Avoid in individuals with a known allergy or hypersensitivity to unprocessed or processed forms of fo-ti.
Side Effects and Warnings
Although not well studied in humans, fo-ti has been taken daily as a tonic by millions of individuals with no known severe adverse effects. Although rare, skin rash may be a sign of hypersensitivity to both forms of fo-ti.
In some individuals, fo-ti may cause hepatitis. Avoid in patients with liver disease because it has been associated with hepatitis.
High doses of unprocessed fo-ti may also lead to hypokalemia (potassium deficiency), muscle weakness, numbness in the arms or legs, and hallucinations.
Use cautiously in patients with low iron levels. Theoretically, chronic use of anthraquinone laxatives may increase the risk for hypokalemia (potassium deficiency) and digoxin cardiotoxicity.
Unprocessed fo-ti may cause diarrhea, abdominal pain, nausea, and vomiting. Avoid unprocessed fo-ti in patients with diarrhea, intestinal obstruction, acute intestinal inflammation (Crohn's disease, ulcerative colitis, appendicitis), ulcer, abdominal pain of unknown origin, nausea, and vomiting due to the probable mechanism of it irritating the lining of the gastrointestinal tract. Although the irritation is minor for most individuals, it can worsen inflammatory bowel conditions.
Use cautiously in patients with constipation since anthraquinone compounds may lead to laxative dependency.
Pregnancy and Breastfeeding
Fo-ti is not recommended in pregnancy due to a lack of sufficient data. Breastfeeding women should also avoid fo-ti since it is known to enter breast milk. Taking it while breastfeeding may cause diarrhea in the infant(s).
Adults (over 18 years old):
There is no proven safe or effective dose for fo-ti. Capsules, dried herb preparations, teas and topical creams or ointments are all commercially available. Doses of 560 milligrams (capsules) 2-3 times a day, and 9-15 grams of the dried herb daily have been taken.
Children (under 18 years old):
There is no proven safe or effective dose for fo-ti in children.
Interactions with Drugs
Fo-ti may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Since fo-ti contains compounds that were found to inhibit the calcium channel, theoretically, it may produce a synergistic effect when taken with these drugs. The effect may be beneficial in some cases, but studies need to be done to further investigate this effect.
The possible effect of fo-ti in causing hypokalemia (potassium deficiency) may increase the risk of side effects from the use of digoxin. There are no documented cases of this interaction in the available literature.
The effects of potassium loss may be enhanced if diuretics are used with fo-ti. This may lead to worsening of the symptoms of hypokalemia (potassium deficiency). However, there are no reports available in literature.
Theoretically, fo-ti may interact with estrogen-containing drugs due to its estrogen content. Caution is advised in patients taking hormone replacement therapy or birth control pills.
Theoretically, concomitant use of fo-ti with other laxatives can increase the risk of fluid and electrolyte depletion.
Fo-ti may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood, and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Interactions with Herbs & Dietary Supplements
Theoretically, fo-ti may cause hypokalemia (potassium deficiency) and increase the risk of side effects from the use of herbs such as foxglove and oleander that contain cardiac glycosides that behave similarly to digoxin.
Fo-ti may act as a weak diuretic and may reduce potassium levels. Use of fo-ti with other diuretic herbs and supplements may lead to hypokalemia (potassium deficiency). However, there are no reports available in literature.
Theoretically, fo-ti may interact with estrogen-containing herbs and supplements due to its estrogen content.
Fo-ti may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Taking fo-ti with other laxative herbs such as alder buckhorn, aloe, cascara, rhubarb, senna, and yellow dock, may contribute additively to the laxative effects of fo-ti.
Licorice and fo-ti both have potassium-depleting properties and, theoretically, may increase the risk of hypokalemia (potassium deficiency).
Fo-ti may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.