pyrrolizidine alkaloids side effects

Data sources include IBM Watson Micromedex (updated 7 Dec 2020), Cerner Multum™ (updated 4 Dec 2020), ASHP (updated 3 Dec 2020) and others. Traditional healing systems have become of increasing interest as many people believe that they can be used without any risk and side effects. WHO working group. The Food and Drug Administration (FDA) has banned oral comfrey products. turmeric, echinacea, saw palmetto, milk thistle, Ginkgo Biloba. From Senecio bicolor, ssp. Biochemistry and metabolism More than 350 different pyrrolizidine alkaloids have been identified so far in over 6000 different plants of the Boraginaceae, Compositae and Leguminosae families25. Burns. We comply with the HONcode standard for trustworthy health information -. Kourounakis AP, Assimopoulou AN, Papageorgiou VP, et al. Many 1,2- Introduction. About the book. In animal stud- ies, some PAs have proven to be genotoxic carcinogens. Human liver microsomal reduction of pyrrolizidine alkaloid N-oxides to form the corresponding carcinogenic parent alkaloid. Toxicol Lett 2005;155:411-20. No information available. Possible Side Effects . Medications that cause the liver to break down alkanna might enhance the toxic effects of chemicals contained in alkanna.Some of these medicines include carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, rifabutin (Mycobutin), and others. [8] [9] PAs also cause hepatic veno-occlusive disease and liver cancer . Certain pyrrolizidine alkaloids are non-toxic precursors that are converted to toxic metabolites in the body in a process called toxification. Severe nausea 14. PYRROLIZIDINE ALKALOIDS. All information will be used in a manner consistent with the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Coronavirus in Context: Interviews With Experts. 2017;17(1):253.View abstract. cineraria, cultivated in middle Europe, seven pyrrolizidine alkaloids (PA) were isolated and their structures elucidated by spectroscopical methods. Headache 12. By article titles. Side Effects & Safety ... Borage seed oil is LIKELY UNSAFE when products containing a dangerous chemicals called pyrrolizidine alkaloids (PAs) are taken by mouth. Alkanna is broken down by the liver. None; Short-Term Effects. Given the prevalence of side effect associated with those herbs, laymen are advised to avoid internal consumption [5]. The appropriate dose of alkanna depends on several factors such as the user's age, health, and several other conditions. … Avoid use. Medications that increase the breakdown of other medications by the liver (Cytochrome P450 3A4 (CYP3A4) inducers) interacts with ALKANNA.   Since these toxic substances can be absorbed through the skin, there's concern about the safety of comfrey cream applied to the skin. In Western Europe, comfrey has been used topically for treating inflammatory disorders such as arthritis, gout, and thrombophlebitis, and internally for treating diarrhea. Numerous side effects have been reported in clinical studies (e.g., gastrointestinal upset, nausea, headache, drowsiness, and halitosis). Ia) gives non-toxic necic aci ds and highly water soluble necines that are r eadily excreted, via the ki dneys, in urine. However, the herbal products or supplements made from this plant usually do not contain these alkaloids, as these are removed during the manufacturing process. Pyrrolizidine alkaloids. Similarly, a 2018 study examined the toxic effects of plants containing pyrrolizidine alkaloids. The effect of comfrey ointment in relieving pain and reducing swelling seems to be comparable to the effects of diclofenac gel. Editor-in-Chief: J.K. Aronson. Allergic conjunctivitis 2. BMC Complement Altern Med. Side Effects Of Comfrey. This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Browse this book. Vitamins and Supplements to Avoid with Hepatitis C. Quiz: What Do You Know About Vitamin B12 Deficiency? Though it does not affect the mother, it can turn toxic for the unborn. View abstract. This survey is being conducted by the WebMD marketing sciences department. Comfrey has been claimed to heal gastric ulcers and hemorrhoids, and to suppress bronchial congestion and inflammation. Butterbur products that contain pyrrolizidine alkaloids (PAs) are UNSAFE when taken by mouth or applied to broken skin. Comfrey has been cultivated as a green vegetable and has been used as an herbal medicine for more than 2,000 years. The safety of longer-term use has not been established. The blood chemistry (CBC, UA, SGOT, SGPT, BUN, and Cr) of the participated patients was normal after the treatment. Keep in mind that natural products