Ding Xiang EUGENIA CARYOPHYLIALA Ron Gui Eugenia caryophyllata (ding xiang) • Cinnamomum cassia (ron gui) • Bing Lang Areca catechu (bing lang).
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Below is general information about the effectiveness of the known ingredients contained in the product Accu Quit [Discontinued]. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Accu Quit [Discontinued]. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
LIKELY UNSAFE ...when used orally, long-term or in high doses. Constituents of betel nut have documented carcinogenic potential, and betel nut use has been associated with precancerous lesions and carcinoma in long-term users (6,17,35216,35238,35240,35296,35312,35321,96983,102877). Chewing betel nut has been associated with chest pain, cardiac arrhythmias, hypotension, coma, dyspnea and tachypnea, acute myocardial infarction, chronic kidney disease, liver fibrosis, heart failure, and death (35224,35294,35327,35351,35353,102878,102879,109490,109487). Eating betel nut 8-30 grams can cause death (6). There is insufficient reliable information available about the safety of short-term use of betel nut.
PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally.
Betel nut has carcinogenic potential as well as central nervous system (CNS) stimulant and cholinergic properties and might adversely affect pregnancy and nursing infants (6,17); avoid using. Neonatal withdrawal has occurred following chronic use by the mother while pregnant (19595).
LIKELY SAFE ...when consumed in amounts commonly found in foods. Cassia cinnamon has Generally Recognized As Safe (GRAS) status in the US for use as a spice or flavoring agent (4912) ...when used orally and appropriately, short-term. Cassia cinnamon 1-2 grams daily has been used safely for up to 3 months (17011,21914). Cassia cinnamon 3-6 grams daily has been used safely for up to 6 weeks (11347,14344). Cassia cinnamon extract corresponding to 3 grams daily of cassia cinnamon powder has also been used safely for up to 4 months (21916).
POSSIBLY SAFE ...when used topically, short-term. Cassia cinnamon oil 5% cream applied topically to the legs has been used safely in one clinical trial (59580).
POSSIBLY UNSAFE ...when used orally in high doses, long-term. Some cassia cinnamon products contain high levels of coumarin. Coumarin can cause hepatotoxicity in animal models (15299,21920). In humans, very high doses of coumarin from 50-7000 mg daily can result in hepatotoxicity that resolves when coumarin use is discontinued (15302). In most cases, ingestion of cassia cinnamon will not provide a high enough amount of coumarin to cause significant toxicity; however, in especially sensitive people, such as those with liver disease, prolonged ingestion of large amounts of cassia cinnamon might exacerbate the condition.
CHILDREN: POSSIBLY SAFE
when used orally and appropriately, short-term.
Cassia cinnamon 1 gram daily has been used safely in adolescents 13-18 years of age for up to 3 months (89648).
PREGNANCY AND LACTATION: LIKELY SAFE
when consumed in amounts commonly found in foods (4912).
There is insufficient reliable information available about the safety of cassia cinnamon when used in medicinal amounts during pregnancy and breast-feeding. Stay on the safe side and stick to food amounts.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Clove, clove oil, and eugenol have Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).
POSSIBLY SAFE ...when clove oil is applied topically (272). A clove oil 1% cream has been applied to the anus with apparent safety for up to 6 weeks (43487). A liposome-based product containing clove oil 45% has been applied to the palms with apparent safety for up to 2 weeks (100596).
LIKELY UNSAFE ...when clove smoke is inhaled. Smoking clove cigarettes can cause respiratory injury (17,43599). ...when clove oil is injected intravenously. This can cause pulmonary edema, hypoxemia, and acute dyspnea (16384). There is insufficient reliable information available about the safety of using clove orally in medicinal amounts.
CHILDREN: LIKELY UNSAFE
when clove oil is taken orally.
Ingesting 5-10 mL of undiluted clove oil has been linked to reports of coagulopathy, liver damage, and other serious side effects in infants and children up to 3 years of age (6,17,43385,43395,43419,43457,43652).
PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts found in foods (4912).
Clove, clove oil, and eugenol have Generally Recognized As Safe (GRAS) status for use in foods in the US (4912). There is insufficient reliable information available about the safety of using clove in medicinal amounts during pregnancy and lactation; avoid using.
