Ginseng abuse syndrome (hypertension, nervousness, insomnia, morning diarrhoea, inability to concentrate and skin reactions) has been reported and there has been a report of a 28-year-old woman who had a severe headache after ingesting a large quantity of ethanol-extracted ginseng. Cerebral angiograms showed 'beading' appearance in the anterior and posterior cerebral and superior cerebellar arteries, consistent with cerebral arteritis (Ryu & Chien 1995). High doses (1 5 g/day) have been associated with confusion, depression and depersonalisation in four patients (Coon & Ernst 2002).
However, the majority of the scientific data suggest that ginseng is rarely associated with adverse events or drug interactions. A systematic review found that the most commonly experienced adverse events are headache, sleep and gastrointestinal disorders. Data from clinical trials suggest that the incidence of adverse events with ginseng mono-preparations is similar to that of placebo. Any documented effects are usually mild and transient. Combined preparations are more often associated with adverse events, but causal attribution is usually not possible (Coon & Ernst 2002).
A case of suspected ginseng allergy has recently been reported in the scientific literature. The case involved a 20-year-old male who developed urticaria, dyspnoea and hypotension after ingesting ginseng syrup. The subject recovered fully and was discharged after 24 hours (Wiwanitkit &Taungjararuwinai 2004).
While ginseng use has been associated with the development of hypertension it has actually been shown to reduce blood pressure in several studies (Coon & Ernst
Ginseng has very low toxicity. Subacute doses of 1.5-1 5 mg/kg of a 5:1 ginseng extract did not produce negative effect on body weight, food consumption, haematological or biochemical parameters, or histological findings in dogs (Hess et al 1983) and no effects have been observed from the administration of similar doses in two generations of rat offspring (Hess et al 1982).
Traditionally, ginseng is not recommended with other stimulants such as caffeine and nicotine and a case report exists of a 39-year-old female experiencing menometrorrhagia, arrhythmia and tachycardia after using oral and topical ginseng along with coffee and cigarettes (Kabalak et al 2004).
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