Advertisement

Drug-induced hyperkalemia: The reply:

      As noted by Dr. Pantanowitz, a number of herbal or natural remedies may be unsafe for general human consumption. This is particularly true for patients with underlying renal disease. Some herbal products have been noted to cause renal failure (Aristolochia spp) and kidney stones (Ma-Huang-Ephedra spp) in normal hosts (
      • Vanherweghem J.L.
      • Depierreux M.
      • Tielemans C.
      • et al.
      Rapidly progressive interstitial renal fibrosis in young women association with slimming regimen including Chinese herbs.
      ,
      • Powell T.
      • Fu Hsu F.
      • Turk J.
      • Hruska K.
      Ma-Huang strikes again ephedrine nephrolithiasis.
      ). However, certain medicinal herbs may induce potentially life threatening hyperkalemia in patients with underlying risk factors (chronic renal insufficiency, hypoaldosteronism, use of other potassium-altering medications) for this electrolyte disorder. Examples include herbs or juices, such as noni juice (Morindia citrifolia), alfalfa (Medico sativa), dandelion (Taraxacum officinale), horsetail (Equisetum arvense), and nettle (Urtica dioica), that contain large amounts of potassium (
      • Mueller B.A.
      • Scott M.K.
      • Sowinski K.M.
      • Prag K.A.
      Noni juice (Morindia citrifolia).
      ,
      • Leung A.Y.
      • Foster S.
      ). Patients with impaired renal potassium handling can develop severe hyperkalemia after ingesting these substances. In addition to the herbs pointed out by Dr. Pantanowitz, Na-K-ATPase impairment by the digoxin-like substances contained in milkweed, lily of the valley, Siberian ginseng, and hawthorne berries may also precipitate hyperkalemia in at-risk patients (
      • Miller L.G.
      Herbal medicinals selected clinical considerations focusing on known or potential drug-herb interactions.
      ,
      • Cheng T.O.
      Herbal interactions with cardiac drugs.
      ). It is therefore prudent that practitioners who care for patients who consume these products become familiar with the associated adverse effects. Furthermore, the FDA should be allowed to enforce the same drug standards for herbal remedies and natural products available in the marketplace that are required for other medications.

      References

        • Vanherweghem J.L.
        • Depierreux M.
        • Tielemans C.
        • et al.
        Rapidly progressive interstitial renal fibrosis in young women.
        Lancet. 1993; 341: 387-391
        • Powell T.
        • Fu Hsu F.
        • Turk J.
        • Hruska K.
        Ma-Huang strikes again.
        Am J Kidney Dis. 1998; 32: 153-159
        • Mueller B.A.
        • Scott M.K.
        • Sowinski K.M.
        • Prag K.A.
        Noni juice (Morindia citrifolia).
        Am J Kidney Dis. 2000; 35: 310-312
        • Leung A.Y.
        • Foster S.
        Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. Wiley & Sons, New York1996
        • Miller L.G.
        Herbal medicinals.
        Arch Intern Med. 1998; 158: 2200-2211
        • Cheng T.O.
        Herbal interactions with cardiac drugs.
        Arch Intern Med. 2000; 160: 870