The issue of herb-drug interactions is an important one for clinicians. However, the recent article by Miller1 on this subject contains a number of errors and unsubstantiated statements.
The claim that Echinacea is hepatotoxic is unreferenced, presumably because there are no reports of this in the literature.
The unreferenced statement that ginkgo should be avoided in patients with epilepsy is not substantiated. The statement that ginkgo toxin is found in both leaf and seed is true but misleading. Ginkgo seeds, which are eaten on special occasions in Asia, contain 4‘-O-methylpyridoxine, an anti–vitamin B6 neurotoxin. Boiling inactivates 99% of this toxin. However, during food shortages in China and Japan, overconsumption of ginkgo seeds resulted in a syndrome called gin-nan sitotoxism, with a 27% mortality rate.2
Fugh-Berman A. Herbal Medicinals: Selected Clinical Considerations, Focusing on Known or Potential Drug-Herb Interactions. Arch Intern Med. 1999;159(16):1954. doi:
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