The Drug-Induced Cardiotoxicity Website and App

Herbals - Dietary botanical therapy - Health products/food - Plants

Including food and dietary supplements, herbals available on e-shops on the Internet, plants (e.g. aconite-nape, Atropa, scopolamine). Browsing the literature indicates nonpulmonary (neurotoxic, hepatic, cardiac, metabolic, genitourinary) adverse effects as well as possible pharmacokinetic/metabolic interactions with therapeutic drugs. Death can occur following exposure. See PMID 9528737, 21896525, 21972388, 22045882. Caution needed about herbals used to treat asthma or obesity, as these may contain steroids or amphetamines respectively (PMID 2323261; http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm238491.htm). Patients should be prudent with herbal 'sexual enhancers', as these may contain undeclared active drugs (PMID 22365331, 25459948). Quality of publications regarding ILD, assessment and attribution of causality is 'wide-ranging'

Frequency - Incidence

Incidence of cardiac adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for cardiac adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic