Sinupret Kids Syrup Sinus & Immune by Bioforce

POSSIBLY EFFECTIVE

• Sinusitis. Taking cowslip orally in specific combination products that also contains gentian root, European elder flower, verbena, and sorrel (SinuComp, Sinupret) seems to help improve symptoms and resolve acute or chronic sinusitis (374,379). Early research also shows that taking a more concentration formulation of cowslip in combination with these ingredients (Sinupret + [formerly known as Sinupret forte], Bionorica AG) daily along with mometasone furoate (Nasonex) 200 mcg intranasal twice daily for 7 days improves acute rhinosinusitis symptoms such as nasal obstruction, rhinorrhea, facial pain and pressure, and impaired sense of smell compared to mometasone alone (95907). More evidence is needed to rate cowslip for this use.

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POSSIBLY EFFECTIVE

• Influenza. Although some small clinical studies show that elderberry extracts can improve influenza symptoms in otherwise healthy adults, a small clinical study enrolling adults and children with or without high risk medical conditions shows it does not reduce the duration of symptoms. Details: Small clinical studies in otherwise healthy adults with influenza presenting within 48 hours of symptom onset show that taking elderberry extract syrup (Sambucol, Nature's Way) 15 mL four times daily for 5 days improves patient ratings of symptoms such as aches and pains, cough, and nasal congestion an average of 4 days earlier than in control groups. It also reduced the use of rescue medications (5260,12235). Another small clinical study in adults shows that taking an elderberry extract lozenge (ViraBLOC, HerbalScience) 175 mg four times daily for 2 days, starting within 24 hours of symptom onset, improves flu-like symptoms, typically within 48 hours, when compared with placebo (17022). However, in a small clinical study in children and adults 5 years and older with influenza, including those with high-risk conditions such as asthma, chronic lung disease, and heart disease, using Sambucol for 5 days starting within 48 hours of symptom onset did not reduce the time to complete resolution of symptoms for a 24-hour period when compared with placebo (103831). These negative findings may be due to the age and baseline health status of the enrolled patients, as well as the use of symptom resolution, as opposed to symptom improvement, as the primary outcome. Elderberry has also been evaluated in combination with echinacea for treating influenza symptoms (95650), but it is not clear whether the combination is better than either ingredient alone.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there is interest in using oral elderberry for allergic rhinitis, there is insufficient reliable information about the clinical effects of elderberry for this purpose.
• Asthenopia (eye strain). Oral elderberry extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults without dry eye disease with occupations requiring the use of video display terminals shows that taking a specific combination product containing elderberry fruit extract 300 mg, zinc 10 mg, L-carnitine 50 mg, currant 100 mg, and Eleutherococcus root 50 mg (Meramirt CM) once daily for 1 month improves measures of eye strain and contrast sensitivity when compared to baseline. Improvements in these measures were lacking in the control group (111295). Statistical comparison between the two groups was not reported. It is unclear if these effects are due to elderberry, other ingredients, or the combination.
• Cardiovascular disease (CVD). It is unclear whether elderberry has any benefit in CVD. In one small study it did not alter disease markers. Details: Preliminary clinical research in postmenopausal women shows that taking elderberry extract 500 mg daily for 12 weeks does not significantly improve markers of CVD, including inflammatory biomarkers, vascular activity, or plasma lipid or glucose levels, when compared with placebo (21141).
• Chronic obstructive pulmonary disease (COPD). Elderberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in men aged 40-70 years with a history of smoking and Stage 2 COPD, shows that a combination of elderberry 165 mg, heart's ease herb 165 mg, and calendula flowers 165 mg (Inflaminat, INAT-Farma), 3 capsules daily for 6 months modestly improves the score on the 5-point breathlessness, cough, and sputum scale (BCSS) and modestly increases the mean forced expiratory volume in 1 second (FEV1), compared with no changes in the placebo group. However, the number of COPD exacerbations per month is not affected (103629). It is unclear if these effects are due to elderberry, the other ingredients, or the combination.
• Chronic fatigue syndrome (CFS). Although there has been interest in using oral elderberry for CFS, there is insufficient reliable information about the clinical effects of elderberry for this purpose.
• Cognitive function. Oral elderberry extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy adults shows that consuming a multi-ingredient beverage containing elderberry extract 50 mg, carob extract, green tea powder, and guarana seed extract improves some measures of cognitive function such as rapid visual information processing and multitasking 120 minutes later when compared with placebo (113940). It is unclear if this effect is due to elderberry, other ingredients, or the combination.
