1.
Dr Joban Modha
MD PhD fellow (IOD, Fl. USA)
Dept. of R.S.B.K. S.G.A.M.
Gujarat Ayurved University
Jamnagar
Email: jkmodha@gmail.com
SGAM/RSBK/Dr Joban K Modha

2.
Why this workshop ?
 To minimize ADRs
 To minimize prescription errors
 To avoid dispensing errors
 To create awareness about ADRs
 A contraindication is a specific situation in
which a drug, procedure, or surgery should
not be used because it may be harmful to the
person.
SGAM/RSBK/Dr Joban K Modha

3.
 “Even a strong poison can become an excellent
medicine if administered properly. On the other
hand even the most useful drug can act like a poison
if handled carelessly“ – Charak Samhita
POISON
MEDICINE

4.
Dispensing Errors: The Numbers
 98.3% accuracy in dispensing medications
 Therefore, 1.7% inaccuracy rate
 Over 3 billion medications dispensed per year
 4 errors per day per 250 prescriptions filled
 Over 51 million dispensing errors per year
Flynn E, et al. J Am Pharm Assoc. 2003;43:191–200.
SGAM/RSBK/Dr Joban K Modha

5.
“Ghee or milk consumed when the
digestive fire and metabolism is on a
low ebb works like poison”
(Viṣopamam)
( Astanga Hridayam; Shastri H, editor. Varanasi: Chaukhambha
Samskrit Sansthan; 2011. p. 561.)
SGAM/RSBK/Dr Joban K Modha

6.
HEAVY METAL TOXICITY CONCERNS
 The use of metallic preparations as single drugs
or as ingredients in many Ayurvedic medicines
has evoked concern and debate in the scientific
and public forums in the recent times.
 Some studies has warned that users of Ayurvedic
medicines may be at risk for heavy metal toxicity
and suggested that testing of Ayurvedic
medicines for toxic heavy metals should be
mandatory.
SGAM/RSBK/Dr Joban K Modha

7.
JAMA CONTROVERSY
SGAM/RSBK/Dr Joban K Modha

8.
SGAM/RSBK/Dr Joban K Modha

9.
HEAVY METALS
 A heavy metal is one with a specific gravity of 5gm
cm-3 or more.
 They are stable elements and cannot be
metabolized by the body.
 Some heavy metals such as zinc, copper,
cobalt, chromium, iron and manganese are
required by body in small measures.
 These same elements can be toxic in larger
quantities.
 Heavy metals may enter the body in food, water, air,
or by absorption through skin.
SGAM/RSBK/Dr Joban K Modha

10.
UNESCO
SGAM/RSBK/Dr Joban K Modha

11.
UNESCO
SGAM/RSBK/Dr Joban K Modha

12.
UNESCO
SGAM/RSBK/Dr Joban K Modha

13.
UNESCO/BBC
SGAM/RSBK/Dr Joban K Modha

14.
SGAM/RSBK/Dr Joban K Modha

15.
SGAM/RSBK/Dr Joban K Modha

16.
SGAM/RSBK/Dr Joban K Modha
The king of poison
The poison of kings

17.
AyurVaidya’s take:
 The heavy or toxic metals in elemental form are toxic but
those in compound form i.e. Bhasma are safe for
humans.
 Bhasma are made from various metals, metal mixtures
and alloys.
 The way they are prepared, evaluated and therapeutically
used leaves no doubt about their safety to the humans.
SGAM/RSBK/Dr Joban K Modha

18.
QUALITY CONTROL OF BHAMAS
 PHYSICAL
PARAMETERS
Varitar
Unnama
Rekhapoornatva
Shlakshnatvam
 CHEMICAL
PARAMETERS
Varna
Gatarasatvam
Nishchandratva
Apoonarbhavatva
SGAM/RSBK/Dr Joban K Modha

19.
SGAM/RSBK/Dr Joban K Modha

20.
CURD TEST FOR TAMRABHASMA
Most of the copper bhasma and other minerals having
copper bhasma are in the form of CuO and CuS in final
product.
It is a test to check free copper metal, because when free
copper reacts with lactic acid (one of the component of curd)
copper salts are formed which gives blue colour and it is
toxic in nature and produces nausea, vomiting because of
free copper ions…
6/10 market
samples of
Tamra Bhasma
could not clear
the test
SGAM/RSBK/Dr Joban K Modha

