Although there is interest in using topical eucalyptus for osteoarthritis, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Rheumatoid arthritis (RA). It is unclear if inhaled eucalyptus oil is beneficial in patients with RA. Details: A small clinical study in patients with RA shows that aromatherapy with eucalyptus essential oil, delivered by applying 2 mL of oil to pads attached to clothing for 5 minutes three times daily for 1 month, reduces pain and improves quality of life when compared with placebo (110094).
• Rhinosinusitis. Although there is interest in using inhaled eucalyptus for rhinosinusitis, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Tinea corporis. Although there is interest in using topical eucalyptus for tinea corporis, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Tuberculosis. Although there is interest in using oral eucalyptus for tuberculosis, there is insufficient reliable information about the clinical effects of eucalyptus for this condition.
• Ventilator-associated pneumonia (VAP). It is unclear if eucalyptus is beneficial for the prevention of VAP. Details: Preliminary clinical research in ventilated adult patients shows that nebulizing a 2% eucalyptus solution for about 20 minutes every 8 hours reduces the incidence of late bacterial pneumonia (occurring more than 96 hours after initiation of ventilation) from 58% to 30% when compared with placebo. In those patients who developed VAP, the onset occurred approximately 3 days later, on average, in the eucalyptus group than in the placebo group (104958).
• Wound healing. Although there is interest in using topical eucalyptus for wound healing, there is insufficient reliable information about the clinical effects of eucalyptus for this condition. More evidence is needed to rate eucalyptus for these uses.

