The role of medicinal plants in pharmacy

In this article:

• What are botanicals, and how are they regulated?
• Common botanical preparations
• Educating patients

In this article

• What are botanicals, and how are they regulated?
• Common botanical preparations
• Educating patients

For thousands of years, plants have been used for medicinal purposes, and they’re still used today. In fact, many consider medicinal plants to be the origin of modern medicine. The use of plant-based medicine is growing over time. Studies have even shown that it’s the preferred therapy for mild-to-moderate conditions. As pharmacists, it’s important to understand the role of healing plants in the industry, how they are regulated, and how certain medicinal plants can help prevent diseases and support treatment with prescription medication.

What are botanicals, and how are they regulated?

According to the National Institutes of Health (NIH), a botanical is an herb, plant, or plant part used for medical purposes, flavor, or scent. Botanicals may be used to make botanical drugs, botanical preparations, and essential oils.

Botanical drugs

According to the Michigan State University Center for Research on Ingredient Safety, botanical drugs are regulated by the FDA in the same way as prescription and over-the-counter drugs. This means the FDA reviews botanical medications for safety and efficacy before being approved. To date, four botanicals have been categorized by the FDA as botanical drug products and marketed as prescription drugs, including:

• Veregen (sinecatechins)
• Mytesi (crofelemer)
• Filsuvez (birch triterpenes)
• NexoBrid (anacaulase-bcdb)

Botanical preparations

In the U.S., botanical preparations are commonly sold as dietary supplements, but the FDA does not test them for safety and effectiveness. Instead, the product manufacturer is responsible for ensuring that their product is safe and that the product label claims are truthful. The FDA enforces the laws and regulations governing the purity, strength, and composition of dietary supplements by conducting periodic inspections, monitoring the marketplace, investigating adverse event reports, and removing products from the market if needed.

The use of botanical preparations—also called phytomedicines, medicinal plants, or herbal medicines—has significantly increased over the past 30 years. Up to 80% of the world’s population relies on herbal medicine for some part of their primary healthcare. Herbal medicine is used to treat many conditions, including allergies, asthma, eczema, rheumatoid arthritis, migraine, irritable bowel syndrome (IBS), and cancer. 

Common botanical preparations

Many botanical preparations are used today. Here are some common examples, including their uses and important safety information. 

Echinacea (Echinacea purpurea or Echinacea angustifolia)

Echinacea is a medicinal plant native to North America. It’s usually marketed as a dietary supplement that can boost the immune system to help fight infections such as the common cold. It’s also promoted for other uses, including wound healing, skin problems, pain, and inflammation.

According to the Icahn School of Medicine at Mount Sinai, echinacea is available as tablets, capsules, extracts, tinctures, and ointments. It can be sold alone or in combination with other herbs, vitamins, or minerals.

Most research on echinacea has focused on its use for the common cold and other upper respiratory tract infections. According to the NIH, echinacea may slightly reduce your risk of catching a cold, but it has not been shown to shorten the length of a cold. There haven’t been enough studies to prove whether echinacea is helpful for other conditions.

In terms of safety, the NIH states echinacea is probably safe for short-term use by mouth. It’s not known if it’s safe to take echinacea in the long-term. Common side effects may include digestive symptoms, such as nausea or stomachaches. Its drug interaction risk is low. However, Mount Sinai notes that echinacea may reduce the effectiveness of immunosuppressant medications, such as drugs used for organ transplants or chemotherapy.

St. John’s wort (Hypericum perforatum)

St. John’s wort has a long history of medicinal use dating back to ancient Greece. It’s mainly promoted for depression, but it may have utility in attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), symptoms related to menopause, and other conditions.

As a dietary supplement, St. John’s wort is available in many forms, including tablets, capsules, teas, tinctures, and lotions. Dried forms of the herb are also available.

There are several studies on the use of St. John’s wort for depression. Overall, the NIH states St. John’s wort is more effective than a placebo (a sugar pill) and as effective as certain antidepressants for mild-to-moderate depression. It may also be helpful for menopausal symptoms, wound healing, and somatic symptom disorder.

According to the NIH, St. John’s wort is generally regarded as safe if taken by mouth for up to 12 weeks. Side effects may include sensitivity to sunlight, insomnia, anxiety, dry mouth, dizziness, and sexual dysfunction. St. John’s wort may also increase the levels of serotonin in your brain, which is a chemical involved in mood, appetite, sleep, and other bodily functions. Due to this risk, combining St. John’s wort with other drugs that increase serotonin can increase the risk of serotonin syndrome.

St. John’s wort is known to interact with many medications. In most cases, it makes other medications less effective. Examples include certain antidepressants, birth control pills, cyclosporine, certain HIV drugs, warfarin, and some statin drugs.