21.
Easy tests to check Tamra Bhasma
SGAM/RSBK/Dr Joban K Modha

22.
SGAM/RSBK/Dr Joban K Modha

23.
Drugs and Cosmetics Rules, 1945 [SCHEDULE-E(1)
[Rule 161 (2)] List of poisonous substances - Ayurvedic
Medicine
I Drugs of vegetable origin
 Ahipena: Papaver somniferum Linn.
 Arka: Calotropis gigantea (linn.)R. Br. ex. Ait.
 Bhallataka: Semecarpus anacardium Linn. F.
 Bhanga: Cannabis sativa Linn.
 Danti: Baliospermum montanum Mull. Arg.
 Dhattura: Datura metal Linn..
 Gunja: Abrus precatorium Linn.
SGAM/RSBK/Dr Joban K Modha

24.
Drugs and Cosmetics Rules, 1945 [SCHEDULE-E(1)
[Rule 161 (2)] List of poisonous substances - Ayurvedic
Medicine
I Drugs of vegetable origin
 Jaipala (Jayapala): Croton tiglium Linn.
 Karaveera: Rerium indicum Mill.
 Langali: Gloriosa superba Linn.
 Parasika Yavani: Hyoscyamus inibar Linn.
 Snuhi: Euphorbia neriifolia Linn.
 Vatsanabha: Acontium chasmanthum Stapfex
Holm.
 Vishamushti: Strychnox nuxvomica Linn.
 Shringivisha: Acontium chasmanthum Stapfex
Holm.
SGAM/RSBK/Dr Joban K Modha

25.
Drugs and Cosmetics Rules, 1945 [SCHEDULE-E(1)
[Rule 161 (2)] List of poisonous substances - Ayurvedic
Medicine
II Drugs of Animal Origin.
Sarpa Visha Snake poison.
III Drugs of Mineral Origin
Gauripashana: Arsenic.
Hartala: Arseno sulphide.
Manahashila: Arseno sulphide.
Parada: Mercury.
Rasa Karpura: Hydrargyri subchloridum.
Tuttha: Copper sulphate.
Hingula: Cinnabar.
Sindura: Red oxide of lead.
Girisindura: Red oxide of mercury.
SGAM/RSBK/Dr Joban K Modha

26.
IF NOT –WHY?/IF YES-HOW?
 Is It Applicable Universally ?
 Are We Aware of Original References ?
 Do We Know The Ingredients And Their
Hypersensivity ?
 Do We Are Confident Regarding Ayurvedic
Prescriptions?
DO OUR MEDICINES HAVE
CONTRA INDICATOINS ?
SGAM/RSBK/Dr Joban K Modha

27.
SGAM/RSBK/Dr Joban K Modha

28.
PRECAUTIONS TO AVOID ADRs
Dosage form specific
Formulation specific
Disease specific
Dose specific
Doshic affinity
Manufacturing method
Anupana- Sahapana-Bala-Desha-
Kala-Agni-Prakriti- Satwa-Satmya etc.
Ref: Dr MS Krishnamurthy www.ayurblog.comSGAM/RSBK/Dr Joban K Modha

29.
DOSAGE FORM SPECIFIC
PRECAUTIONS TO AVOID ADRs
Fresh Drug – Acute conditions (Psychological Setup),
Children, Susceptible individuals (Garlic, Onion,
Ajawain, Colour specific, Cow’s urine etc)
Decoction – Children, women, poor mental ability,
Minor sufferings, Non accustomed, Religious
Tablets-Younger age group (size of tablet), Higher
society, Extra awareness, Vomiting, Tastelessness,
Constipation, Indigestion etc
Powders-Younger age group, women, Nausea, Mental
disliking
Syrup-DM, Disliking towards Preservatives and
colouring agents, Consistency specific
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

30.
DOSAGE FORM SPECIFIC
PRECAUTIONS TO AVOID ADRs
Asava-Arishta-Religious, Women, Nausea/
Susceptible, Paittic individuals, DM
Avleha-DM, Gurutva, Indigestion
Ghee and Oil- Gurutva, Indigestion and
Nausea, Liver disorders, Renal insufficiency
Rasoushadhis-Renal-Cardiac-Hepatic-
Neurological-Pancreatic disorders
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

31.
Most popular Rasaushadhi in our practices
 Aarogyavardhini Rasa
 Bruhad or Laghu
Suvarna Vasant Malini
Rasa
 Chandamarutham Ras
 Chandraprabha Vati
 Garbhpal Ras
 Laxmivilas Rasa
 Mahayograj Guggulu
 Makardhwaja Rasa etc.
 Panchamrita Parpati
 Simhanada Guggulu
 Swasakuthar Rasa
 Tamra Bhasma
 Tribhuvan Kirti Rasa
 Trivanga Bhasma
 Vaat Vidhvamsana Rasa
 Yogaraja Guggulu
http://apps.who.int/medicinedocs/pdf/whozip23e/whozip23e.pdf
SGAM/RSBK/Dr Joban K Modha

32.
FORMULATION SPECIFIC
PRECAUTIONS TO AVOID ADRs
Choorna-
Sitopaladi, Talisadi-DM
Avipattikara- Diarrhoea, DM
Pushyanuga-Constipation
Hingwashtaka-Leucorrhoea, Bleeding disorders,
BPH, Constipation
Shivakshara –Urinary incontinency, BPH
Shatavari-Sore throat, Kaphaja Roga
Haritaki- Garbhini
SGAM/RSBK/Dr Joban K Modha

33.
FORMULATION SPECIFIC
PRECAUTIONS TO AVOID ADRs
Tablets-
Yogaraja guggulu-Constipation, Reduced urine
output
Gokshuradi and Punarnavadi- Diuresis,
Sleeplessness
Chitrakadi–Stomatitis
Laghu sootashekhara – Constipation, mouth ulcer
Rasnadi-Constipation
Lashunadi-Constipation, Burning
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

34.
FORMULATION SPECIFIC PRECAUTIONS TO
AVOID ADRs
Leha-
Shatavari-Sore throat, Cold, Cough, Asthama,
Indigestion
Chyavana prasha,Dashamula hareetaki-
Mandagni, Constipation, Burning of the body, Non
specific headache
Pancha jeeraka guda-Excess appetite
AmritBhallatak Rasayan: Paittik disorders, blood
disorders
Trivrit lehya-Ulceration
Haridrakhanda rasayana-Dry skin, Vaatik P/P/V
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

35.
FORMULATION SPECIFIC
PRECAUTIONS TO AVOID ADRs
Asava-Arishta
Lodhrasava, Saraswatarishta-DM
Dashamula-Constipation
Sariva,Usheera-Kaphaja disorders
Kharjoora, Shreekhanda-DM
Kutaja- Constipation,Vatic disorders
Kumari no 1-Menorrhagia
Ashoka-Constipation
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

36.
FORMULATION SPECIFIC PRECAUTIONS
TO AVOID ADRs
Ghrita and Taila-
Kalyanaka- Menorrhagia
Shatavari, Falaghrita- Cold, Sore throat
Pinda taila- Internal administration
Most Taila/Ghrita-Rhumatoid arthritis
Maharaja prasarini-Burning chest
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

37.
Hepatic/ Biliary Disorders-Haratala, Manashila,
Vatsanabha, Naga, Vanga, Dhattura, Hingula
Anaemia- Constipatives, Hingula, Vatsanabha,
Gandhaka, Navasagara
Fever-Gastric irritants, Khadira-Ashoka-Lodhra-
Arjuna-Bilva-Shilajatu
Mouth ulcers-Haratala, Manashila, Dhattura,
Hingula, Dashamula katutraya, Kanakasava, TBKR, A
Bhairava
Back ache-Sangrahi..
DISEASE SPECIFIC PRECAUTIONS TO
AVOID ADRs
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

38.
DISEASE SPECIFIC PRECAUTIONS TO
AVOID ADRs
Male Sterility-Vatsanabha, Jayapala, Navasagara, Kshara,
Lavana
Head ache-Constipation, Dysuria, Irritant drugs
Peripheral neuritis-Hingula, Manashila, Vanga
Scanty menstruation-Chandrakala rasa, Bolabaddha rasa,
Ashokarishta(mere)
Menorrhagia-Formulations containing Manashila, Haratala,
Jayapala, Hingu, Kumari, Shanapushpi
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