(Read more about EUCALYPTUS)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Lemon has only been evaluated in combination with quince in a nasal spray for hay fever; its effect when used alone is unclear. Details: A small clinical study in patients with grass pollen allergy shows that using a specific nasal spray (Gencydo, Weleda AG) containing lemon and quince three times daily for 7 days does not improve the symptoms of allergic rhinitis when compared with placebo. In this study, using the nasal spray reduced airway resistance during inspiration at 10 and 20 minutes after pollen exposure, and reduced airway resistance during expiration at 20 minutes after pollen exposure (98826).
• Anxiety. It is unclear if aromatherapy with lemon essential oil reduces test anxiety. Details: A small clinical study in first year nursing students in Turkey shows that administering aromatherapy with lemon essential oil for 15 minutes prior to an exam reduces test anxiety scores when compared with control students (110779). However, it is unclear whether any improvements are clinically significant or lead to improved test scores.
• Halitosis. Lemon essential oil has only been evaluated in combination with other essential oils; its effect when used alone is unclear. Details: Preliminary research in males with dementia in a long-term care facility shows that cleaning the tongue, gums, and teeth with a solution of lemon, peppermint, and tea tree essential oils twice daily for 7 days improves oral condition, measured on the Korean Oral Assessment Guide scale, increases salivary pH into the normal range, and decreases halitosis score when compared with saline control. On a scale of 0 to 5, the essential oil mixture reduced the halitosis score by 1.24 points, compared with 0.2 points for the control (112957).
• Hypertension. It is unclear if oral lemon is beneficial in patients with high blood pressure. Details: A small, prospective, population study in middle-aged Japanese women has found that increased lemon intake is associated with a modest reduction in systolic, but not diastolic, blood pressure (93471).
• Kidney stones (nephrolithiasis). It is unclear if oral lemon juice is beneficial for recurrent idiopathic calcium oxalate nephrolithiasis. Details: A randomized, controlled trial in patients with recurrent idiopathic calcium oxalate nephrolithiasis shows that taking fresh lemon juice 60 mL orally twice daily for 2 years with a standard diet does not improve the time to stone recurrence when compared with no supplementation. The validity of these findings is limited due to poor patient adherence, which declined from 79% at 6 months, to 68% at 1 year, and 48% at 2 years. When restricted to a 1-year follow-up, stone recurrence occurred in 10% of patients taking lemon juice, compared with 21% of patients in the control group; this difference was statistically significant (107489).
• Meniere disease. Although there is interest in using lemon orally for Meniere disease, there is insufficient reliable information about the clinical effects of lemon for this condition.
• Myocardial infarction (MI). It is unclear if aromatherapy with lemon essential oil is beneficial in patients with acute MI. Details: A small clinical study in hospitalized patients with acute MI shows that administering aromatherapy with lemon essential oil over 3 days moderately reduces systolic blood pressure, but not diastolic blood pressure, when compared with a paraffin control. Heart rate and anxiety were reduced by a small amount the day following the completion of lemon aromatherapy (103455).
• Nausea and vomiting. It is unclear if aromatherapy with lemon oil is beneficial in palliative care patients with nausea and vomiting. Details: A small observational study in hospitalized palliative care patients with advanced cancer has found that administering aromatherapy with lemon oil pads relieves nausea and vomiting in 73% of applications (110778). The interpretation of these findings is limited by the use of a retrospective chart review and the lack of a comparator group.
• Obesity. Although there is interest in using lemon orally for obesity, there is insufficient reliable information about the clinical effects of lemon for this condition.
• Oral mucositis. Lemon has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A randomized, controlled trial in patients with head and neck cancer receiving external beam radiotherapy 5 days weekly shows that using a 2:1 oral honey-lemon throat spray four to eight times daily, beginning 1 day prior to radiotherapy initiation and continuing for 5 weeks, does not improve severity of mucositis when compared with oral benzydamine hydrochloride throat spray applied four to eight times daily. The actual rate of oral mucositis occurrence is 65% in those receiving the honey-lemon spray, compared with 35% with the benzydamine hydrochloride spray; however, this difference was not statistically significant (107487). This study may have been inadequately powered to detect a difference between groups. Also, the validity of these findings is limited due to the lack of objective outcome measures.
• Postoperative nausea and vomiting (PONV). It is unclear if aromatherapy with lemon essential oil is beneficial in patients with PONV. Details: Preliminary research in patients undergoing lower extremity fracture surgery shows that aromatherapy with lemon essential oil started the morning of surgery, then every 2 hours to the end of surgery, in the recovery room, and 16 hours after surgery reduces the frequency, severity, and amount of PONV, and the frequency of anti-emetic drug administration after surgery, when compared with control. The intensity of pain is also reduced, but not the amount of post-operative opioid needed (112956).
• Pregnancy-induced nausea and vomiting. It is unclear if aromatherapy with lemon essential oil is beneficial in patients with nausea and vomiting due to pregnancy. Details: A small clinical study in pregnant patients shows that practicing aromatherapy with 2 drops of lemon essential oil placed on a cotton ball as needed modestly reduces pregnancy-induced nausea and vomiting on 2 of 4 days of the study when compared with placebo (93475).
• Radiation-induced sialadenitis. Aromatherapy with lemon essential oil has only been evaluated in combination with other essential oils; its effect when used alone is unclear. Details: A small clinical study in patients with thyroid cancer shows that receiving 10-minute aromatherapy baths with lemon and ginger essential oils prior to meals for 2 weeks before treatment with radioactive iodine therapy attenuates damage to the salivary gland when compared with distilled water baths (98129).
• Respiratory tract infections. Although there is interest in using lemon orally for respiratory tract infections such as cold and flu, there is insufficient reliable information about the clinical effects of lemon for these conditions. More evidence is needed to rate lemon for these uses.

