key: cord-0815316-dx574tqm
authors: DiPietro, Michael A.; Mondie, Christopher
title: In support of “Toxicity of herbal medications suggested as treatment for COVID‐19: A narrative review”
date: 2021-07-02
journal: J Am Coll Emerg Physicians Open
DOI: 10.1002/emp2.12482
sha: 9a4ec7820e26be0aeb9aee1baa72d9ade637ee11
doc_id: 815316
cord_uid: dx574tqm

nan

The authors of the article entitled "Toxicity of herbal medications suggested as treatment for COVID-19: A narrative review" have recently read the letter to the editor that was written in response entitled "Antiviral Effects of Oleandrin" by R.A. Newman and K.J. Sastry.

Although the research provided by these authors in their response is intriguing and may potentially lay the groundwork for future treatments of COVID-19 and other viruses, we believe the authors may have misconstrued the focus and scope of the original article.

The original article states multiple times that herbal medications, including the extract of the cardiac glycoside Nerium oleander, have been used successfully for centuries for the treatment and cure of many different diseases. We also stated multiple times in the original review that few clinical studies had been performed examining the efficacy of any of the herbal medications listed in the review, but there have been many anecdotal reports of successful treatment of COVID-19 using these herbal medications. We finally go on to state that the focus and scope of the review is to identify toxicities from herbal medications that are misused or used without the guidance of an experienced healthcare provider and explicitly comment that the review is not to examine the efficacy of any of the herbal preparations.

The authors of the response to the review quote the Father of Toxicology, Paracelsus, stating "only the dose makes the poison," which is a sentiment the authors of the original review also share. A perfect example of this statement is provided by the authors of the response, when they highlight the potential toxicity of another cardiac glycoside, digoxin, despite it being used regularly in modern medicine. Digoxin toxicity has been well-researched and written about extensively for as long as it has been used as medicine, and its efficacy as treatment of disease has nothing to do with this potential toxicity. Therefore, although oleandrin may be safe at nanomolar concentrations, as suggested by the research provided in the previously mentioned response, it does not change the supplements' potential toxicity. The 

Toxicity of herbal medications suggested as treatment for COVID-19: a narrative review

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