39.
DISEASE SPECIFIC PRECAUTIONS TO
AVOID ADRs
Eye disorders-Manashila, Naga, Vanga, Bhallataka
Ear disorders-Unless specified oils(mridupaka),Acidic
substances
Tonsilitis-Shatavari yoga, Coolants to scalp, Ghrita
preparations
Cold, Cough, Asthama-milk products, Shatavari, Coolants,
medicated Ghee –if not specified
Cardiac diseases-Hingula, Vatsanabha, Jayapala, Dhattura
Urinary calculi-Hingula, Tamra bhasma, Vanga, Naga,
Dhattura
 PCOD-Careful usage of irritants
 Lactation-Anti diabetic, Sthoulyahara medicaments
 Gynaeco-mastia- Galactogogues like Shatavari
SGAM/RSBK/Dr Joban K Modha Ref: Dr MS Krishnamurthy www.ayurblog.com

40.
BE CAUTIOUS while
penning
Yastimadhu, Kantakari
Sarpagandha,Vidanga, Soma, Kutaja, Vacha, Parsik
Yavani*
Bilva, Dhattura, Vacha, Bakuchi, Bhallataka
Trivrit, Danti, Sonamukhi, Katukarohini
Vatsanabha, Vishatinduka
Naga, Vanga, Tamra, Parada, Hingula, Haratala, Manashila
Un known/Less known
 *banned or restricted in US/UK/EU
SGAM/RSBK/Dr Joban K Modha

41.
Medicines which contains Manahshila
 Shvaskuthar Ras (for asthma with cough and in
remittent fever with cerebral complications).
 Smriti Sagar Rasa (for psychotherapy).
 Unmada Gajakesari Rasa (psychological
disorders).
 Externally, the paste of Mansil is applied on diseases
of skin. e.g. hair removing creams or Switra related
medicines. Test dose should be applied first.
 Shilasinduraa
SGAM/RSBK/Dr Joban K Modha

42.
Medicines which contains Hartal
 Hartal malham
 Rasa Manikya-dose?
 Hartal bhasma
 Talsindura
SGAM/RSBK/Dr Joban K Modha

43.
Medicines which contains lead
 Vaatvidhvansan Ras
 Tribang Bhasma
 Garbhapaal Ras
SGAM/RSBK/Dr Joban K Modha

44.
Medicines which contains Bhallataka
 Bhallataka Rasayana:
 Amrita Bhallataka Ghrita:
 Sanjivani Vati:
 allergic reactions like rash, itching and swelling
 the antidotes: externally -coconut oil, rala ointment,
ghee, coriander leaves pulp or butter mixed with
Musta (Cyperus rotundus)
 A cream of Shatadhauta can be administered.
SGAM/RSBK/Dr Joban K Modha

45.
Medicines which contains Gunja
 Neelibhrungadi tailam
 Sarivadi Vati
 If not purified properly or if used in excess dosage than
prescribed, it can cause severe vomiting and diarrhea.
 Unpurified seed powder used over wounds or direct
contact with blood can also produce toxic effects.
 Roots – if used in excess dose can cause vomiting
It is best to avoid Gunja or medicines containing it during
pregnancy, lactation and in children below 5 years of age.
 Antidote: There is no specific antidote for abrin
poisoning, and treatment is mainly supportive with
intravenous fluids and correction of electrolyte
abnormalities.
SGAM/RSBK/Dr Joban K Modha

46.
Medicines which contains Ativisha:
 Kutaj Ghan Vati
 Chandraprabha Vati
 Khadiradi Gutika
 Rasnairandadi kashayam
 Bal chaturbhadra Churna
 Yogaraja guggul
 May produce allergic reactions like skin rash,
burning, itching and swelling
 Overdose
SGAM/RSBK/Dr Joban K Modha

47.
Side effects of Guggulu preparations:
 It should be used under observation in people who
are suffering from hypertension or any serious illness
of chronic origin, in pregnancy and during active
severe bleeding.
 It is not a single handed remedy in the mentioned
disorders and shall need the support of co-
prescriptions in the form of disease modifying
formulations.
SGAM/RSBK/Dr Joban K Modha

