Informal Trade of Psychoactive Herbal Products in the City of Diadema, SP, Brazil: Quality and Potential Risks
Table 1
16 PHs investigated in this study and their ethnopharmacological, microbiological, and pharmacognostic data and published reports indicating their possible risks of use.
16 PHDs (52 lots)
Ethnopharmacology Psychoactive use (parts)
Microbiology (no. of lots containing the following microorganisms)
Pharmacognosy authenticity (no. of lots containing foreign material)
Literature data indicating risk of use
Star anise (2 lots analyzed)
Depressant and stimulant (seeds)
Not detected
(+) Illicium verum Hook. f. (Schisandraceae)
Toxicity: neurotoxicity has been associated with the use of star anise infusions in infants. The toxicity is attributed to adulteration or contamination of Chinese star anise (Illicium verum) with Japanese star anise (I. anisatum), which contains toxic sesquiterpene lactones such as anisatin [10]. According to Alonso [11] this plant also contains shikimin, and substances with proven cardiotoxic activity
Matricaria flower (3)
Depressant and stimulant (flowers)
Enterobacter
spp., (2 lots)
(+) Matricaria recutita L. (Asteraceae) (2 lots)
Contraindications: hypersensitivity to matricaria flower or other members of the Asteraceae family, atopic high fever or asthma, and pregnancy. Pregnancy category: internal consumption of the whole plant should be avoided during early pregnancy. Adverse effects: anaphylaxis, emesis in high doses, conjunctivitis, eye-lid angioedema, contact dermatitis, eczema, and rhinitis. Interactions: anticoagulants [10]. There may also be interaction with potential anticoagulant plants and other herbal medicines which also alter coagulation, such as garlic, ginseng, ginger, ginkgo, angelica, anise, arnica, fenogreco, and willow. Interaction with other depressants of the CNS, since theoretically the concomitant use of herbal matricaria flower with other CNS depressants may increase the therapeutic and adverse effects, including valerian, kava-kava, calamus, lemongrass, among others [12]
Catuaba (4)
Stimulant (stem barks)
Enterobacter spp., Aspergillus flavus (4)
(−) Anemopaegma mirandum (Cham.) Mart. ex DC. (Bignoniaceae) corresponds to the stem barks of Trichilia catigua A. Juss. (Meliaceae)— species not listed in the Pharmacopoeia
Interactions: front of antidepressant effects experimentally verified with mechanisms of inhibition of the reuptake of serotonin and dopamine; catuaba Trichilia catigua can theoretically increase the therapeutic and adverse effects of other antidepressants with the same mechanism (e.g.,: fluoxetine, duloxetine, sertraline, fluvoxamine, amineptine, bupropion, and minaprine) and can also interact with MAO, increasing the dopaminergic effects of the plant [13, 14]
(+) Tynanthus fasciculatus Miers, T. elegans Miers (Bignoniaceae)
Interactions: checking for the presence of coumarin in parts of the plant allows to relate theory, its potential interaction with drugs and herbal anticoagulants [15]; it may also induce seizures in epileptic patients on medication [12]. Contraindications: (T. fasciculatus) during pregnancy, lactation, in children, in epilepsy, seizures, or hyperactivity
Adverse events: dermatitis is likely to occur following contact with the plant. It can be irritating to mucous membranes and, if ingested or placed in the eye, it might cause periorbital edema, cheilitis, eye irritation, stomatitis, and rectal irritation. In sensitized patients, it can produce pruritus ani. Nausea and vomiting may occur after ingesting the leaf extract or the seeds. Contraindications: hypersensitivity to ginkgo; concomitant use of aspirin or other antiplatelet medication. Interactions: drugs such as anticonvulsants, anticoagulants, low molecular weight heparins, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and thiazide diuretics. Pregnancy: pregnancy risk category C; not recommended during lactation [10]