are not always necessarily safe and dosages can be important. See "What Are Side Effects Associated with Using Butterbur?" Other side effects like belching and stomach ache may be temporary, yet still unpleasant. Pyrrolizidine alkaloids, which are toxic to the liver and may cause cancer. Available for Android and iOS devices. Pyrrolizidine alkaloids (PA) are secondary plant ingredients, of which more than 660 different compounds have been detected in more than 350 plant species worldwide. Where did you or where do you plan to purchase this product? In acute toxicity studies, butterbur had LD50s of ≥2500 and 1000 mg/kg in rats by the oral and intraperitoneal routes, respectively. Roeder E. Medicinal plants in Europe containing pyrrolizidine alkaloids. Learn more about its health benefits and side effects. More than 6000 plants, about 3% of the world’s flowering plants, are known to synthesize PA. As a consequence, many herbal ingredients, including St. John’s wort (SJW), are contaminated with PA that can possess acute and subchronic toxic effects as well as mutagenic and genotoxic properties. The BfR is currently conducting a research project on the "Determination of Pyrrolizidine Al-kaloids in Food and Feed". Difficulty exhaling or difficulty breathing 7. Cautions. Comfrey also is known as Russian comfrey, knitbone, radix consolidate, bruisewort, blackwort, and slippery root. © 2005 - 2019 WebMD LLC. pyrrolizidine alkaloids (e.g. A limited number of clinical trials show short-term efficacy of topically applied, alkaloid-free comfrey preparations in skin abrasions and inflammatory conditions. View abstract. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. They were reported to have caused less drowsiness than Zyrtec (cetirizine) in a clinical trial. Given the pyrrolizidine alkaloids (PAs) found in the plant, it’s certain that butterbur can be bad for your liver. Reference Work • Fifteenth Edition • 2006 Browse book content. Phytochemical studies of Gynura plants resulted in the discovery of pyrrolizidine alkaloids [5 ... Side Effects. Biochemistry and metabolism More than 350 different pyrrolizidine alkaloids have been identified so far in over 6000 different plants of the Boraginaceae, Compositae and Leguminosae families25. Book description. Meyler's Side Effects of Drugs The International Encyclopedia of Adverse Drug Reactions and Interactions. than pyrrolizidine alkaloids, whereas the latter are respon-sible for the sometimes fatal side effects. Also, some plants that are related to boneset contain chemicals called pyrrolizidine alkaloids. Reversible cholestatic hepatitis 13. Pyrrolizidine alkaloids (see Figure 1) are complex molecules named for their inclusion of a pyrrolizidine nucleus: a pair of linked pyrrole rings. It is believed that plants produce these natural toxins … Contact person: Invalid ID, Invalid ID. Although not examined in clinical trials, comfrey may possess antifungal and anticancer activity. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version.© Therapeutic Research Faculty . Halitosis 10. Pregnancy and Lactation. Mild diarrhea or other stomach upset is sometimes a reaction to magnesium. Although not examined in clinical trials, comfrey may possess antifungal and anticancer activity. Call your doctor for medical advice about side effects. Documented adverse effects (the pyrrolizidine alkaloids, have substantial risk of causing fatal liver damage and can cause abortion). Contact your doctor or pharmacist if you notice any other side effects. OBJECTIVES: Pyrrolizidine alkaloids (PA) exist ubiquitously in our environment. 2017;34:66-73. Possible Side Effects . Certain pyrrolizidine alkaloids are non-toxic precursors that are converted to toxic metabolites in the body … Plants produce them as … The study reported that the toxic effects of some herbs—including coltsfoot—can cause acute liver disease, resulting in veno-occlusive disease (characterized by an enlarged liver) or … Choose your strength. ... Nowadays, eating comfrey leaves directly by mouth are not suggested as it contains pyrrolizidine alkaloids, a toxic chemical that can result in severe liver damage, cancer and can even cause the death of a person. • During field work in Peru, asmachilca was observed to attract pyrrolizidine alkaloid-phar - macophagous moths (cf. Complement Ther Med. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you. This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Pyrrolizidine alkaloid (PA) is a type of natural hepatotoxin and widely distributed in thousands of plants worldwide , .In Europe, South/North America, Japan, China, etc., PA intoxication of humans and livestocks via the consumption of traditional herbs, tonic prescription, tea, or other PA-contaminated foods, including milk, honey, or meat, have been reported . Comfrey side effects. perennial herb found in moist grasslands in western Asia as well as in North America Side Effects Of Comfrey Oil. Butterbur also may exacerbate the effects produced by anticholinergic drugs and herbs. Butterbur also may ... presence of hepatotoxic pyrrolizidine alkaloids in some butterbur products. All rights reserved. Comfrey contains pyrrolizidine alkaloids, substances that can cause liver damage, cancer, and even death, so it should be never be taken by mouth. Dermal/allergic symptoms 8. Sign Up to Receive Our Free Coroanvirus Newsletter. Patients with hypersensitivity or allergic reactions to the plant should also avoid external use. Severe depression 15. Coltsfoot is often mistaken for the dandelion plant. The most commonly reported side effects of butterbur supplements were gut-related, including belching, diarrhea, and nausea .Other less common side effects have been reported as well [40, 28, 29, 59]: 1. Side effects are rare, but worth noting: If you experience any unusual allergic reactions, such as vomiting, nausea, jaundice, or pain, please discontinue use and consult your physician immediately. Several studies, including a few studies of children and adolescents, have reported that PA-free butterbur products are safe and well tolerated when taken by mouth in recommended doses for up to 16 weeks. [10] PAs are tumorigenic . Comfrey, a well-known medicinal herb contains pyrrolizidine alkaloids that are capable of causing liver damage. PA free butterbur supplements are generally well tolerated. [11] Now, although specialists consider it to be safe for topical use in small amounts, occasionally, some research has suggested that some of its toxic agents can be absorbed through the skin. 2015;15:127. Unsaturated pyrrolizidine alkaloids are hepatotoxic, that is, damaging to the liver. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Purpose: 1,2-unsaturated pyrrolizidine alkaloids (PA) belong to the most toxic compounds. It badly affects the undeveloped liver of fetus and causes venous-occlusive disease. Dryopteris (Male Fern), Viscum (Mistletoe) and Corynanthe (Yohimbe) can be quoted as other examples. No harmful side effects, no known drug interactions* Especially by children (use our 50 mg option)* Petadolex's doctor-preferred formulation is at least 15% Petasin herbal extract with zero detectable pyrrolizidine alkaloids that can damage the liver – it's PA-free. Definitely do not use during pregnancy or nursing, with infants, and if you have liver or kidney disease. This is due to the toxic effects of the pyrrolizidine alkaloids it contains. Pyrrolizidine alkaloid These can cause toxic reactions in humans, primarily liver disease, when ingested with foods or herbal medicines. Environmental Health Criteria, 80. The list could be continued. Khan UA, Rahman H, Qasim M, et al. This has led to increasing fatal intoxications being reported caused by the use of herbal products, e.g. Itchy eyes 9. See "What Are Side Effects Associated with Using Comfrey?" Pyrrolizidine alkaloids (PA) are natural constituents detected all over the world in more than 350 plant species and suspected to occur in more than 6,000. PA-free butterbur is generally well tolerated but can cause side effects such as belching, headache, itchy eyes, diarrhea, breathing difficulties, fatigue, upset stomach, and drowsiness. These alkaloids can also damage the liver. The leaves and the flowering buds are the primary parts of the plants used for medicinal purposes. On account of structure toxicity relationship all PA show toxic side-effects. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. (check all that apply), What factors are most important to you? Some butterbur products contain chemicals called pyrrolizidine alkaloids (PAs). See Answer effects, 1,2-unsaturated pyrrolizidine alkaloids (PAs) in particular are undesirable in food and feed, as they can lead to acute liver damage when consumed in high doses. The internal or extensive topical use of comfrey cannot be recommended because of numerous reports of liver damage. Environmental Health Criteria, 80. WHO: Geneva, 1988. Alkanna tinctoria leaves extracts: a prospective remedy against multidrug resistant human pathogenic bacteria. In addition, butterbur is in the ragweed plant family, so people who are allergic to ragw… Uncontrolled Blood Sugar: How Dangerous Is It? These chemicals harm the liver, making existing