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Herbal medicines
  1. M Pirmohamed
  1. Correspondence to:
 Professor Munir Pirmohamed, Department of Pharmacology and Therapeutics, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK; 

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Always ask your patient about herbal medicines

Complementary and alternative medicine (CAM) is a generic term for a range of therapies and practices including herbal medicine and acupuncture. Herbal medicines are the most widely used form of CAM.1 The general public has a more positive view of herbal medicines compared with conventional medicines, largely because they are perceived as being “natural” and “safe”. However, recent events have shown that herbal medicines can have severe adverse health consequences. For example, aristolochia and kava kava have recently been withdrawn from the UK market because of their association with nephrotoxicity and hepatotoxicity, respectively.2 Similarly, regulatory action had to be instituted against St John’s Wort because of its potential to interact with other medicines which led to serious adverse events such as graft rejection (interaction with immunosuppressants) and failure to suppress HIV (interaction with protease inhibitors).3

Ginkgo biloba extract is a widely used herbal preparation derived from the broad leaves of the maidenhair tree. It is …

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