Columbus, OH—Pharmacists might want to add a word of caution to customers purchasing certain dietary supplements: Just like prescription drugs, those products should be kept out of the reach of children.

A new study published in the Journal of Medical Toxicology reports that poison control centers in the United States receive a call every 24 minutes, on average, with concerns about dietary supplement exposures.

The research, led by the Center for Injury Research and Policy and the Central Ohio Poison Center, both at Nationwide Children’s Hospital in Columbus, finds that the rate of calls related to dietary supplement exposures increased 46.1% from 2000 to 2002, decreased 8.8% from 2002 to 2005 and increased again by 49.3% from 2005 to 2012.

Study authors note that the decrease from 2002 to 2005 appears to have been related to the ban by the FDA of the botanical stimulant ma huang, which previously was used in some supplements.

A majority, 70%, of the calls involved children aged younger than 6 years who usually swallowed the substance, with the ingestion being unintentional most of the time. The home was the most dangerous place to be for pediatric exposure to dietary supplements; that’s where the ingestion occurred more than 97% of the time.

In 4.5% of the exposures, serious medical outcomes resulted, and the most serious occurred in children aged 6 years and older.

“Many consumers believe dietary supplements are held to the same safety and efficacy standards as over-the-counter medications,” explained senior author Gary Smith, MD, DrPH, director of the Center of Injury Research and Policy at Nationwide Children’s. “However, dietary supplements are not considered drugs, thus they are not required to undergo clinical trials or obtain approval from the FDA prior to sale, unless the product is labeled as intended for therapeutic use.”

With 43.9% of calls involving miscellaneous substances found in commonly used dietary supplements, the poison control centers also handled concerns about exposures to botanicals (31.9%), hormonal products (15.1%), and other supplements (5.1%).

In terms of serious medical outcomes, energy products, and botanical and cultural medicines were the most common types of dietary supplements involved. Especially concerning, according to the authors, was yohimbe, which caused 28.2% of the serious medical outcomes. The study found that nearly 30% of yohimbe exposure calls involved moderate or major effects in children. Background information in the articles states that yohimbe can cause heart beat rhythm changes, kidney failure, seizures, heart attack, and death.

Energy product exposures—usually unintentional and occurring among young children —resulted in heart and breathing problems, seizures, and other clinical issues.

“Lack of federal oversight has led to inconsistencies in the quality of dietary supplements, product mislabeling and contamination with other substances,” noted coauthor Henry Spiller, MS, D.ABAT, director of the Central Ohio Poison Center at Nationwide Children’s. “Although the majority of these exposure calls did not result in serious medical outcomes, exposures to yohimbe and energy products can be dangerous, suggesting the need for child-resistant packaging, caregiver education and FDA regulation of these substances.”

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