(Read more about LEMON)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. It is unclear if topical myrtle is beneficial in patients with acne. Details: Preliminary clinical research in adults and adolescents with mild to moderate acne shows that applying myrtle leaf extract topically to the face twice daily for 16 weeks reduces facial lesion count and acne severity scores by 23% to 45% when compared to baseline. Improvements were similar to clindamycin 1% topical solution (106777). Also, a small, single-blind trial in females whose mild-to-moderate acne resolved after receiving conventional acne therapy shows that applying a lotion containing myrtle extract and azelaic acid twice daily for 16 weeks reduces the risk of acne relapse, decreases the number of acne lesions, and improves post-inflammatory hyperpigmentation when compared with a placebo cream (111733). It is unclear if these effects are to myrtle, azelaic acid, or the combination.
• Bacterial vaginosis. Although there has been interest in using topical myrtle for bacterial vaginosis, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Canker sores. It is unclear if topical myrtle is beneficial in patients with canker sores. Details: A small clinical study in patients with recurring canker sores shows that applying a paste containing myrtle leaf extract 5% to canker sores four times daily for 6 days decreases ulcer size, pain, and redness when compared with placebo (98643).
• Diarrhea. Although there has been interest in using oral myrtle for diarrhea, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Gastroesophageal reflux disease (GERD). It is unclear if oral myrtle is beneficial in patients with GERD. Details: Preliminary clinical research in adults with GERD shows that taking myrtle berry or myrtle berry extract 1000 mg orally daily for 4 weeks improves GERD symptom scores and frequency when compared with baseline. The improvements were similar to taking omeprazole 20 mg daily. However, the study may have been inadequately powered to detect a difference between groups (98641). Preliminary clinical research in children 1-7 years of age with GERD shows that taking myrtle berry extract syrup 0.21 mL/kg orally three times daily and with meals along with omeprazole 1 mg/kg daily orally for 8 weeks does not reduce GERD scores or symptoms, including vomiting and regurgitation, when compared with taking placebo along with omeprazole. However, the study may have been inadequately powered to detect a difference between groups. (106781).
• Gingivitis. It is unclear if topical myrtle is beneficial in patients with gingivitis. Details: A small cross-over trial in young adults with plaque-induced gingivitis shows that rinsing with an herbal mouth rinse containing fresh plant extracts of myrtle, pomegranate, Quercus brantii, Portulaca oleracea, and Boswellia serrata twice daily after brushing for 2 weeks improves gingivitis indices when compared with placebo, with similar improvements when compared with chlorhexidine 0.2% mouth rinse (111734). Information on the specific plant parts used for each species was lacking. Further, it is unclear if these findings are due to myrtle, other ingredients, or the combination.
• Human papillomavirus (HPV). It is unclear if intravaginal myrtle is beneficial in patients with HPV. Details: Clinical research in adults with cervicovaginal HPV infection shows that insertion of vaginal suppositories containing myrtle leaf extract 10% and essential oil 0.5% daily on non-menstruating days for up to three menstrual cycles reduces positive HPV tests by an additional 30% when compared with placebo suppositories. The myrtle leaf suppository also reduces symptoms of vaginal itching and burning when compared with placebo (98644).
• Intestinal parasite infection. Although there has been interest in using oral myrtle for intestinal parasite infection, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Menorrhagia. It is unclear if oral myrtle is beneficial in patients with menorrhagia. Details: Preliminary clinical research in adults with menorrhagia shows that taking myrtle fruit syrup 5 mL three times daily for 7 days, starting on the first day of bleeding and repeating for three consecutive menstrual cycles, reduces the duration of bleeding by 2.4 days when compared to baseline. The validity of this study is limited by the lack of a comparator group (98642). Other preliminary clinical research in adults with menorrhagia shows that taking myrtle berry powder 750 mg orally three times daily for 5 days during menses for 2 cycles improves blood loss assessment scores by 58% and hemoglobin levels by 17% when compared to baseline. Improvements were similar to tranexamic acid 500 mg twice daily. However, the study may have been inadequately powered to detect a difference between groups (106778).
• Oropharyngeal candidiasis. Although there has been interest in using topical myrtle for oropharyngeal candidiasis, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Respiratory tract infections. Although there has been interest in using oral myrtle for respiratory tract infections, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Vaginal candidiasis. Although there has been interest in using oral myrtle for vaginal candidiasis, there is insufficient reliable information about the clinical effects of myrtle for this purpose.
• Vaginitis. It is unclear if intravaginal myrtle is beneficial in patients with vaginitis. Details: Preliminary clinical research in adults with vaginitis secondary to bacterial vaginosis or trichomoniasis shows that applying a vaginal suppository containing myrtle extract 10% and oak gall extract 10% for 7 days reduces malodor discharge after intercourse when compared with placebo, but not when compared with metronidazole vaginal suppository. It is unclear if this effect is due to myrtle extract, oak gall, or the combination. Using the combination product did not reduce itching, dysuria, irritation, or dyspareunia when compared with placebo or metronidazole (106779).
• Warts. Although there has been interest in using topical myrtle for warts, there is insufficient reliable information about the clinical effects of myrtle for this purpose. More evidence is needed to rate myrtle for these uses.

