Using herbal medicines: Advice to consumers

General advice to consumers

• Remember that herbal remedies are medicines.  As with any other medicine they should be used with care.
• Any medicine – herbal or otherwise – has the potential to have adverse effects.
• Before you take any herbal medicine you need to be sure it is the correct product for you.
• Remember that natural does not mean safe.  Many plants can be poisonous to humans.  Many pharmaceutical medicines have been developed from plants because of the powerful compounds they contain.
• Herbal remedies can interact with other medicines.  This could result in the other medicines having reduced or enhanced effects, including side-effects.  When consulting your doctor or pharmacist about your health always tell them about any herbal medicines you are taking.
• As with all medicines, keep herbal medicines out of the sight and reach of children.

Are any particular groups at risk?

• In many cases the safe use of herbal medicines has not been established  in:
• • pregnant women
  • breastfeeding mothers
  • children
  • elderly.
    
• Therefore caution should be taken about use of herbal medicine in pregnancy, when breast feeding or in children/elderly.
• If you are due to have a surgical operation always remember to tell your doctor about any herbal medicines you are taking.  Some herbal medicines could alter the effects of anaesthetics or other medicines during surgery.
• Anyone with a history of liver complaints or any other serious health condition is advised not to take any herbal medicine without speaking to their doctor first. 

Which herbal medicines have been assessed by the Regulator?

• Look for the PL or THR number on the product labels. 
• Licensed herbal medicines have a Product Licence (PL) number.  Under a new scheme products with a Traditional Herbal Registration (THR) number will come on to the UK market in the coming months.
• Both these kinds of medicines are regulated by the MHRA and meet assured standards.
• Other herbal medicines on the UK market have not been assessed by the MHRA.
• To find out more about herbal products that have been licensed or registered since 30 October 2005 you can check the public assessment report:

› Public Assessment Reports for herbal medicines

In addition key safety information on the main herbal ingredient used in these products can also be found under the Herbal safety advice section.

How can I tell if an unlicensed medicine is made to acceptable standards?

• Consumers should be aware that unlicensed herbal medicines on the UK market have not been assessed by the MHRA as to their safety, quality or patient information.
• There is evidence that standards vary considerably in the unlicensed sector.  It is likely that some companies manufacture products to good standards.   However, there is also evidence of poor or patchy standards in parts of the sector. Information about this is regularly published on the MHRA’s website under Herbal Safety News. 
• It is not generally possible for consumers to identify which unlicensed medicines are made to acceptable standards.  However, there are a number of pointers, in particular from the product information, which may be indicative of poor or unreliable standards.

How can I find out about the safety of individual herbs?

• Where a herbal product has a PL or THR number the safety of the product and its ingredients will have been assessed by the MHRA.
• But the safety of unlicensed herbal medicines has not been assessed by the MHRA.
• With some unlicensed herbal medicines information for the consumer may be patchy or incomplete.
• To help consumers MHRA has started a new service.  We are preparing herbal information sheets on the safe use of individual herbs. The first information sheets available can be found under the Herbal information sheets section.  The information will be based on herbal products we have assessed since October 2005; the number available will grow as we grant more registrations under the new THR scheme.
• The main purpose of the information sheet is to provide consumers with advice on specific herbal ingredients. This may help consumers identify, and avoid, any unlicensed herbal products that come with obviously unreliable or incomplete consumer information.
  
  Remember that the quality, strength and usage of individual unlicensed herbal products may vary widely. This means that the MHRA information sheets can only be a broad guide as to what consumer information would ideally be provided by the manufacturer of an unlicensed product.

Advice for consumers when buying unlicensed herbal medicines

• Treat with caution claims about safety that are not backed by credible evidence.  Be wary of products making claims such as :
• • The herbal remedy is “100% safe”
  • Herbal remedies are “safe because they are natural” 
  • This herbal medicine “has no side effects”
  • “Chinese medicines will not interfere with the effects of any western medicine”
  • You can avoid Chinese medicines interfering with other medicines if you take them an hour apart.
    
    
• Be wary of any unlicensed medicine suggesting the consumer should stop taking, or change the dosage of, a prescribed medicine.  The MHRA advise you not to follow such advice - you should always consult your doctor about making changes to your prescribed medication
• Treat with caution any unlicensed herbal medicine that makes medicinal claims for the product (that is claims to prevent, treat or cure illnesses).  These claims will not have been assessed by the MHRA and could be misleading
• Be wary of any product if:
• • It is not labelled in English
  • It does not have information about safe usage
  • The herbal practitioner cannot or will not give a list of ingredients.
    
    
• Apparently similar unlicensed herbal medicines may be accompanied by different patient information. Do not assume that the medicine with fewer warnings is necessarily safer to use.
   

Buying herbal medicines over the Internet

• There is an international trade in poor quality unregulated herbal products.  Unlicensed “herbal” products in the UK and elsewhere have been found containing banned pharmaceutical ingredients or heavy metals.  Products may contain harmful herbs that are not permitted in the UK.  Be aware that unlicensed herbal medicines manufactured outside the UK may not be subject to any form of effective regulation.
• If a product refers to licences granted in other countries there may be no guarantees that the product actually complies with requirements or that standards applied in other counties match those that a UK consumer would expect from regulated products.

What to do if you think you have had an adverse reaction to your herbal medicine?

• All medicines, including herbal medicines, may cause side effects or unwanted reactions.
• If you think you have had a reaction to your herbal medicine, you should discontinue use and tell your doctor or pharmacist.
• If you think you or someone else has had an unwanted or harmful reaction after taking a herbal medicine (commonly referred to as a suspected adverse drug reaction), we would like to know. This will help us give advice to other patients and healthcare professionals - and will help us make sure herbal medicines in the UK are safe.
• You can report a reaction yourself directly to us using a system called the Yellow Card Scheme.
• This can be done online or by filling out a paper yellow form which is available upon request by calling 020 7084 2000.
• Alternatively, you can ask your doctor or pharmacist to report the reaction us on your behalf.
• Any information received by us will be held in complete confidence and your personal details will not be given to anyone else without your permission.