You have to be careful when using an herbal remedy. Herbal remedies are a type of dietary supplement. They are not medicines. Here are some things you should know about herbals:

• Herbals are not regulated like medicines.
• Herbals do not need to be rigidly tested before they are sold.
• Herbals may not work as claimed.
• Labels do not need to be approved by any authority. It may not list the correct amount of an ingredient.
• Some herbal remedies may contain ingredients or contaminants not listed on the label.

Many people think that using plants to treat illness is safer than taking medicine. People have been using plants in folk medicine for centuries. So, it is easy to see the appeal. Yet "natural" does not mean safe. Unless taken as directed, some herbals can interact with other medicines or be toxic at high doses. Also, some may cause side effects.

Here are some examples:

• Kava is an herb used for anxiety, insomnia, symptoms of menopause, and other ailments. Some studies show it may work for anxiety. But kava can also cause severe liver damage. The FDA has issued a warning against its use.
• St. John's Wort may work for mild to moderate depression. However, it can interact with birth control pills, antidepressants, and other drugs. It can also cause side effects such as stomach upset and anxiety.
• Yohimbe is a bark used to treat erectile dysfunction. The bark can cause high blood pressure, increased heart rate, anxiety, and other side effects. It can interact with certain medicines for depression. Taking it in high does or for a long time can be dangerous.

Of course, some herbals have been tested and work well for their intended purpose. Many are also quite safe, but the word "natural" will not tell you which ones are safe and which ones are not safe.

Some herbals can make you feel better and help keep you healthy. But you need to be a smart consumer. Use these tips when choosing herbal remedies.

• Look closely at the claims made about the product. How is the product described? Is it a "miracle" pill that "melts away" fat? Will it work faster than regular care? Is it a secret your health care provider and drug companies don't want you to know? Such claims are red flags. If something sounds too good to be true, it probably is not.
• Remember "real-life stories" are not scientific proof. Many products are promoted with real-life stories. Even if the quote comes from a provider, there's no proof that other people will get the same results.
• Before trying a product, talk with your provider. Ask for their opinion. Is the product safe? What are the chances it will work? Are their risks? Will it interact with other medicines? Will it interfere with your treatment?
• Buy only from companies that have certification on the label, such as "USP Verified" or "ConsumerLab.com Approved Quality." Companies with these certifications agree to test the purity and quality of their products.
• Do not give herbal supplements to children or use them if you are older than age 65 years. Talk to your provider first.
• Do not use herbals without talking to your provider if you are taking any medicines.
• Do not use them if you are pregnant or breastfeeding.
• Do not use them if you are having surgery.
• Always let your provider know what herbals you use. They can affect the medicines you take as well any treatment you receive.

These sites can help you learn more about specific herbal supplements:

• NIH MedlinePlus database of herbs and supplements -- medlineplus.gov/druginfo/herb_All.html
• The National Center for Complementary and Integrative Health (NCCIH): Herbs at a glance -- nccih.nih.gov/health/herbsataglance.htm
• American Cancer Society: Complementary and alternative medicine -- www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine.html

Aronson JK. Herbal medicines. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier B.V.; 2016:707-742.

Gardiner P, Filippelli AC, Low Dog T. Prescribing botanicals. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 104.

National Center for Complementary and Integrative Health website. Using dietary supplements wisely. nccih.nih.gov/health/supplements/wiseuse.htm. Updated January 2019. Accessed November 24, 2022.

US Food & Drug Administration website. Information for consumers on using dietary supplements. www.fda.gov/Food/DietarySupplements/UsingDietarySupplements/default.htm. Updated October 21, 2022. Accessed November 24, 2022.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.