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COMPLEMENTARY AND ALTERNATIVE MEDICINE

Evaluation of Presence of Aspirin-Related Warnings with Willow Bark

Assistant Professor, Pharmacy Practice; Drug Information Specialist, College of Pharmacy—West Palm Beach Program, Nova Southeastern University, Palm Beach Gardens, FL

Marile L Santamarina, PharmD

Student, College of Pharmacy— West Palm Beach Program, Nova Southeastern University

Christian M Buettner, PharmD

Student, College of Pharmacy— West Palm Beach Program, Nova Southeastern University

Jacintha S Cauffield, PharmD

Assistant Professor, Pharmaceutical Sciences; Academic Facilitator, College of Pharmacy—West Palm Beach Program, Nova Southeastern University

Reprints: Dr. Clauson, Drug Information Center, Nova Southeastern University, 3970 RCA Blvd., Ste. 7006A, Palm Beach Gardens, FL 33410-4231, fax 561/627-0972, clauson{at}nova.edu

BACKGROUND: The dietary supplement willow bark, also known simply as willow, contains salicylates that may present a safety risk to people. Current regulations do not require willow bark to include any cautions on its label.

OBJECTIVE: To evaluate the absence or presence of label warnings related to salicylates contained in willow bark to ascertain whether a potentially dangerous lack of information exists.

METHODS: The label of each willow supplement and willow-containing product was assessed for the presence or absence of 3 warnings: (1) aspirin allergy/sensitivity, (2) use of anticoagulants or "blood thinners," and (3) children with flu-like symptoms or Reye's syndrome. Products from pharmacies and health food stores were targeted and their labels analyzed. A compilation of the identified products was used to conduct a similar evaluation of warnings from their Web sites.

RESULTS: A total of 58 willow bark–containing and 12 single-ingredient willow bark products were assessed. Of the 70 products evaluated, only 8.6% listed a warning. The warning regarding aspirin sensitivity was present on 4.3%, Reye's syndrome was 2.9%, and interactions with anticoagulants/"blood thinners" was 4.3%. One product was labeled as aspirin-free. Percentages were lower on Web sites.

CONCLUSIONS: There is a dearth of information regarding potential safety risks on the labels of willow bark and willow bark–containing products. Combination products containing willow bark may pose a greater danger to at-risk patients based on their sheer volume. Counseling of patients who take dietary supplements can improve the situation; however, it may ultimately take improved requirements for dietary supplement labeling to fully address this problem.

Key Words: willow bark: anticoagulants, aspirin sensitivity, product labeling, Reye's syndrome

Published Online, May 31, 2005. www.theannals.com, DOI 10.1345/aph.1E650

This article has been cited by other articles:

				A. Vasquez and D. N Muanza Comment: evaluation of presence of aspirin-related warnings with willow bark Ann. Pharmacother., October 1, 2005; 39(10): 1763 - 1763. [Full Text] [PDF]

				K. A Clauson, M. L Santamarina, and J. S Cauffield Ann. Pharmacother., October 1, 2005; 39(10): 1763 - 1764. [Full Text] [PDF]