(Read more about MYRTLE)

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

POSSIBLY SAFE ...when eucalyptol, a constituent of eucalyptus oil, is used orally and appropriately. Eucalyptol appears to be safe for up to 12 weeks (13302).

POSSIBLY UNSAFE ...when the undiluted oil is used topically. Prolonged or widespread exposure has caused neurotoxicity (12869). There is insufficient reliable information available about the safety of diluted eucalyptus oil when used topically.

LIKELY UNSAFE ...when the undiluted oil is ingested orally. Ingesting 3.5 mL of undiluted oil can be fatal in adults (12867). There is insufficient reliable information available about the safety of eucalyptus oil when inhaled as aromatherapy or when eucalyptus leaf is used orally in medicinal amounts.

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

CHILDREN: LIKELY UNSAFE
when eucalyptus oil is used orally (12867,49002,107493,107495). ...when eucalyptus oil is used topically in infants and young children. There are reports of neurotoxicity in infants and young children exposed to topical eucalyptus oil. In one of these cases, a 12-month-old child was bathed in water containing eucalyptus oil and other essential oils; in another case, a child had a dressing containing eucalyptus oil applied every 2-4 hours daily for 2 days (12868,12869). ...when eucalyptus solutions are inhaled using a vaporizer (49002).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods (4912). There is insufficient reliable information available about the safety of medicinal amounts of eucalyptus oil; avoid using.

(Read more about EUCALYPTUS)

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

POSSIBLY SAFE ...when inhaled in amounts used for aromatherapy, short-term. Lemon essential oil has been used with apparent safety as aromatherapy for up to 2 weeks in clinical research (93475,98128,98129). There is insufficient reliable information available about the safety of lemon when used topically, or when used orally or intranasally in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available. Avoid using in amounts greater than those typically found in foods.

(Read more about LEMON)

POSSIBLY SAFE ...when myrtle berry is used orally, short term. Myrtle berry powder 2,250 mg daily has been used with apparent safety for up to 5 days (106778). ...when diluted myrtle leaf extract is used topically and appropriately, short term. A paste containing myrtle leaf extract 5% has been used with apparent safety for up to 6 days (98643). Other myrtle leaf extracts have been applied to the face for up to 16 weeks with apparent safety (106780). ...when myrtle leaf extract is used intravaginally and appropriately, short term. Vaginal suppositories containing myrtle leaf extract 10% and leaf essential oil 0.5% have been used with apparent safety for up to three menstrual cycles (98644).

LIKELY UNSAFE ...when the undiluted oil of myrtle leaf is used orally. Myrtle leaf contains cineole. Ingesting more than 10 grams of cineole can result in respiratory failure and collapse (18). There is insufficient reliable information available about the safety of myrtle leaf and branch when used orally. There is also insufficient reliable information available about the safety of myrtle berry when used topically or myrtle berry extract when used orally or topically.

CHILDREN: LIKELY UNSAFE
when myrtle oil is used orally. Avoid facial contact with myrtle oil preparations which may cause glottal spasm, bronchospasm, asthma-like attacks, or respiratory failure in infants or small children (18). There is insufficient reliable information available about the safety of myrtle berry or myrtle berry extract when used orally in children.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally (18); avoid using.

