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Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews

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Abstract

Purpose

The aim of this overview of systematic reviews is to summarise and critically evaluate the evidence from systematic reviews of the adulteration and contamination of herbal medicinal products (HMPs).

Methods

Five electronic databases were searched to identify all relevant systematic reviews.

Results

Twenty-six systematic reviews met our inclusion criteria. The most commonly HMPs were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively.

Conclusions

Collectively these data suggest that there are reasons for concerns with regards to the quality of HMPs. Adulteration and contamination of HMPs can cause serious adverse effects. More stringent quality control and its enforcement seem to be necessary to avoid health risks.

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Authors and Affiliations

  1. Complementary Medicine, Peninsula Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK

    Paul Posadzki, Leala Watson & Edzard Ernst

Authors
  1. Paul Posadzki
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  2. Leala Watson
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  3. Edzard Ernst
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Corresponding author

Correspondence to Paul Posadzki.

Appendix

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Table 4 Search strategy for MEDLINE
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Posadzki, P., Watson, L. & Ernst, E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol 69, 295–307 (2013). https://doi.org/10.1007/s00228-012-1353-z

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  • DOI: https://doi.org/10.1007/s00228-012-1353-z

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