Contraindications: hypersensitivity to guarana, arrhythmia, pregnancy, breastfeeding, and severe signs of toxicity have not been reported but the usual cautions regarding caffeine apply; guarana should not be used or used with caution in patients with cardiovascular disease, chronic headache, diabetes, gastric ulcer, and in those taking theophylline, not recommended for excessive long-term use. Pregnancy: do not use during pregnancy; do not use during lactation. Interactions: drugs such as clonazepam, diazepam, alendronate, cimetidine, theophylline, and pantoprazole. Adverse effects: agitation, insomnia, nervousness, restlessness, gastrointestinal irritation, serious: arrhythmias (at high doses), palpitations (at high doses), tachycardia (at high doses), and excessive central nervous system stimulation [10, 17]
Adverse effects: Information is limited concerning toxicity of Passiflora. The herbal extract has been used in American traditional medicine for many years and has not generally been associated with acute or chronic toxicity. However, the pharmacological profile of the extracts of this plant suggests that large doses may result in CNS depression and ventricular dysrhythmias. Trace amounts of cyanogenic glycosides have been found in Passiflora species, but cyanide poisoning due to these glycosides has not been reported nor is it expected. Interactions: barbiturates, benzodiazepines; it is theoretically possible that excessive Passiflora doses may potentiate the effects of monoamine oxidase inhibitor drugs or might cause MAOI-type interactions with other drugs or food but these effects have not yet been documented in clinical studies or reports. Contraindications: not to be used during pregnancy. Range of toxicity: acute toxicity of Passiflora incarnata appears to be minimal. One human case of toxicity occurred possibly due to an inherited enzyme metabolizing defect resulting in toxic levels of the herbal, with resultant nausea, vomiting, CNS depression, prolonged QTc interval, and ventricular tachycardia [10, 11]
Interactions: although there is little information available, it was found that crude ethanolic extract of marapuama increases the amphetamine-induced toxicity in animal models (amphetamine stereotypy test, lethality of yohimbine and by reversal of reserpine ptosis). There was occurrence of convulsions, cyanosis, and increased mortality of animals used in testing [18]. Such effects contraindicate the combination of extracts of marapuama with amphetamines, as used to be common in weight loss formulas for some years in Brazil [19]
Lemon balm (2)
Depressant (leaves)
Enterobacterspp., (1)
(−) Melissa officinalis L. (Lamiaceae)
**
Mulungu (4)
Depressant (barks)
Enterobacter spp., Aspergillus flavus (4)
(−) Erythrina mulungu Mart. ex Benth. (Fabaceae)
**
Node of dog (4)
Stimulant (roots)
Escherichia coli, Enterobacter spp., (3)
(−) Heteropterys aphrodisiaca O. Mach. (Malpighiaceae). The lots match to Vernonia cognata Less. (Asteraceae) rhizome
Little information is available for both H. aphrodisiaca as for V. cognata, allowing consideration of risks and adverse effects.
(+) Tilia cordata Mill. and Tilia platyphyllos Scop. (Malvaceae)
Contraindications: it topically can cause hives; frequent use of flowers in the form of tea is associated with rare cardiac damage and should be used with caution in patients with heart problems. A case of a pollinic patient sensitized to lime flower pollen (T. cordata) was reported. Collateral effects: it can cause nausea and vomiting in sensitive people [12, 20, 21]. Interactions: for its mild anxiolytic effect it may theoretically show synergy with other drugs and herbal anxiolytic [22]
Adverse effect: chronic ingestion of valerian has been associated with headache, insomnia, agitation, and hepatotoxicity. Cardiac complications and delirium have been reported following abrupt withdrawal. Symptoms of overdose have included fatigue, lightheadedness, abdominal pain, tremor, hypotension, and mydriasis. Interactions: barbiturates, benzodiazepines, ethanol, hepatotoxic agents, loperamide, and opioid analgesics [10]
(+) Plants that have their authenticity confirmed by the Pharmacopoeia and (−) plants that had no confirmation of their authenticity. Data on the adverse effects were not collected due to the absence of their botanical identification.