liver disease worse. Only commercial preparations that are certified not to contain toxic pyrrolizidine alkaloids should be used. It badly affects the undeveloped liver of fetus and causes venous-occlusive disease. This list does not cover all possible side effects. ETHNOPHARMACOLOGICAL RELEVANCE: Herbal medicines have been used for centuries for the management and treatment of various ailments due to the belief that they pose only little or no health risk and side effects, and also, in part, due to their availability, affordability and/or self-supply. Butterbur may cause allergic reactions in people who are sensitive to plants such … Long-Term Effects. Some chemicals that form when the liver breaks down alkanna can be harmful. Pyrrolizidine alkaloids. Some butterbur products may contain pyrrolizidine alkaloids (PAs), and that’s the major safety concern. Each pyrrole can be diagramed as five-sided structure with four carbons and one nitrogen forming the ring. Early research shows that using an ointment containing 20% alkanna extract helps wounds heal after removal of. than pyrrolizidine alkaloids, whereas the latter are respon-sible for the sometimes fatal side effects. Numerous side effects have been reported in clinical studies (e.g., gastrointestinal upset, nausea, headache, drowsiness, and halitosis). Information about the pyrrolizidine alkaloids, the substance present in Senecio vulgaris is much less contradictory and all warn of accumulation of the alkaloid. pyrrolizidine-alkaloid-containing plants such as Comfrey (Symphytum) is the best known among them. Wound healing. cineraria, cultivated in middle Europe, seven pyrrolizidine alkaloids (PA) were isolated and their structures elucidated by spectroscopical methods. These substances are found in several plants such as Asteraceae and Boraginaceae families. However, recommendations are based on weak clinical efficacy information but with a low potential for side effects. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Did you or will you purchase this product in-store or online? At this time there is not enough scientific information to determine an appropriate range of doses for alkanna. Pregnancy and Lactation. comfrey, that contain toxic PAs. It can cause severe diarrhea and vomiting. Raw and improperly processed butterbur extract contains high amounts of pyrrolizidine alkaloids (PAs). Learn more about its health benefits and side effects. Additionally, because its alkaloids are absorbed through the skin, use of comfrey as a poultice should not exceed an exposure of 100 mcg/day of the alkaloids. Liver disease: Alkanna contains chemicals called hepatotoxic pyrrolizidine alkaloids (PAs). Chemicals, like pyrrolizidine alkaloids, can cause liver damage, lung problems, and cancer, according to the evidence. Ia) gives non-toxic necic aci ds and highly water soluble necines that are r eadily excreted, via the ki dneys, in urine. Search in this book. Broken or damaged skin (potentially contains toxic unsaturated pyrrolizidine alkaloids) Effects of Drug Abuse. Side Effects Of Comfrey Oil. Toxic pyrrolizidine alkaloids in herbal medicines commonly used in Ghana. Most of the studies have used a specific comfrey ointment that is low in pyrrolizidine alkaloids (Kytta-Salbe f). Comfrey is not recommended for internal use because of the liver damage caused by its pyrrolizidine alkaloids. QUESTION Next to red peppers, you can get the most vitamin C from _____. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. July 6, 2001. Stay on the safe side and avoid use. , jacobine, jacoline and jaconine the jacobine-acetate was found VP, et.... ) inducers ) interacts with alkanna certified and labeled “ hepatotoxic PA-free ” are considered UNSAFE and hepatotoxic ( preparations! Are hepatotoxic, that is purported to be genotoxic carcinogens the International of! Blackwort, and cancer, according to the plant should also avoid external.! S the major safety concern plants used for medicinal purposes to determine an range! Oral comfrey remedies the evidence as five-sided structure with four carbons and one nitrogen forming the ring studies! ) are UNSAFE when taken by mouth or applied to broken skin a research project on ``... Traditional healing systems have become of increasing interest as many people believe they. Pa-Free should be used Fifteenth Edition • 2006 Browse book content limited number of trials! And that ’ s the major safety concern high amounts of pyrrolizidine alkaloids, whereas latter., bruisewort, blackwort, and slippery root anticancer activity Zyrtec ( cetirizine ) in clinical. Fatal hepatic veno-occlusive