Medicinal Plant Research 2024, Vol.14, No.1, 11-30 http://hortherbpublisher.com/index.php/mpr 20 Aromatic medicinal plants are widely used in complementary and alternative medicine (CAM) approaches. Their use is based on ethnobotanical evidence and cultural acceptance, making them a popular choice for chronic treatments. CAM approaches often involve the use of whole plant extracts or essential oils, which can provide a synergistic effect due to the presence of multiple bioactive compounds (Kieliszek et al., 2020). These approaches are particularly valuable in regions where access to conventional medicine is limited. Despite their potential, there are several barriers to the integration of aromatic medicinal plants into conventional medicine. These include a lack of standardized protocols for their use, limited clinical evidence, and regulatory challenges (Maggio et al., 2016). To overcome these barriers, more rigorous clinical trials are needed to validate the therapeutic claims of these plants. Additionally, establishing guidelines for the standardization and quality control of plant extracts can help ensure their safety and efficacy (Fitsiou and Pappa, 2019). Collaboration between researchers, healthcare providers, and regulatory agencies is essential to facilitate the integration of these plants into mainstream medicine (Krishnaprabu et al., 2020; Šarčević-Todosijević et al., 2023). 7 Safety and Toxicology 7.1 Toxicological profiles Aromatic medicinal plants have been extensively studied for their safety profiles in both preclinical and clinical settings. Preclinical studies typically involve in vitro and in vivo experiments to evaluate the toxicological effects of these plants' active compounds. For instance, studies on essential oils such as menthol, eugenol, and linalool have shown low toxicity levels when used within recommended doses (Ribeiro-Silva et al., 2022; Wu et al., 2023). Clinical trials have further validated these findings, demonstrating that these compounds are generally safe for humans when used appropriately. Studies have shown that linalool, when used in combination, can significantly enhance its antibacterial effects while maintaining low toxicity levels (Silva et al., 2021). This makes it potentially valuable for applications in food preservation and the medical field. However, it is essential to consider the specific context and formulation, as some compounds may exhibit toxic effects under certain conditions. While aromatic medicinal plants are generally considered safe, they can cause side effects and have contraindications. Common side effects include skin irritation, allergic reactions, and gastrointestinal disturbances. For example, tea tree oil may cause contact dermatitis in sensitive individuals. A study reported two cases where patients developed eczema-like lesions after using products containing tea tree oil, one of whom was a 4-year-old girl (Martínez Campayo et al., 2020). High doses of peppermint oil can cause heartburn or gastroesophageal reflux, and it should be used with caution during pregnancy, breastfeeding, and certain medical conditions. Sanders (2023) found that a postpartum woman developed a systemic rash after taking capsules containing peppermint oil, indicating that peppermint oil may trigger allergic reactions in some cases. Additionally, rosemary oil should be used with caution in patients with epilepsy due to its potential neurostimulatory effects (Liu et al., 2020). The toxicological effects of aromatic medicinal plants are often dose-dependent. At recommended doses, these plants are usually safe and well-tolerated. However, excessive intake can lead to adverse effects. For example, high doses of eugenol from clove oil can cause liver toxicity, and excessive consumption of menthol can result in central nervous system depression (Ribeiro-Silva et al., 2022). It is crucial to adhere to established dosing guidelines to avoid such toxic effects and ensure safe use. 7.2 Regulatory considerations Regulations and guidelines for the use of aromatic medicinal plants vary across regions. In the United States, the Food and Drug Administration (FDA) regulates these plants under the Dietary Supplement Health and Education Act (DSHEA) (Sarma et al., 2021). Essential oils and plant extracts are categorized as dietary supplements, and manufacturers must ensure their safety and efficacy (Shipkowski et al., 2018). In the European Union, the European Medicines Agency (EMA) provides guidelines for the use of herbal medicinal products, requiring evidence of safety and therapeutic efficacy (Qu et al., 2018; Knoess and Wiesner, 2019).
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