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(More customer reviews)This new edition of the PDR for Herbal Medicines goes beyond the first edition, published in December of 1998. While the first edition was somewhat limited by dated, unreferenced information, this one is much more up-to-date and includes recent references to the literature, such as the St. John's wort interactions with indinavir and cyclosporin that were just published this year. Each entry gives a botanical overview, describes actions and pharmacology, and discusses indications and usage in various medical traditions. There is information on clinical trials, and more material on herb/drug interaction, precautions, contraindications, adverse reactions, and dosage. Having a complete herbal reference is a necessity for physicians and other health-care providers in today's world - whether they want to include some herbals in their armamentarium or merely wish to head off possible herb-drug interactions among the patients who are treating themselves.
A careful reading of the hypericum section, however, revealed that several newer clinical trials were not included, while an old (1994) study remained.
In this reference, the physician would learn St. John's wort taken concomitantly with sertraline may lead to "serotonin syndrome," e.g., sweating, tremor, flushing, confusion and agitation. The likelihood of seeing this effect would be difficult to judge, however, since these anecdotal reports from the literature are taken a face value with little critical appraisal. If we don't know how many patients have taken this particular combination, we have no denominator. The inclusion of all material related to toxicologic effects is good for the sake of a comprehensive overview, but the drawback is to lose the feel for what may really be important. An example is the inclusion of a reference regarding hypericum toxicity when directly incubated with sperm or oocytes. Without pointing out that this very unusual study is not the way reproductive or teratogenic is determined during drug development, the reader may be left with the belief that hypericum showed reproductive toxicity. The reference to an interaction with theophylline might have mentioned that the patient was on a plethora of other drugs and relied on her recollection of events. It might also have mentioned that direct human studies of the 1A2 and 2D6 enzymes found no effect from hypericum. Rather, it stated that hypericum "...may significantly affect plasma concentrations of any drug that is metabolized by the cytochrome P-450 system." This is not supported by data. Also unsupported is the incorrect statement taken from Schultz et al's Rational Phytotherapy that phototoxicity may occur at hypericin plasma concentrations of 50 mcg/mL. This should have read 50 mcg/L (or 50 ng/mL) as the original paper reported. Also not useful is the daily dosage recommendation of 200 - 1000 mcg hypericin for depression; one might conclude that there is evidence for this.
While this book is sold as a mainstream reference it may be somewhat daunting for the layman. It's well-organized style and the provision of recent scientific and medical references will make it a useful starting place for more in depth research for health-care professionals. Perhaps the publication of an erratum could be recommended.
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