Below is general information about the interactions of the known ingredients contained in the product Accu Quit [Discontinued]. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
In vitro and animal research suggests that betel nut extract can inhibit acetylcholinesterase activity (6,19584). Additionally, in one case series, adults who were treated with procyclidine, an anticholinergic drug, and neuroleptics for the management of extrapyramidal symptoms (EPS) due to fluphenazine ultimately developed severe EPS, such as tremor and stiffness, thought to be related to betel nut use (35297, 35359). Theoretically, concurrent use of anticholinergic drugs and betel nut might decrease the effectiveness of betel nut or the anticholinergic agent.
 Details
Some anticholinergic drugs include atropine, benztropine (Cogentin), biperiden (Akineton), procyclidine (Kemadrin), and trihexyphenidyl (Artane). Avoid concomitant use.
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In vitro and animal research suggests that betel nut extract can inhibit acetylcholinesterase activity (6,19584). Theoretically, concurrent use of betel nut with other cholinergic drugs might have additive effects and increase the risk of cholinergic side effects.
Details
Cholinergic drugs include bethanechol (Urecholine), donepezil (Aricept), echothiophate (Phospholine Iodide), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmin), physostigmine (Antilirium), pyridostigmine (Mestinon, Regonol), succinylcholine (Anectine, Quelicin), and tacrine (Cognex). Avoid concomitant use.
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In one case report, a woman treated with doxorubicin for breast cancer developed severe oral, genital, and anal mucositis that was considered to be probably related to betel nut use. It was hypothesized that chewing betel nut increased the risk of mucositis related to doxorubicin (35263). Theoretically, concomitant use of betel nut with doxorubicin might increase the risk for adverse effects. Until more is known, tell patients treated with doxorubicin to avoid betel nut.
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Animal research suggests that betel nut extract can inhibit monoamine oxidase (35207). Theoretically, this may affect serotonin levels, potentially causing additive adverse effects if used with MAOIs. However, moclobemide, an MAOI, has been used with apparent safety to help improve betel nut chewing cessation rates in one small clinical trial (109494).
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Theoretically, cassia cinnamon may have additive effects with antidiabetes drugs.
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Theoretically, large doses of cassia cinnamon might cause additive effects when used with hepatotoxic drugs.
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There is some concern that ingesting large amounts of cassia cinnamon for an extended duration might cause hepatotoxicity in some people. Cassia cinnamon contains coumarin, which can cause hepatotoxicity in animal models (15299,21920). In humans, very high doses of coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin use is discontinued (15302,97249). Lower amounts might also cause liver problems in sensitive people, such as those with liver disease or those taking potentially hepatotoxic agents.
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Theoretically, clove oil may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
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Theoretically, concomitant use of clove extracts with antidiabetes drugs might increase the risk of hypoglycemia.
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Clinical and laboratory research suggest that polyphenol extracts from clove flower buds might lower blood glucose levels (100595). Dosing adjustments for insulin or oral hypoglycemic agents may be necessary when taken with clove. Monitor blood glucose levels closely.
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Theoretically, topical application of clove oil with ibuprofen might increase the absorption and side effects of topical ibuprofen.
Details
Laboratory research shows that topical application of clove oil increases the absorption of topical ibuprofen (98854). This interaction has not been reported in humans.
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Below is general information about the adverse effects of the known ingredients contained in the product Accu Quit [Discontinued]. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General ...Betel nut is generally regarded as unsafe for use. Any benefits of therapy may not outweigh the risk of toxicity. Orally, betel nut use is associated with precancerous lesions and carcinoma in long-term users (35216,35238,35240,35296,35312,35321,35335,96983,102877,109484,109445,109489,109493). Chewing betel nut has also been associated with chest pain, cardiac arrhythmias, heart failure, hypotension, coma, dyspnea and tachypnea, acute myocardial infarction, liver fibrosis, chronic kidney disease, nephrolithiasis, diverticulosis, oral submucous fibrosis, more difficult tracheal intubation, and death (35224,35294,35327,35351,35353,102878,109443,109444,109486,109487,109488,109490). Rarely, chewing betel nut has been reported to cause cholinergic crisis, as well as dizziness, numbness, seizures, difficulty breathing, and coma (35204,35224,35232,35235,35323). Less serious adverse effects of chewing betel nut, either alone or as part of betel quid, have included stained teeth and mouth, tooth wear, periodontitis, gingivitis, increased risk of diabetes, and gastrointestinal issues (6,18,35211,35224,35233,35246,35249,35270,35273,35276)(35284,35326,49519,102879). Habituation and dependence can also occur in users of betel nut (35301,35331).
Cardiovascular
...Chewing betel nut has been associated with short-term chest pain, ventricular arrhythmias, tachycardia or a slight increased heart rate, palpitations, hypotension, and myocardial infarction (35224,35294,35327,35351,35353,102879).
Increased systolic blood pressure has occurred in new chewers of betel nut (35327). Although most individuals recovered within 24 hours, there are some cases of death associated with acute myocardial infarction and ventricular fibrillation (35224,35353). Observational research in adults hospitalized with cardiopulmonary symptoms has found that chewing betel nut is associated with premature ventricular contractions and heart failure (109490).
Some, but not all, population research suggests that chewing betel nut increases the risk of cerebrovascular and/or cardiovascular disease (35281,35287,35290). Population research has also found that chewing betel nut is associated with obesity, dyslipidemia, hypertension, and metabolic syndrome. Population research also suggests that these risks increase with longer durations of betel nut use (109485).
Dental ...Chewing betel nut, either alone or as part of betel quid, has been reported to cause tooth wear or abrasion, periodontitis, gingivitis, and red-stained teeth (6,35233,35276,35284).
Dermatologic ...Chewing betel nut can cause red-stained mouth and lips (18).
Endocrine ...Some population research suggests that chewing betel nut, either alone or as part of betel quid, increases the risk of type 2 diabetes. However, not all research supports this relationship. Also, any increased risk is possibly related to the fact that consuming betel nut is also associated with an increased rate of obesity (35211,35246,35249,35270,35273,35326,109485).
Gastrointestinal
...Orally, consuming betel nut may cause vomiting, nausea, stomach pain, and diarrhea (6,35224).
Chewing betel nut causes red-stained mouth, lips, and feces (18,35233).
Population research in adult males has found that chewing betel nut is associated with 59% to 70% greater odds of having diverticulosis when compared with non-users (109488).
Betel nut chewing can also cause oral submucous fibrosis (OSMF) in susceptible individuals (327,328,329,109444). Chewing betel nut chronically (daily for at least 5 years) is also associated with more difficult tracheal intubations, which is believed to result from OSMF (109443).
In one case report, a 35-year-old female developed sore throat, dysphagia, and heartburn thought to be related to consuming betel nut as part of daily handfuls of pan masala (49519). In another case, a 45-year-old male presented with swallowing obstruction one hour after chewing betel nut. Upon examination, submucosal hematoma and multiple esophageal lesions were observed (102879).
Hepatic ...Population research in adults with metabolic syndrome has found that chewing betel nut is associated with 5. 5 times greater odds of having liver fibrosis when compared with non-users. However, in adults without metabolic syndrome, chewing betel nut was not associated with liver fibrosis (109487).
Immunologic ...In one case report, cheilitis granulomatosa, a painless swelling of the lips, occurred after chewing betel quid. However, the patient was determined to be allergic to betel leaves (Piper betel) and not to betel nut. Betel leaves are not related to betel nut (96984).
Neurologic/CNS ...Orally, betel nut has rarely been reported to cause cholinergic crisis with salivation, sweating, eye tearing, urinary incontinence, diarrhea, gastrointestinal upset, and vomiting (35204,35224,35323). Dizziness, numbness, and coma have also been reported rarely (35224). In a case report, seizures were related to intake of betel nuts (35232).
Oncologic ...Population research has found that chewing betel nut, either alone or as part of betel quid, increases the risk of cervical dysplasia, colorectal polyps, esophageal cancer, oral cancer, and oropharyngeal cancer (35216,35238,35240,35296,35312,35321,35335,96983,102877,109484,109493). Population research in adults with oropharyngeal or oral cancer also suggests that a history of chewing betel nut and continued betel nut chewing both reduce 5-year overall survival when compared with non-users (109484,109489). A meta-analysis of observational studies also suggests that quitting betel-nut use reduces the risk of developing pharyngeal cancer when compared with continued use (109445).
Psychiatric
...Habituation and dependence can occur in users of betel nut (35301,35331).
Signs of withdrawal, such as anxiety, despondency, and memory lapses, also occur (35309).
