Botanical Ingredients*

 Total

 Single

Multiple

Selected adverse events

Ma huang (Asian Ephedra spp)

90

10

80

Neurologic: Seizures, syncope, dizziness, agitation

Cardiovascular: Chest pain, myocardial infarction, tachycardia, hypertension

Respiratory: shortness of breath

Gastrointestinal: vomiting, diarrhoea, abdominal pain

Dermal: rash and pruritus

Other: myalgias

Guarana/kolanut (62 Paullinia cupana ; 11 Cola spp Caffeine-containing)

69

2

67

Neurologic: Agitation

Respiratory: shortness of breath

Gastrointestinal: vomiting

Dermal: rash

Ginseng (Panax ginseng or  P quinquefolius)

49

9

 40

Neurologic: drowsiness, agitation, dizziness, headache

Cardiovascular: Tachycardia, hypertension, dysrhythmias

Respiratory: shortness of breath

Heme/Hepatic: bleeding

Gastrointestinal: vomiting, diarrhea

Dermal: rash

St John’s wort (Hypericum perforatum)

41

21

20

Neurologic: agitation, headache, dizziness, confusion, seizure, nightmares, peripheral numbness

Cardiovascular: tachycardia

Respiratory: shortness of breath

Heme/Hepatic: Transaminase elevation, petechia

Gastrointestinal: abdominal pain, vomiting, diarrhea

Dermal: rash, especially photosensitivity rash

Other: Hyperthermia

Ginger (Zingiber officinalis)

24

1

23

Neurologic: headache

Gastrointestinal: burning, nausea

Ginkgo biloba (Ginkgo biloba)

22

5

17

Neurologic: seizure, headache

Cardiovascular: tachcardia, chest pain

Heme/Hepatic: bleeding, transaminase elevation

Gastrointestinal: vomiting

Dermal: rash

Bee pollen (any bee contributions:  non-botanical)

22

4

18

Dermal/hypersensitivity: rash, edema, throat tightening

Goldenseal (Hydrastis canadensis)

21

3

 18

Neurologic: agitation, movement disorder with fasciculations, rigidity or writhing

Cardiovascular: atrial fibrillation, chest pain

Respiratory: shortness of breath

Gastrointestinal: abdominal pain, vomiting

Dermal: rash

Licorice (Glycyrrhiza glabra)

20

3

17

Neurologic: drowsiness, headache, muscle weakness, seizure, syncope

Cardiovascular: conduction disturbance, hypertension, tachycardia

Heme/hepatic: cytopenia

Gastrointestinal: abdominal pain, vomiting

Dermal: rash

Other: Electrolyte disturbances

Cayenne (Capsicum spp)

20

0

20

Neurologic: headache, agitation

Cardiovascular: hypertension, atrial fibrillation, tachycardia

Gastrointestinal: abdominal pain, vomiting

Dermal: rash, irritation

Valerian (Valeriana officinalis)

19

6

 13

Neurologic: drowsiness, dizziness, peripheral numbness, agitation

Cardiovascular: tachycardia,

Respiratory: apnea, shortness of breath

Gastrointestinal: vomiting, diarrhoea, abdominal pain

Dermal: rash

Echinacea (Echinacea  purpurea, E angustifolia,

 E pallida )

18

3

15

Neurologic: peripheral numbness

Cardiovascular: tachycardia

Respiratory/hypersensitivity: chest tightness

Gastrointestinal: vomiting, diarrhoea

Dermal: rash, oedema

Tea tree oil (Melaleuca alternifolia)

15

14

 1

Neurologic: drowsiness, ataxia, coma, confusion

Respiratory: shortness of breath, coughing, throat swelling

Gastrointestinal: vomiting, maroon colored stool

Dermal: irritation/pain

Gotu kola (Centella asiatica)

15

0

15

Neurologic: agitation, headache

Cardiovascular: chest pressure, hypertension, tachycardia

Heme/hepatic: transaminitis, INR elevation

Gastrointestinal: abdominal pain, vomiting

Dermal: erythema, oedema

Other: Electrolyte abnormality

Kava kava (Piper methysticum)

