title: Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews.
abstract: OBJECTIVE
  The aim of this overview of systematic reviews is to summarise and critically evaluate the evidence from systematic reviews of the adulteration and contamination of herbal medicinal products (HMPs).
  
  
  METHODS
  Five electronic databases were searched to identify all relevant systematic reviews.
  
  
  RESULTS
  Twenty-six systematic reviews met our inclusion criteria. The most commonly HMPs were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively.
  
  
  CONCLUSIONS
  Collectively these data suggest that there are reasons for concerns with regards to the quality of HMPs. Adulteration and contamination of HMPs can cause serious adverse effects. More stringent quality control and its enforcement seem to be necessary to avoid health risks.
authors: Complementary Medicine, Peninsula Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK. paul.posadzki@pcmd.ac.uk
authors: Paul
authors: P
authors: Posadzki
authors: Leala
authors: L
authors: Watson
authors: Edzard
authors: E
authors: Ernst
mesh_terms: D004340:Drug Contamination / Q000517:prevention & control; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000032:analysis; D006801:Humans; D061214:Patient Safety; D008517:Phytotherapy / Q000009:adverse effects* / Q000592:standards; D028321:Plant Preparations / Q000009:adverse effects* / Q000032:analysis* / Q000592:standards; D010946:Plants, Medicinal; D011786:Quality Control; D018570:Risk Assessment
chemical_list: D004365:Drugs, Chinese Herbal; D028321:Plant Preparations