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COMPLEMENTARY AND ALTERNATIVE MEDICINE

Application of FDA Adverse Event Report Data to the Surveillance of Dietary Botanical Supplements

Professor, Department of Epidemiology, University of Iowa, Iowa City, IA

Brian M Gryzlak, MSW MA

Research Assistant, Department of Epidemiology, University of Iowa

M Bridget Zimmerman, PhD

Clinical Associate Professor, Department of Biostatistics, University of Iowa

Nicole L Nisly, MD

Clinical Professor, Department of Internal Medicine, University of Iowa

Reprints: Dr. Wallace, Department of Epidemiology, C21-N GH, University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242, fax 319/384-5004, robert-wallace{at}uiowa.edu

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.

Key Words: alternative medicine, dietary supplements, herbal medicine, MedWatch, pharmacoepidemiology

Published Online, April 8, 2008. www.theannals.com, DOI 10.1345/aph.1K611