• Common cold. Oral elderberry extract does not seem to PREVENT colds when taken prophylactically, but it may reduce the duration and severity of existing colds. Details: Clinical research in healthy adults shows that taking capsules containing elderberry extract (BerryPharma, Iprona AG) 600 mg daily for 8 days before overseas air travel, and then 900 mg daily starting 1 day before traveling and continuing for 4-5 days after arriving at the destination, does not reduce the number of colds or impact quality of life when compared with placebo. However, this product does reduce the duration of colds by about 2 days and the severity of colds by about 58% when compared with placebo (91374).
• Constipation. Oral elderberry extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial among airline flight crew shows that taking a specific product (ACTIVE) containing elderberry extract 70 mg and a specific probiotic formulation (SYNBIO) daily for 1 month improves constipation, stool volume and consistency, ease of defecation, intestinal regularity, flatulence, and diarrhea compared to baseline, but not when compared with placebo (112134). It is unclear if these effects are due to elderberry, the probiotics, or the combination.
• Gingivitis. Elderberry has been evaluated as a mouthwash or patch in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that using a mouth rinse (HM-302, Izun Pharmaceuticals) containing elderberry, echinacea, and gotu kola 15 mL three times daily for 14 days might prevent worsening of gingivitis when compared with a placebo rinse. However, it only minimally improves symptoms (20069). Other preliminary clinical research shows that applying a periodontal patch (PerioPatch, Izun Pharmaceuticals) containing elderberry, echinacea, and gotu kola either as a single dose, or three times daily for 1 day then once daily for 2 days, reduces some, but not all, measures of inflammation and gingivitis when compared with no treatment (20068,20070).
• HIV/AIDS. Although there has been interest in using oral elderberry for HIV/AIDS, there is insufficient reliable information about the clinical effects of elderberry for this purpose.
• Hyperlipidemia. It is unclear if elderberry is beneficial for the treatment of hyperlipidemia. Details: One preliminary clinical study in patients with hyperlipidemia shows that taking capsules containing spray-dried elderberry 400 mg, providing 10% anthocyanins, three times daily for 2 weeks does not reduce serum lipids when compared with placebo (21142).
• Lower respiratory tract infections. Oral elderberry extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in children aged 2-6 years with recurrent respiratory tract infections shows that adding a specific combination product (Stimunex gocce) containing elderberry extract, beta-glucans, zinc, and vitamin D3 to standard therapy does not reduce the number or duration of lower respiratory tract infections when compared with standard therapy alone. In the four months after treatment completion, the number of infections was reduced by about 50%; however, the total number of infections in each group was small. The dose was 1 drop/kg daily for one month, followed by 1 drop/kg daily for 15 consecutive days each month for the next three months (109212). The validity of this study is limited by lack of blinding.
• Obesity. Elderberry has been studied for weight loss in combination with other ingredients; its effect when used alone is unclear. Details: Observational research in overweight adults shows that replacing all meals for 8 days with a kit containing elderberry juice (from 120 grams of elderberries/day), dried elderberry (225 mg/day), dried elderflower (3.9 grams/day), elderflower extract (600 mg/day), and dried asparagus (40.5 grams/day), while also taking psyllium 2-3 teaspoons daily for 2 weeks, is associated with a mean decrease in body weight of 3.2 kg over 14 days when compared with baseline (94939). The validity of this study is limited by the lack of a comparator group. Also, it is unclear whether this effect is due to elderberry, other ingredients, the combination, or fasting from regular food.
• Psychological well-being. Oral elderberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial among airline flight crew shows that taking a specific product (ACTIVE) containing elderberry extract 70 mg and a specific probiotic formulation (SYNBIO) daily for 1 month improves scores on the Psychological General Well Being Index when compared with placebo. The index measures symptoms of anxiety and depression, general health status, and feelings of vitality and general self-control (112134). It is unclear if these effects are due to elderberry, the probiotics, or the combination.
• Respiratory tract infections. Oral elderberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in children aged 2-6 years with recurrent respiratory tract infections shows that adding a specific combination product (Stimunex gocce) containing elderberry extract, beta-glucans, zinc, and vitamin D3 to standard therapy reduces the duration of respiratory tract infections by about 1.7 days and modestly improves parent-perceived symptom severity when compared with standard therapy alone. However, there was no effect on the number of total, upper, or lower respiratory tract infections, the use of antibiotics or antipyretics, or the number of days missed from school. The product was dosed as 1 drop/kg daily for one month, followed by 1 drop/kg daily for 15 consecutive days each month for the next three months (109212). The validity of this study is limited by lack of blinding.
• Rhinosinusitis. Although there has been interest in using oral elderberry for rhinosinusitis, there is insufficient reliable information about the clinical effects of elderberry for this purpose.
