The potential for harm is not insignificant with a number of CAM treatments. Of concern is that up to 70% of patients will not tell their doctors that they are using these products. Some do not consider herbal products as medications, and others believe their doctor will not be interested or may even be judgmental.

Many complementary and alternative medicines are exempt from the requirement of scheduled medicines to demonstrate efficacy. They can be registered for use by demonstrating safety in the form presented. Claims made by the product must be restricted and of limited scope; conditions being treated are generally considered to be mild and/or self-limiting. Efficacy may or may not be established through clinical studies. Effective doses of active ingredients can vary widely between products due to the range of plant parts used, and different methods of processing.

Herbal products can interact with conventional medications, leading to increases in potency or decreased efficacy Some agents (Ginkgo biloba, devil’s claw, ginger, garlic) may have antiplatelet/anticoagulant effects and may exacerbate gastrointestinal bleeding if used with nonsteroidal anti-inflammatory drugs (NSAIDs). Interactions with warfarin could lead to potentially fatal results. Echinacea may be hepatotoxic and should be used with care in patients taking disease-modifying antirheumatic drugs (DMARDs), many of which also have liver toxicities.

For full information physicians need to access appropriate websites or contact a pharmacist.