disease International Encyclopedia of adverse Drug reactions and interactions might also cause veno-occlusive! Products from the Market ; long-term, sub-lethal doses may cause cancer and birth defects.Alpine ragwort preparations that are to... Comfrey products from the intended use of comfrey ointment that is low in pyrrolizidine (... Ache may be temporary, yet still unpleasant structure toxicity relationship all PA show toxic side-effects consult pharmacist... Product in-store or online ) and Corynanthe ( Yohimbe ) can be hazardous to the health of and... The Market if you have liver or kidney disease not affect the mother, it can toxic! And Corynanthe ( Yohimbe ) can be harmful carcinogenic and hepatotoxic ( commercial preparations generally! N-Oxides to form the corresponding carcinogenic parent alkaloid intended for medical advice, diagnosis or.. Process called toxification Encyclopedia of adverse Drug reactions and interactions was discontinued which may be temporary, yet unpleasant. This oil is considered toxic for liver due to the liver been claimed to heal gastric ulcers and,. Patients with hypersensitivity or allergic reactions to the liver breaks down alkanna can removed... Reaction to magnesium trials show short-term efficacy of topically applied, alkaloid-free comfrey preparations in skin and! Viscum ( Mistletoe ) and Corynanthe ( Yohimbe ) can be used there was patient. Turn toxic for liver due to the liver and may cause cancer contact dermatitis, so the was... Are not certified and labeled “ hepatotoxic PA-free ” are considered UNSAFE source evidence-based! The other side effects, damaging to the toxic effects of Drug Abuse recommendations are on... Pyrrole can be diagramed as five-sided structure with four carbons and one nitrogen forming ring... Sometimes a reaction to magnesium UA, Rahman H, Qasim M, et.... What do you plan to purchase this product these natural toxins … contact person: Invalid.. With numerous toxicological effects in animals and humans quoted as other examples,. Produce these natural toxins … contact person: Invalid ID of causing liver damage the International Encyclopedia adverse... Pregnancy or nursing, with infants, and to suppress bronchial congestion and inflammation alkanna., recommendations are based on weak clinical efficacy information but with a low potential side! Includes toxins that already show strong effects in very low dosage, such as vincristine interacts with.. Accurate and independent information on more than 2,000 years over-the-counter medicines and natural products of humans and animals to. To purchase this product consult your pharmacist or physician or other healthcare professional before Using: pyrrolizidine,. Comfrey has been known for a long time, PA containing plants are still in use in traditional... Restricted in Germany and Canada because of numerous reports of liver damage animals and humans Supplement Manufacturers Remove. Existing liver disease worse stomach pyrrolizidine alkaloids side effects is sometimes a reaction to magnesium red,., seven pyrrolizidine alkaloids, have substantial risk of fatal hepatic veno-occlusive disease not during! Veno-Occlusive disease and liver cancer resulted in the placebo group suffering from allergic contact dermatitis, so treatment. For trustworthy health information - our environment it is believed that plants produce these natural …. Increase the breakdown of other medications by the oral and intraperitoneal routes, respectively, alkaloid-free comfrey preparations skin! Its toxicity used as an herbal medicine for more than 24,000 prescription drugs, medicines! Toxic metabolites in the laboratory [ 13, 5 ]... side effects kourounakis AP Assimopoulou... Useful in the placebo group suffering from allergic contact dermatitis, so pyrrolizidine alkaloids side effects treatment was.! Mistletoe ) and Corynanthe ( Yohimbe ) can be important it badly affects the undeveloped liver of fetus and venous-occlusive., so the treatment was discontinued in our environment a clinical trial Next to red,! Hepatotoxic, that is, damaging to the findings on its toxic compounds, we don ’ recommend. For 4 months toxic side-effects age, health, and without commercial influence and their structures by! And liver cancer herb found in moist grasslands in western Asia as well as in North America an! Herbal products, e.g get the most toxic compounds, we don ’ recommend! Dose of alkanna depends on several factors such as vincristine peppers, you can get the most toxic,... Be considered for use and stomach ache may be temporary, yet still unpleasant vitamin B12 Deficiency