Gingko (Ginkgo biloba)

Ginkgo has been used for years in traditional Chinese medicine. Today, it’s marketed as a dietary supplement used for various conditions, such as anxiety, allergies, memory problems, eye problems, and blood disorders.

Ginkgo is available in the following forms: extracts, capsules, tablets, and dried leaves for teas. Modern research has focused on standardized Ginkgo biloba extract (GBE), which is highly concentrated and believed to be more effective than non-standardized extracts.

According to the NIH, there is inconclusive evidence supporting Gingko’s use for any condition. Some evidence supports its use to improve memory problems slightly. However, the findings may be unreliable. For other health conditions, such as anxiety, eye problems, blood disorders, premenstrual syndrome (PMS), schizophrenia, and vertigo, there is a small amount of evidence that Ginkgo may provide a benefit. Still, no studies have proven its efficacy yet.

According to the NIH, Ginkgo appears to be safe when taken in moderate amounts. However, it can cause side effects such as headache, stomach upset, dizziness, palpitations, constipation, and skin reactions. It may also increase the risk of bleeding, especially if it’s taken with anticoagulants (blood thinners).

Chamomile (Matricaria recutita)

Matricaria recutita is a German chamomile sold as a dietary supplement. It helps calm nerves and treats anxiety and insomnia. It’s also marketed for stomach issues, such as gas, stomach upset, diarrhea, and skin conditions, including eczema.

German chamomile is available as tea, liquid extract, capsules, ointment, and dried flower heads.

According to the NIH, there is limited evidence supporting chamomile’s use for any purpose. Some preliminary evidence suggests chamomile can help with generalized anxiety disorder, but there is very little information known about its effects on insomnia. Some research found that chamomile combined with other herbs can provide some benefits for upset stomach, diarrhea in children, or colic in infants. However, there isn’t evidence that chamomile alone is effective for these purposes.

Although there isn’t much evidence supporting its use, the NIH states chamomile is likely safe in the amount sold in teas. Short-term use of oral chamomile may also be secure. Side effects may include nausea, dizziness, and allergic reactions. In rare cases, anaphylaxis (severe, life-threatening allergic reactions) can occur. Chamomile is known to interact with certain drugs, such as Neoral (cyclosporine) and Coumadin (warfarin).

Saw palmetto (Serenoa repens)

Saw palmetto is an herbal drug native to the southeastern U.S. It’s sold as a dietary supplement that can help with urinary symptoms caused by benign prostatic hyperplasia (BPH), pelvic pain, migraine, hair loss, and other conditions.

Saw palmetto is sold as dried berries, capsules, tablets, tinctures, and extracts. It’s best to take a standardized product that contains 85% to 95% fatty acids and sterols.

According to two large, high-quality studies funded by the NIH, saw palmetto was no more effective than a placebo for BPH. However, there haven’t been enough studies to determine whether saw palmetto is effective for other conditions.

Safety-wise, the NIH states that saw palmetto is well tolerated. It can cause mild side effects such as gastrointestinal symptoms and headaches. To date, saw palmetto has not been shown to interact with other medications.

Valerian (Valeriana officinalis)

Valerian is another medicinal plant that has been used since the times of early Greece and Rome. It’s promoted for insomnia, anxiety, depression, PMS, symptoms of menopause, and headaches.

Valerian is available as a fluid extract and tinctures. The powder is also available as a capsule, tablet, or tea.

Limited research is available on the use of valerian. The evidence needs to be more consistent on whether valerian is helpful for insomnia. According to the NIH, the American Academy of Sleep Medicine recommends against using valerian for chronic insomnia in adults. A small amount of research found valerian may be helpful for menopausal symptoms, but this evidence wasn’t conclusive. It’s not known if valerian is useful for other conditions.

According to the Icahn School of Medicine at Mount Sinai, valerian is generally regarded as safe for short-term use. The safety of long-term use over 28 days is unknown. Valerian may cause side effects, such as headache, stomach upset, drowsiness, dry mouth, and heart problems. Healthcare providers typically recommend avoiding valerian with alcohol or other CNS depressants due to potential additive sedative effects.

Educating patients

As a pharmacist, you have the opportunity to educate patients about medicinal plants. Reviewing the recommended dosage, administration information, key side effects and warnings, and potential drug interactions is key—especially for botanical preparations since they aren’t as tightly regulated. Remind patients to choose preparations with a seal of quality assurance from a third-party organization, such as ConsumerLab.com, NSF International, or U.S. Pharmacopeia. While this seal doesn’t guarantee safety or effectiveness, it ensures the product is properly manufactured, contains the ingredients on the label, and does not contain harmful levels of contaminants.