• Upper respiratory tract infection (URTI). Oral elderberry has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in children aged 2-6 years with recurrent respiratory tract infections shows that adding a specific combination product (Stimunex gocce) containing elderberry extract, beta-glucans, zinc, and vitamin D3 to standard therapy does not reduce the number or duration of upper respiratory tract infections when compared with standard therapy alone. At four months after treatment completion, the number of infections was reduced by about 44%; however, the total number of infections in both groups was small. The product was dosed as 1 drop/kg daily for one month, followed by 1 drop/kg daily for 15 consecutive days each month for the next three months (109212). The validity of this study is limited by lack of blinding. More evidence is needed to rate elderberry for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Cancer. Although there has been interest in using topical gentian for cancer, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Diabetes. Although there has been interest in using oral gentian for diabetes, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Diarrhea. Although there has been interest in using oral gentian for diarrhea, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Flatulence. Although there has been interest in using oral gentian for flatulence, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Gastritis. Although there has been interest in using oral gentian for gastritis, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Gastroesophageal reflux disease (GERD). Although there has been interest in using oral GERD for diarrhea, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Hypertension. Although there has been interest in using oral gentian for hypertension, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Malaria. Although there has been interest in using oral gentian for malaria, there is insufficient reliable information about the clinical effects of gentian for this purpose.
• Obesity. It is unclear if oral gentian is beneficial for obesity. Details: Preliminary clinical research in healthy adults shows that consuming a pudding containing microencapsulated gentian root extract 1.25 g at breakfast modestly reduces caloric intake over 24 hours, but does not affect self-reported feelings of hunger or fullness, when compared with placebo pudding (96534).
• Rhinosinusitis. Oral gentian has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research shows that taking a specific combination product (SinuComp; Sinupret) that contains gentian root 6 mg , elderflower, verbena, cowslip flower, and sorrel improves the symptoms of acute or chronic sinusitis when compared with placebo (374,379). Observational research in adults with acute rhinosinusitis suggests that taking the same combination product orally three times daily, in addition to topical mometasone furoate nasal spray, for 7 days is associated with lower symptom scores when compared with mometasone nasal spray alone (95907).
• Wound healing. Although there has been interest in using topical gentian for wound healing, there is insufficient reliable information about the clinical effects of gentian for this purpose. More evidence is needed to rate gentian for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Breast cancer. Oral sorrel has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A retrospective review of females with breast cancer shows that taking a specific combination product containing sorrel, burdock root, rhubarb, and slippery elm bark (Essiac, Resperin Canada Limited) does not improve quality of life or mood when compared with a historical control group (37419).
• Bronchitis. Although there is interest in using oral sorrel for bronchitis, there is insufficient reliable information about the clinical effects of sorrel for this condition.
• Rhinosinusitis. Oral sorrel has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Taking sorrel orally as a specific combination product that also contains gentian root, elderflower, verbena, and cowslip flower (SinuComp; Sinupret, Bionorica Arzneimittel GmbH), 2 tablets or 50 drops three times daily for up to 14 days, seems to improve symptoms of acute or chronic rhinosinusitis, such as congestion and headache (374,379,64515,75140). Taking this combination product orally three times daily in combination with mometasone furoate nasal spray (Nasonex) 200 mcg twice daily for 7 days improves symptoms, such as nasal obstruction, rhinorrhea, facial pain and pressure, impaired sense of smell, and mucopurulent secretions, when compared with mometasone nasal spray alone (95907). It is unclear if these effects are due to sorrel, other ingredients, or the combination. More evidence is needed to rate sorrel for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Gingivitis. Clinical research in patients with chronic gingivitis shows that rinsing with 10 mL of a verbena leaf decoction after brushing and flossing twice daily for 28 days reduces plaque and gingivitis by a small amount more than using a saline rinse (101048).
• Rhinosinusitis. Preliminary clinical research shows that taking a combination of verbena, gentian root, elderflower, cowslip flower, and sorrel (SinuComp, Integrative Therapeutics; Sinupret, Bionorica) orally with antibiotics and nasal decongestants, seems to reduce the duration of acute sinusitis, compared with using the conventional medications alone (374,379). Using the same product along with just a nasal decongestant also seems to improve nasal obstruction, rhinorrhea, facial pain and pressure, impaired sense, and mucosal edema compared to taking the nasal decongestant alone (95907). More evidence is needed to rate verbena for these uses.

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POSSIBLY SAFE ...when used orally. Cowslip has been used with apparent safety in combination with other herbs (SinuComp, Sinupret, Sinupret +, Bronchipret) (374,379,13557).

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

(Read more about COWSLIP)

LIKELY SAFE ...when used orally in the amounts typically found in foods. Elderberry has generally recognized as safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when elderberry fruit extract is used orally, short-term. One specific elderberry fruit extract (Sambucol, Nature's Way) has been used with apparent safety for up to 5 days (5260,12235,103831); another (BerryPharma, Iprona AG) has been used with apparent safety for up to 15 days (91374). A specific elderberry fruit extract lozenge (ViraBLOC, HerbalScience) has been used with apparent safety for 2 days (17022). Other elderberry fruit extracts have been used with apparent safety for up to 12 weeks (21141,21142).

POSSIBLY UNSAFE ...when elder tree leaves and stems, or unripe or uncooked elderberries, are consumed. The unripe green fruit, as well as the leaves and stems of the elder tree, contain a cyanide-producing chemical, which can cause serious toxicity (17020,17021,21143,21144,91374). Cooking eliminates the toxin.

CHILDREN: LIKELY SAFE
when consumed in the amounts typically found in foods.

CHILDREN: POSSIBLY SAFE
when used orally for up to 3 days. A specific fruit extract (Sambucol, Nature's Way) has been used in doses of 15 mL twice daily for 3 days in children 5 years and older (5260,103831).

CHILDREN: POSSIBLY UNSAFE
when unripe or uncooked elderberries are consumed. The unripe green fruit, as well as the leaves and stems of the elder tree, contain a cyanide-producing chemical , which can cause serious toxicity (17020,17021,21143,21144,91374). Cooking eliminates the toxin.

PREGNANCY AND LACTATION: LIKELY SAFE
when consumed in the amounts typically found in foods. There is insufficient reliable information available about the safety of elderberry when used for medicinal purposes; avoid using in amounts greater than those found in foods.

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LIKELY SAFE ...when the root preparations are used in amounts commonly found in foods. Gentian root is categorized by the FDA as a safe food additive flavoring in the US (4912).

POSSIBLY SAFE ...when gentian root is used orally in a specific combination that contains gentian root, elderflower, verbena, cowslip flower, and sorrel (SinuComp, Sinupret) (374,379,95907). There is insufficient reliable information available about the safety of the topical use of gentian.

PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of gentian in medicinal amounts during pregnancy and lactation; avoid using.

(Read more about GENTIAN)

POSSIBLY SAFE ...when used orally in amounts commonly found in foods. There is insufficient reliable information available about the safety of sorrel used in medicinal amounts.

POSSIBLY UNSAFE ...when used orally in large amounts. The oxalate content may cause serious adverse effects, including damage to the kidneys, liver, and gastrointestinal tract (71314,75138,94019).

PREGNANCY AND LACTATION: POSSIBLY SAFE
when used orally in amounts commonly found in foods. There is insufficient reliable information available about the safety of sorrel used in medicinal amounts during pregnancy and lactation; avoid using.

