Warning Signs After Taking Herbs: When to Stop and Get Care

If this is an emergency

Call 911 (US) for trouble breathing, swelling of the lips, tongue or throat, fainting, chest pain, a fast or irregular heartbeat, or stroke signs: slurred speech, weakness on one side of the face, arm or leg, or loss of vision. These appear on FDA's list of serious reactions to dietary supplements, which include herbs. [1] For a possible poisoning, such as a child who swallowed an herbal product or someone who took too much, call Poison Help in the US at 1-800-222-1222; it is free, available 24/7, and you should call even for a minor, unexpected exposure. [2] Outside the US, use your local emergency number and poison center. See Poison help by country and Poisoning: what to do first.

The NHS (UK) says to call 999 if you think someone is having a severe allergic reaction, whose symptoms come on very quickly and can include swelling of the throat and tongue. [3]

Stop and get care promptly

FDA says that if you think a supplement caused a serious reaction, you should immediately stop using the product and report it. [1] It lists these signs, among others:

• Itching, rash, hives or wheezing. [1]
• Severe, persistent nausea, vomiting, diarrhea or abdominal pain. [1]
• Yellowing of the skin or eyes. [1]
• Difficulty urinating, decreased urination, or dark urine. [1]
• Blood in urine, stool, vomit or sputum, or abnormal bleeding from the nose or gums. [1]
• Marked mood, thinking or behavior changes, including thoughts of suicide. [1]

In the US, the 988 Suicide and Crisis Lifeline is available by calling 988. Do not stop prescribed medicines on your own; tell your prescriber what happened.

What the signs may point to

For fuller background, see Liver injury from Chinese herbs, Aristolochic acid and kidney injury and Chinese herbs and prescription medicines.

Why feeling fine is not proof of safety

Some harms are silent at first. FDA's import alert says a product containing a small amount of aristolochic acid could be used for years with no apparent adverse effects until serious, irreversible effects such as kidney damage occur. [8] Kidney specialists note that nephrotoxicity from herbs can be overlooked because of the belief that herbal medications are innocuous, and that the exact incidence is not known. [6]

Who needs extra care

The NHS says herbal medicines are not recommended for children because not enough is known about their safety, and that people should not take them if pregnant or breastfeeding or if they have kidney or liver problems. [9] The NHS also lists medicines that may not mix well with herbs, including blood thinners such as warfarin, and says to check with a pharmacist first. [9] See TCM in pregnancy.

Contamination and mix-ups

NCCIH reports that some Chinese herbal products have been contaminated with undeclared drugs, heavy metals, pesticides or sulfites, and that manufacturing errors replacing one herb with another have caused serious complications. [7]

After the emergency

Tell every clinician what you took, including teas, patches and "natural" products. Then consider reporting the problem. For a quick overview, see the TCM safety quick reference.