(Read more about MYRTLE)

AMPHETAMINES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, inhaling eucalyptol may reduce the effectiveness of amphetamines.  Details Animal research suggests that inhaling eucalyptol may reduce the levels of amphetamines in the blood (48987).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, eucalyptus leaf might increase the risk of hypoglycemia.  Details Animal research suggests that eucalyptus leaf might have hypoglycemic activity, and might have additive effects when used with antidiabetes drugs (12871).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, eucalyptus might increase the levels of CYP1A2 substrates.  Details In vitro research suggests that eucalyptus oil might inhibit CYP1A2, although this has not been reported in humans (12479).

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, eucalyptus might increase the levels of CYP2C19 substrates.  Details In vitro research suggests that eucalyptus oil might inhibit CYP2C19, although this has not been reported in humans (12479).

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, eucalyptus might increase the levels of CYP2C9 substrates.  Details In vitro research suggests that eucalyptus oil might inhibit CYP2C9, although this has not been reported in humans (12479).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, eucalyptus might increase the levels of CYP3A4 substrates.  Details In vitro research suggests that eucalyptus oil might inhibit CYP3A4, although this has not been reported in humans (12479).

PENTOBARBITAL (Nembutal) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, inhaling eucalyptol might reduce the effectiveness of pentobarbital.  Details Animal research suggests that inhaling eucalyptol reduces the level of pentobarbital that reaches the brain (48987).

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ITRACONAZOLE (Sporanox) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking itraconazole capsules or tablets with a beverage containing lemon might increase the levels and clinical effects of itraconazole.  Details In one case report, dissolving itraconazole tablets in a small amount of specific beverages containing lemon prior to administration increased the level of itraconazole in a lung transplant patient. In this case, the increased bioavailability was desirable and was likely due to improved tablet dissolution in the acidic beverage (110781).

(Read more about LEMON)

(Read more about MYRTLE)

General ...Orally, diluted eucalyptus oil is generally well tolerated, but the undiluted oil can cause toxicity.
Most Common Adverse Effects:
Orally: Diarrhea, nausea, vomiting.
Topically: Burning, itching, redness, stinging.
Serious Adverse Effects (Rare):
Orally: Signs of toxicity can occur with the undiluted oil at doses as low as 1 mL and include central nervous system depression, shallow respiration, rapid pulse, apnea, coma, and death.
Topically: Prolonged exposure or large amounts of eucalyptus oil can cause agitation, ataxia, drowsiness, muscle weakness, seizures, and slurred speech. The risk of toxicity may be greater in children.
Inhalation (as aromatherapy): Seizures.

Cardiovascular ...Orally, one case of premature ventricular contractions has been reported in a previously healthy 29-year-old male who ingested approximately one ounce of eucalyptus oil (48983).

Dermatologic ...Topically, eucalyptus pollen, leaves, oil, and the constituent eucalyptol can cause contact dermatitis in sensitive people (13303,48931,92856,92858,92859,98497). In some cases, symptoms respond to treatment with topical corticosteroids and tacrolimus (92856). In one case report, transient local redness, burning, and irritation was reported in a 4-year-old child who was bathed in water containing eucalyptus oil. The symptoms resolved within one hour of rinsing the skin with clear water (48983). In a clinical study, treatment with a combination of eucalyptus oil and lemon tea tree oil caused burning, redness, itching, or stinging in up to 20% of the patients. Stinging usually resolved within 10 minutes of application and redness within 30 minutes (19188,98492).

Gastrointestinal ...Orally, eucalyptus oil can cause nausea, vomiting, and diarrhea (48983,48993,48995). Abdominal pain has been reported in a trial of the eucalyptus constituent eucalyptol for inflammatory bowel disease (IBD) (48936).

Immunologic ...A case of IgE-mediated exacerbation of asthma and rhinitis symptoms has been reported in a patient who consumed eucalyptus. Similar worsening of symptoms occurred when the patient inhaled eucalyptus pollen (48957).
Occupational exposure to eucalyptus may cause allergic dermatitis (98497).

