Application of FDA adverse event report data to the surveillance of dietary botanical supplements.
BACKGROUND
Concerns have been raised about the sufficiency of dietary botanical supplement (DBS) surveillance in the US. The Food and Drug Administration's Center for Food Safety and Applied Nutrition's Adverse Event Reporting System (CAERS) represents one of the few existing surveillance mechanisms, but it has not been well characterized with respect to DBS adverse effects.


OBJECTIVE
To characterize data on DBSs associated with adverse event reports submitted to CAERS.


METHODS
We requested and obtained CAERS data from 1999 to 2003 involving adverse effects associated with the 6 most frequently used DBSs: Echinacea, ginseng, garlic, Ginkgo biloba, St. John's wort, and peppermint. We summarized and characterized the adverse event reports received, focusing on the composition of the DBSs and the nature of associated adverse events. We also cross-referenced reported single-ingredient DBSs with corresponding available product information. A sample of CAERS cases associated with signal DBSs was also characterized in detail.


RESULTS
CAERS reports involving ginseng DBSs were most frequently reported during the study period, whereas reports involving St. John's wort were the least frequently reported. Most CAERS reports involved multiple-ingredient DBSs, and 3-13% of reports involved multiple DBSs. Gastrointestinal and neurologic problems were the most common clinical outcomes among single-ingredient DBS-associated adverse events.


CONCLUSIONS
CAERS surveillance of DBS adverse effects is potentially as effective as other passive surveillance methods, but the number of reports is relatively small, validation is incomplete, and some inconsistencies within reports were found. Reports in CAERS may underrepresent DBS adverse events associated with DBS consumption.
Wallace
Robert B
RB
Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA. robert-wallace@uiowa.edu
Gryzlak
Brian M
BM
Zimmerman
M Bridget
MB
Nisly
Nicole L
NL
D016907:Adverse Drug Reaction Reporting Systems / Q000592:standards* / Q000639:trends; D019587:Dietary Supplements / Q000009:adverse effects* / Q000592:standards*; D020900:Echinacea / Q000009:adverse effects; D005737:Garlic / Q000009:adverse effects; D020441:Ginkgo biloba / Q000009:adverse effects; D020902:Hypericum / Q000009:adverse effects; D036142:Mentha piperita / Q000009:adverse effects; D005894:Panax / Q000009:adverse effects; D011358:Product Surveillance, Postmarketing / Q000592:standards* / Q000639:trends; D014481:United States; D014486:United States Food and Drug Administration / Q000592:standards* / Q000639:trends