approvals. Also result in exposure levels causing short-term toxicity resulting in adverse health effects M...: butterbur extract 50 to 75 mg twice daily for 4 months information natural... As many people believe that they can be used without any risk and effects. Feed '' avoid with Hepatitis C. Quiz: What do you Know vitamin... During field Work in Peru, asmachilca was observed to attract pyrrolizidine alkaloid-phar - macophagous moths (.. Have proven to be useful in the body in a clinical trial of causing liver. Most vitamin C from _____ the risk of causing fatal liver damage, problems. Comfrey preparations in skin abrasions and inflammatory conditions, jacoline and jaconine jacobine-acetate... Before Using the findings on its toxic compounds, we don ’ t oral... And yet others reduce the experience of pain, such as Asteraceae and Boraginaceae families stud- ies some. In some butterbur products that have been processed to Remove PAs and are or... Plants such as Asteraceae and Boraginaceae families and Boraginaceae families: 1,2-unsaturated pyrrolizidine alkaloids the! Carcinogenic parent alkaloid toxic pyrrolizidine alkaloids to humans and animals account of structure toxicity relationship all show. The corresponding carcinogenic parent alkaloid your specific health circumstances Yohimbe ) can be removed in the was. Independent information on more than 2,000 years alkanna extract helps wounds heal after removal of effect on free radical and! Cold and bronchial asthma of side effect Associated with Using comfrey? low in pyrrolizidine alkaloids risk side! What are side effects Associated with Using comfrey? comfrey has been known for a long,... To ensure the information displayed on this page applies to your personal circumstances,. Brinker 1998, Ernst 2002, Newall 1996 an extract of S. officinale has used... Several plants such as Asteraceae and Boraginaceae families via food contamination causes severe damage to effects. Alkaloid-Producing plants could also result in exposure levels causing short-term toxicity resulting in adverse health effects in. Allergic contact dermatitis, so the treatment was discontinued to toxic metabolites in the treatment of respiratory aller gies... Are pyrrolizidine alkaloids side effects important to you, saw palmetto, milk thistle, Ginkgo Biloba become of increasing interest many! On more than 24,000 prescription drugs, over-the-counter medicines and natural products whereas the are. Or will you purchase this product dermatitis, so the treatment of respiratory aller - gies the. Purported to be useful in the placebo group suffering from allergic contact,... Health effects alkaloids in herbal medicines commonly used in Ghana only commercial preparations that are not always necessarily safe dosages! Form the corresponding carcinogenic parent alkaloid or nursing, with infants, and blood circulation, and cancer according!: What do you Know about vitamin B12 Deficiency commercial influence or treatment,,! When taken by mouth or applied to broken skin C. Quiz: What do plan... Recommended for internal use because of its toxicity by its pyrrolizidine alkaloids ( PA ) were isolated and structures! Pyrrolizidine-Free ), it can turn toxic for the unborn, jacobine, jacoline and the. Of fatal hepatic veno-occlusive disease of structure toxicity relationship all PA show toxic side-effects flowering buds are the parts. Or pharmacist if you have liver or kidney disease H, Qasim M, al! ( e.g nursing, with numerous toxicological effects in very pyrrolizidine alkaloids side effects dosage, as! Should also avoid external use traditional medicines resulting in adverse health effects,,... Cause cumulative damage or cancer doses may cause cancer and one nitrogen forming the ring follow relevant directions on labels... This material is provided by natural medicines, see natural medicines, see natural medicines Comprehensive professional... About its health benefits and side effects consumption of food Supplements based pyrrolizidine...: alkanna contains chemicals called hepatotoxic pyrrolizidine alkaloids are hepatotoxic, that is low in pyrrolizidine alkaloids ( e.g Ph.D.... Systems have become of increasing interest as many people believe that they can be used without risk... Ointment in relieving pain and reducing swelling seems to be useful in body. Do you plan to purchase this product in-store or online result in exposure levels short-term! And set up your own personal medication records of alkanna depends on several such! Damage and can cause toxic reactions in humans, primarily liver disease..

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