Neurologic/CNS ...Orally, eucalyptus oil can cause central nervous system depression, coma, and status epilepticus (12867,48946,48983).
Topically, orally, and by inhalation, eucalyptus oil has been associated with seizures. A systematic review describes the characteristics of 49 children and 61 adults with seizures associated with various routes of administration. Patients with no seizure history were classified as a eucalyptus oil-induced seizure (EOIS), while patients with a history of seizure or susceptibility to seizure were defined as a eucalyptus oil-provoked seizure (EOPS). In EOIS cases, topical use was reported in 74%, inhalation in 22.5%, and ingestion in 3.5%; for EOPS cases, topical use was reported in 79%, inhalation in 16%, and ingestion in 5%. Generalized tonic-clonic seizures are the most prominent type of seizure in EOIS cases (96%). Among EOPS patients, 37% had focal onset motor seizures with impaired awareness, 24% had focal onset aware motor seizures, 13% had focal to bilateral tonic-clonic seizures, and 26% had generalized onset tonic-clonic seizures (107494). One prospective observational study that was included in this systematic review provided additional details on eucalyptus-induced seizures. This study included 18 reports of EOIS and 28 reports of EOPS in adults and children after topical or inhaled use of eucalyptus oil, either alone or in combination with camphor. The time to seizure onset was 0.5-48 hours after topical application, 2-30 minutes after inhalation, and 0.5-6 hours after ingestion. (105028).
One prospective observational study and one case series have described 20 case reports of seizures occurring in children after ingestion of eucalyptus oil. Most of these seizures are generalized tonic-clonic in nature, occur 15-30 minutes after exposure, and do not reoccur following the discontinuation of eucalyptus oil. Seizures have been reported with both overdoses and therapeutic doses (107493,107495) and include cases of both EOIS and EOPS (107495). Additionally, children appear more likely to require intensive care and mechanical ventilation when compared with adult cases (107494).
A case of fever and headache has been reported in a patient who routinely applied a teaspoon of gel containing eucalyptus extract in his throat or nose to treat sore throat or rhinitis (48946).

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General ...Orally, lemon is well tolerated in amounts commonly found in foods. A thorough evaluation of safety outcomes has not been conducted on the use of larger amounts.
Most Common Adverse Effects:
Orally: Epigastralgia and heartburn with the regular consumption of fresh lemon juice.

Dermatologic ...Topically, the application of lemon oil might cause photosensitivity, due to furocoumarin derivative content. This occurs most often in fair-skinned people (11019).

Gastrointestinal ...Orally, fresh lemon juice, taken as 60 mL twice daily, has been reported to cause gastrointestinal disturbances in 37% of patients in one clinical trial, compared with 8% of patients in the placebo group. Specifically, of the patients consuming lemon juice, 21% experienced heartburn and 8% experienced epigastralgia, compared to 1% and 3%, respectively, in the placebo group (107489).

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General ...There is currently a limited amount of information on the adverse effects of oral and intravaginal myrtle. A thorough evaluation of safety outcomes has not been conducted. Topically, myrtle leaf seems to be generally well tolerated in adults.
Most Common Adverse Effects:
Topically: Dry skin.
Intravaginally: Vaginal irritation and dryness.
Serious Adverse Effects (Rare):
Orally: Hypotension, respiratory failure.
Topically: Bronchial spasm and respiratory failure, most commonly in infants or children.

Cardiovascular ...Orally, very large amounts of undiluted myrtle leaf oil might lead to low blood pressure and circulatory disorders due to the cineole constituent (18).

Dermatologic ...Topically, myrtle leaf extract has been reported to cause dry skin (106777).

Gastrointestinal ...Orally, myrtle berry extract has been reported to cause constipation in infants and young children (106781).

Genitourinary ...Intravaginally, myrtle leaf extract suppositories have been reported to cause vaginal irritation and dryness (98644).

Pulmonary/Respiratory ...Orally, consumption of very large amounts of undiluted myrtle leaf oil might lead to respiratory failure and collapse (18).
Topically, facial contact with myrtle oil preparations may cause glottal or bronchial spasm, asthma-like attacks, or respiratory failure in infants and children (18).

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