Illegal herbal remedies containing Aristolochia: vigilance needed

MHRA continues to identify cases of herbal medicines, particularly traditional Chinese medicines, which contain illegal and toxic Aristolochia or aristolochic acids.

Article date: November 2007

Aristolochia is a plant genus of the family Aristolochiaceae. Various Aristolochia species have been used in herbal medicines worldwide as anti-inflammatory agents for gout, arthritis, rheumatism, and chronic inflammatory skin diseases.

Use of Aristolochia species in herbal medicines was prohibited in the UK in 1999 because of the toxicity of the aristolochic acid constituents, which are nephrotoxic, carcinogenic, and mutagenic—even at very small doses. The UK prohibition order also includes several other plant species that do not cause nephrotoxicity on their own, but which were commonly substituted with Aristolochia in the remedies.

Aristolochia is associated with distinctive renal fibrosis, which has been called Chinese Herb Nephropathy. End-stage renal failure in Chinese Herb Nephropathy can be reached 6–24 months after ingestion of Aristolochia. Furthermore, some patients have developed transitional-cell carcinoma in the renal pelvis, ureter, and bladder.

The MHRA continues to identify cases of herbal medicines, particularly traditional Chinese medicines, which contain Aristolochia or aristolochic acids. Commonly, there has been no reference to Aristolochia on the list of ingredients for the products. In recent years, the MHRA has found Aristolochia in the following products:

Products

Products that contain Aristolochia are illegal. Anyone with information about the sale or supply of products suspected to contain Aristolochia should contact the MHRA immediately.

Healthcare professionals should ask patients who present with unexplained nephrotoxicity about any herbal products they may have taken, particularly traditional Chinese medicines.

Article citation: Drug Safety Update November 2007, vol 1 issue 4: 8a.

See also…
MHRA warns against Traditional Chinese Medicines found to contain Aristolochia
Safety warnings and messages for herbal medicines

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