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LIKELY SAFE ...when used orally in amounts commonly found in foods. Verbena has Generally Recognized As Safe status (GRAS) for use in foods in the US (4912). There is insufficient reliable information available about the safety of verbena when used orally or topically in medicinal amounts.

PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of verbena in medicinal amounts during pregnancy and lactation; avoid using.

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IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, elderberry might interfere with immunosuppressant therapy due to its immunostimulant activity.  Details Elderberry has immunostimulant activity, increasing the production of cytokines, including interleukin and tumor necrosis factor (10796).

PAZOPANIB (Votrient) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, elderberry might interact with pazopanib, potentially increasing the risk of adverse effects.  Details In one case, a 65-year-old patient taking pazopanib for 4 weeks for soft-tissue sarcoma developed severe nausea, loose stools, and elevated alanine transaminase and aspartate transaminase levels and was diagnosed with grade 3 liver injury. The patient reported taking elderberry supplements for 2 years, dose unspecified, and was also taking a multivitamin and a calcium supplement. The patient's symptoms and liver enzyme levels improved upon discontinuation of pazopanib and all supplements. Pazopanib treatment was re-initiated, at a lower dose, with no further evidence of liver injury. It was unclear in this case report if the elderberry supplements were derived from the berry, the flower, or the combination (113939).

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ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking gentian with antihypertensive drugs might increase the risk of hypotension.  Details In vitro research shows that gentian can cause vasodilation and lower blood pressure (13439,13441).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, sorrel might cause additive effects and side effects when used with anticoagulant or antiplatelet drugs.  Details In vitro, sorrel has been shown to inhibit platelet aggregation (103607). However, this effect has not been reported in humans.

FEXOFENADINE (Allegra) Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Likely •  Level of Evidence = D Sorrel might reduce the effectiveness of fexofenadine by reducing its absorption from the gut.  Details In vitro research shows that an ethanol extract of sorrel inhibits organic anion-transporting polypeptide 1A2 (OATP1A2), which transports fexofenadine from the intestine into cells. In rats, concomitant administration of sorrel extract with fexofenadine reduces oral absorption of fexofenadine and the area under the plasma concentration-time curve (AUC) (103606).

ORGANIC ANION-TRANSPORTING POLYPEPTIDE SUBSTRATES (OATP) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Sorrel might reduce the effectiveness of OATP substrates by reducing their absorption from the gut.  Details In vitro research shows that sorrel inhibits OATP1A2 (103606). Theoretically it may inhibit other OATPs. The OATPs are expressed in the small intestine and liver and transport drugs into cells. Inhibition of OATP may reduce the bioavailability of oral drugs that are substrates of OATP.

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CYTOCHROME P450 2B1 (CYP2B1) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D In vitro research suggests that beta-myrcene, a terpene constituents of verbena, can significantly inhibit cytochrome P450 2B1 (CYP2B1) enzyme activity (82024). Theoretically, verbena might increase levels of drugs metabolized by this enzyme. However, this interaction has not been reported in humans.  Details Some substrates of CYP2B1 include cyclophosphamide, ifosfamide, barbiturates, bromobenzene, and others.

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General ...Orally, cowslip in combination with other herbs is generally well tolerated (95907). Studies show it can cause gastrointestinal adverse effects and allergic skin reactions (374,379,13557).

Dermatologic ...Orally, cowslip in combination with other herbs can cause allergic skin reactions (374,379,13557).

Gastrointestinal ...Orally, cowslip in combination with other herbs can cause gastrointestinal adverse effects (374,379,13557).

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General ...Orally, elderberry extracts prepared from ripe fruit seem to be well tolerated.
Most Common Adverse Effects:
Orally: When adverse effects occur, they are likely due to ingestion of raw and unripe elderberries, or seeds, leaves, and other plant parts. Due to cyanogenic glycosides, these may cause nausea, vomiting, severe diarrhea, weakness, dizziness, numbness, and stupor. Cooking eliminates the toxin.

Gastrointestinal ...Orally, nausea and vomiting have been reported after consuming a specific elderberry and echinacea product Vogel Bioforce AG) (95650). However, it is unclear if this was due to the elderberry or Echinacea contained in the product.
Raw and unripe elderberries, and the seeds, leaves, and other elder tree parts might cause nausea, vomiting, or severe diarrhea due to cyanogenic glycosides (17020,17021). Cooking eliminates the toxin.

Hepatic ...In one case report, a 60-year-old female with underlying autoimmune disease presented with autoimmune hepatitis after taking elderberry at an unknown dose for several years. The patient presented with nausea, jaundice, abdominal pain, and abdominal distention. Liver function tests returned to baseline 4 weeks after initiating treatment with prednisone 40 mg daily and discontinuing elderberry (110123).

Immunologic ...Elder tree pollen might cause an allergic reaction characterized by rhinitis and dyspnea in some patients who are allergic to grass pollen. These patients might also experience an allergic reaction to elderberry extracts (11095).

Neurologic/CNS ...Raw and unripe elderberries might cause weakness, dizziness, numbness, and stupor due to cyanogenic glycosides (17020,17021). Cooking eliminates the toxin.

(Read more about ELDERBERRY)

General ...Orally, gentian root, in combination with other herbs, seems to be generally well tolerated. There is insufficient reliable information available about the adverse effects of gentian when taken as a medicine alone.
Most Common Adverse Effects:
Orally: Allergic skin reactions, gastrointestinal discomfort.

Gastrointestinal ...Orally, gentian root, in combination with other herbs, has been reported to cause gastrointestinal adverse effects (374,379). Gastrointestinal intolerance occurred in patients with cancer-associated anorexia who took gentian tincture 1 mL three times daily, in conjunction with turmeric 1 gram and ginger 1 gram twice daily, for 14 days. Six of 17 patients discontinued the regimen due to nausea, 3 due to vomiting, 2 due to diarrhea, and 2 due to bloating. It is unclear if this gastrointestinal intolerance was caused by gentian, the other herbs, or the patients' predisposing conditions (96263).

Immunologic ...Orally, gentian root, in combination with other herbs, has been reported to cause allergic skin reactions (374,379). It is unclear if these reactions were caused by gentian, the other herbs, or the combination.

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General ...Orally, sorrel seems to be generally well tolerated, based on limited data, mainly from studies with combination products.
Serious Adverse Effects (Rare):
Orally: Gastrointestinal irritation, kidney damage, liver necrosis.

Dermatologic ...Orally, sorrel, when used in combination with other herbs, has been reported to cause allergic skin reactions (374,379).

Gastrointestinal ...Orally, sorrel, when used in combination with other herbs, has been reported to cause gastrointestinal side effects including nausea and an unpleasant aftertaste (374,379,37419).

Hepatic ...Extensive liver necrosis with hepatic failure has been reported with the ingestion of large amounts of sorrel; this was likely due to its oxalate content (75138).

Pulmonary/Respiratory ...Environmental exposure to sorrel pollen may trigger allergic rhinitis or bronchial asthma in hypersensitive individuals, and allergic cross-sensitivity may occur in up to 19% of people who are allergic to weed pollen (75141).

Renal ...Sorrel contains oxalates; irolithiasis and nephrosis may be caused by the systemic absorption of oxalates and may result in kidney damage (71314). A case of acute tubulointerstitial nephritis (TIN) has been reported in a 12-year-old who consumed an unknown amount of wild sorrel. The patient presented with polyuria, hypophosphatemia, proteinuria, glucosuria, and hyperoxaluria. Recovery occurred after oral rehydration and electrolyte replacement. The TIN was likely due to formation of calcium oxalate crystals in the kidneys (94019).

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General ...Orally, verbena is well tolerated when used orally in amounts commonly found in foods (4912). When used in medicinal amounts and in combination with other herbs, adverse effects have included gastrointestinal adverse effects and allergic skin reactions (374,379).
Topically, verbena can cause contact dermatitis (13431).

Gastrointestinal ...Orally, verbena in combination with other herbs can cause gastrointestinal adverse effects (374,379).

Immunologic ...Orally, verbena in combination with other herbs can cause allergic skin reactions (374,379). Topically, verbena can cause contact dermatitis (13431).

(Read more about VERBENA)