Some research has evaluated medications that may improve betel nut cessation. Preliminary clinical research in males with betel nut dependence shows that taking escitalopram 10 mg or moclobemide 150 mg orally daily for 8 weeks increases the likelihood of cessation by 6.3 and 6.8 times that of placebo, respectively (109494).
Pulmonary/Respiratory ...Chewing betel nut has been reported to cause trouble breathing (35224,35235).
Renal
...A meta-analysis of population research shows that betel nut chewing is associated with 44% greater odds of developing chronic kidney disease when compared with non-users (102878).
Population research in adult males has also found that chewing betel nut is associated with 1% to 25% greater odds of developing nephrolithiasis when compared with non-users. Population research suggests that these risks increase in subjects that use higher quantities of betel nut (109486).
Additionally, two patients who chewed large quantities of betel nuts prepared in a paste of calcium carbonate from oyster shells developed milk-alkali syndrome, characterized by hypercalcemia, metabolic alkalosis, and renal insufficiency. The abnormalities resolved after discontinuation of the mixture and intravenous saline. This adverse effect was attributed to the large intake of calcium, 6-9 grams, in the preparation, and not to the use of betel nut (35345).
Other ...Orally, consuming betel nut 8-30 grams has been reported to cause death (6).
General
...Orally, cassia cinnamon appears to be well-tolerated.
Significant side effects have not been reported in most patients.
Most Common Adverse Effects:
Topically: Burning mouth, stomatitis.
Dermatologic
...In one clinical trial, a rash was reported in one patient taking cassia cinnamon 1 gram daily for 90 days (17011).
In one case, a 58-year-old female with a documented allergy to topically applied cinnamic alcohol presented with eyelid dermatitis, which was found to be a manifestation of systemic contact dermatitis to cinnamon in the diet. Symptoms improved in two days and completely cleared five days after discontinuing the addition of cinnamon to food products (95599). In other case reports, two adults presented with allergic contact cheilitis following the ingestion of chai tea with cinnamon and yogurt with cinnamon. Cinnamon components were confirmed as the causative allergic agents with patch tests, and both cases of allergic contact cheilitis completely resolved upon cessation of the cinnamon-containing products (113516,113515).
Topically, allergic skin reactions and stomatitis from toothpaste flavored with cassia cinnamon have been reported (11915,11920). Intraoral allergic reactions with symptoms of tenderness and burning sensations of the oral mucosa have also been reported in patients using breath fresheners, toothpaste, mouthwash, candy, or chewing gum containing cinnamon, cinnamic aldehyde or cinnamic alcohol as flavoring agents. Glossodynia, or burning mouth syndrome, has also been reported in a 62-year-old female who ate apples dipped in cinnamon nightly (95598), and allergic contact dermatitis has been reported in a teenage female using a homemade cinnamon sugar face scrub (95596).
Endocrine ...In one clinical trial, a hypoglycemic seizure was reported in one patient taking cassia cinnamon 1 gram daily for 3 months. The event occurred one day after enrolling in the study (89648). It is unclear if cassia cinnamon caused this event.
Hepatic ...There is some concern about the safety of ingesting large amounts of cassia cinnamon for extended durations due to its coumarin content. Coumarin can cause hepatotoxicity in animal models (15299). In humans, very high doses of coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin is discontinued (15302). In clinical trials, taking cassia cinnamon 360 mg to 12 grams daily for 3 months did not significantly increase levels of aspartate transaminase (AST) or alanine transaminase (ALT) (21918,96280,108259). However, in one case report, acute hepatitis with elevated AST and ALT occurred in a 73-year-old female who started taking a cinnamon supplement (dose unknown) one week prior to admission. The cinnamon supplement was added on to high-dose rosuvastatin, which may have led to additive adverse hepatic effects. After discontinuing both products, liver function returned to normal, and the patient was able to restart rosuvastati without further complications (97249). In most cases, ingestion of cassia cinnamon won't provide a high enough amount of coumarin to cause significant toxicity; however, in especially sensitive people, such as those with liver disease or taking potentially hepatotoxic agents, prolonged ingestion of large amounts of cassia cinnamon might exacerbate the condition.
Immunologic ...An unspecified allergic reaction was reported in one patient taking cassia cinnamon 1 gram daily for 3 months (89648).
General
...Orally, clove is well tolerated when consumed as a spice; however, clove oil in doses of only 5-10 mL can be toxic in children.
Topically, clove is generally well tolerated. When inhaled or used intravenously, clove may be unsafe.