14

12

2

Neurologic: drowsiness, syncope, headache, dizziness

Cardiovascular: tachycardia, hypertension

Gastrointestinal: vomiting, abdominal pain

Dermal: rash

Siberian ginseng (Eleutherococcus senticosus)

14

1

 13

Neurologic: drowsiness, agitation

Cardiovascular: tachycardia, dysrhythmia

Gastrointestinal: vomiting

Other: bilirubin elevation

Willow (Salix alba)

13

0

13

Neurologic: headache, agitation, peripheral numbness

Cardiovascular: tachycardia, hypertension

Respiratory: tachypnoea

Gastrointestinal: vomiting, abdominal pain

Dermal: rash

Sarsparilla (Smilax spp From Latin America)

12

0

12

Neurologic: headache, agitation

Cardiovascular: tachycardia

Respiratory:

Gastrointestinal: abdominal pain, vomiting

Dermal: erythema

Yohimbe (Pausinystalia yohimbe)

10

4

 6

Neurologic: Agitation, muscle weakness

Respiratory: conduction disturbance, tachycardia, hypertension

Gastrointestinal: vomiting, abdominal pain

Dermal: erythema

Other: excess secretions

Nettle (Urtica dioica)

9

0

 9

Neurologic: agitation, dizziness

Cardiovascular: palpitations

Gastrointestinal: vomiting

Dermal: rash (hives)

Non-botanicals ingredients

Chromium trivalent salts (eg, Chromium picolinate)

60

4

56

Gastrointestinal: vomiting

Melatonin

38

31

 7

Neurologic: drowsiness, coma, confusion, ataxia, nightmares, agitation, peripheral numbness

Cardiovascular: tachycardia, hypertension

Respiratory: shortness of breath

Heme/hepatic:  transaminase elevation, INR elevation

Gastrointestinal: vomiting

Zinc

34

12

 22

Heme: anaemia

Gastrointestinal: abdominal pain, vomiting, diarrhoea

Dermal: rash

Lecithin (6 choline)

21

0

 21

Neurologic: agitation, dizziness

Cardiovascular: tachycardia

Respiratory:

Gastrointestinal: abdominal pain, vomiting, diarrhoea

Dermal: rash, oedema

g-hydroxybutyrate (GHB) precursor  (eg 1,4 butanediole, g-butyrolactone)

19

 17

 2

Neurologic: coma, seizure, drowsiness, fasciculations, headache, withdrawal

Cardiovascular: bradycardia, tachycardia

Respiratory: depression and arrest

Gastrointestinal: vomiting

Carnitine (14 specified as L-)

20 

1

19

Gastrointestinal: vomiting

Creatine

18

12

 6

Neurologic: dizziness, syncope, peripheral numbness

Cardiovascular: chest pain, tachycardia

Respiratory: shortness of breath, bronchospasm

Gastrointestinal: abdominal pain, vomiting, constipation

Other: Urinary retention, electrolyte abnormalities

Royal jelly  (plus 2 bee propylus)

10

1

 9

Neurologic: agitation

Cardiovascular: chest pressure

Respiratory: bronchospasm, shortness of breath

Gastrointestinal: vomiting

Dermal: oedema, erythema, pruritus

Cyanobacteria: 6 spirulina , 3 blue green algae*

9

 2

 7

Neurologic: Peripheral numbness

Heme/Hepatic: transaminitis with INR elevation

Selenium

8

3

 5

Neurologic: dizziness, headache, muscle weakness

Cardiovascular: tachycardia/palpitations

Gastrointestinal: diarrhoea, vomiting, abdominal pain

Dermal: rash, alopecia

Other: myalgias

Glucosamine/chondroitin

6

0

 6

Neurologic: agitation, peripheral numbness

Cardiovascular: tachycardia

Heme/Hepatic: transaminitis, PT prolongation

Gastrointestinal: abdominal pain, vomiting

Dermal: erythema/flushing