Most Common Adverse Effects:
Topically: Burning, contact dermatitis, dental decay, itching, mucous membrane irritation, tingling, ulcers.
Inhaled: Dental decay, hypertension, itching, tachycardia.
Serious Adverse Effects (Rare):
Orally: Liver failure, respiratory distress.
Inhaled: Pneumonitis, pulmonary edema, respiratory distress.
Cardiovascular ...Smoking clove cigarettes increases heart rate and systolic blood pressure (12892).
Dental ...Population research has found that the risk of dental decay is increased in clove cigarette smokers (43332). Repeated topical application of clove in the mouth can cause gingival damage and skin and mucous membrane irritation (4,272,512). Eugenol, a constituent of clove and a material commonly found in dentistry, has been associated with side effects including gum inflammation and irritation (43365,43373,43522).
Dermatologic ...The American Dental Association has accepted clove for professional use, but not nonprescription use, due to potential damage to soft tissue that may be induced by clove application. In clinical research, small aphthous-like ulcers appeared in the area of the mouth where clove gel was applied in four participants (43448). Skin irritation and stinging have been reported with clove oil application (43338,43626). In a 24-year-old, exposure to a clove oil spill resulted in permanent local anesthesia and anhidrosis, or lack of sweating, at the affected area (43626).
Endocrine ...A case of hypoglycemia and metabolic acidosis have been reported after administration of one teaspoon of clove oil to a seven-month-old infant (43457). A case of electrolyte imbalance following accidental ingestion by a seven-month-old has also been reported (6).
Hematologic ...A case of disseminated intravascular coagulation has been reported in a 2-year-old patient after consuming between 5-10 mL of clove oil. The patient was treated with heparin, fresh frozen plasma, protein C, factor VII, and antithrombin III. On the fifth day, the patient started to improve and made a full recovery (43652).
Hepatic ...There are three cases of hepatic failure occurring in children after ingestion of 5-10 mL of clove oil (43395,43419,43652). Liver injury also occurred in a 3-year-old male (96949). These patients were successfully treated with N-acetylcysteine. The course of liver injury seems to be milder and shorter with early N-acetylcysteine treatment (43395,43419,96949). Another patient, who also presented with disseminated intravascular coagulation, was successfully treated with heparin, fresh frozen plasma, protein C, factor VII, and antithrombin III (43652).
Immunologic ...Contact dermatitis and urticaria has been reported following topical exposure to clove oil or eugenol, a constituent of clove oil (12635,43339,43606,43346).
Neurologic/CNS ...CNS depression has been reported in a 7-month-old who was given one teaspoon of clove oil accidentally in place of mineral oil for diarrhea. The patient was successfully treated with supportive care and gastric lavage (43457). A case of confusion and inability to speak has been reported secondary to oral exposure to clove oil and alcohol. The patient required intubation and was successfully treated with thiamine and normal saline (43580). Seizure and coma have been reported in a two-year-old male after ingesting 5-10 mL of clove oil (43652).
Pulmonary/Respiratory
...Clove cigarettes have been associated with throat and chest tightness (43337), pulmonary edema (43618), and fatal aspiration pneumonitis (43599).
The causative factor may be clove alone or clove along with other substances found in cigarettes. Clove cigarettes contain significant amounts of nicotine, tar, and carbon monoxide and increase plasma levels of nicotine and exhaled carbon monoxide, which might cause long-term health effects similar to tobacco smoking (12892). According to the American Medical Association, inhaling clove cigarette smoke has been associated with severe lung injury in a few susceptible individuals with prodromal respiratory infection. Also, some individuals with normal respiratory tracts have apparently suffered aspiration pneumonitis as the result of a diminished gag reflex induced by a local anesthetic action of eugenol, which is volatilized into the smoke (43602).
Intravenous injection of clove oil in a 32-year-old female resulted in hypoxia, acute dyspnea, interstitial and alveolar infiltrates, and non-cardiogenic pulmonary edema. The patient was managed with supplemental oxygen and recovered over the next seven days (16384).
Occupational exposure to eugenol, a constituent of clove, has also been reported to cause asthma and rhinitis (43492).
Renal ...Proteinuria and other urinary abnormalities were observed in a seven-month-old infant given one teaspoon of clove oil accidentally in place of mineral oil for diarrhea. The patient was successfully treated with supportive care and gastric lavage (43457).