48.
Are not alternative for
other Guggulu preparations
 Sinhnaad Guggulu contains Eranda Taila so the most
common side effect occurs due to the purgative action of
Simhanada Guggulu. Some people may experience loose
stools. In high dosage, it can also cause diarrhea. Rarely,
people have reported restlessness after taking it, which
generally occurs with its high dosage
 Yogaraja Guggulu contains Ativish, Hingu and Vacha..
So uses with caution in Ushna Kaal, Prakriti. It may lead
to some rare side effects in some sensitive people.
 Acidity
 Heartburn
 Burning sensation in abdomen
SGAM/RSBK/Dr Joban K Modha

49.
Medohar Guggulu is POSSIBLY SAFE and WELL
TOLERATED with dosage less than 2 grams per day. But it
contains Vidanga and other Ushnavirya Dravyas so heavy
dosage may cause following side effects.
 Heartburn
 Dull headache (commonly associated with acidity and
occurs in people with history of acidity, gastritis or ulcer)
 Increase in appetite (it may not its side effects, as people
feel it initially and after a few days it reduces itself)
 Loss of appetite (it occurs in people with chronic gastritis
or digestive troubles)
 Medohar Guggul in pregnancy and lactation it is
contraindicated as it has warm property, which means it
produces heat in the body.
SGAM/RSBK/Dr Joban K Modha

50.
 Sushruta has explained Torticollis (neck stiffness) and
yellowish discoloration of eyes, stools and urine as the
toxic effect of Vatshanabhi.
 The text book Rasaratna Samucchaya explains 8 stages of
toxic effects of Vatsanabha. These stages refers to
spreading of poison in different parts of the body. These
stages are also dependent on level of toxicity and dosage
of Vatsanabha.
 1st stage – Twak Vikara – skin rashes,
 2nd stage – Vepathu – tremors
 3rd stage – Daha – burning sensation all over the body.
 4th stage – Vikrata – deformity
 5th stage – phenodgati – frothing
 6th stage – skandha bhanga – drooping and wasting of
shoulders.
 7th stage – Jadyata – wasting and comatose of whole body.
 8th stage – Marana – death.
Evil effects of Vatsanabha
SGAM/RSBK/Dr Joban K Modha

51.
Antidotes for Vatsanabha poisoning:
 The treatment for Vatsanabha is possible upto 5th stage
only. – (Rasaratna Samucchaya)
During Aconitum ferox toxicity due to over-dosage or
usage without purification procedure, then ghee along
with Tankana bhasma is given.
Combination of Honey, ghee and bark of Arjuna
(Terminalia arjuna) is also used as antidote.
 Whenever Vatsanabha is used in any formulation,
Tankana Bhasma (Borax calx) is always used in equal
quantity. If used so, it will nullify all the toxic effects of
Vatsanabha and hence there will not be any toxic effects.
Example: Tribhuvana Kirti Ras – a potent Ayurvedic
medicine used in fever, has both Vatsnabha and Tankana.
SGAM/RSBK/Dr Joban K Modha

52.
Vatsanabh yoga
 Tribhuvan kirti ras
 Agnitundi vati
 Anand bhairav ras
 Krimikuthar ras
 Sanjivani vati
 Sutshekhar ras
 Shwaskuthar ras
 Vaatvidhvamsan ras
SGAM/RSBK/Dr Joban K Modha
Agnitundi Vati- also contains Kupilu*
*Break after 15 days/avoid in
children

53.
Ras atisevan/ Kshar atisevan
 Single Prescription shouldn’t contain similar drug in
more than 2 compounds…
 E.g. “Ras”…Guduchi
 Medicines containing kshar for oligospermia
 Tikta ati ras sevan:
 Neem
 Guduchi
 Vasa
Lavana ras pradhan aushadh atisevan
SGAM/RSBK/Dr Joban K Modha

54.
Non sulfide form of mercury-
Chandmarutam ras -Ras karpura
SGAM/RSBK/Dr Joban K Modha

55.
SARPAGANDHA
 Sarpagandha side effects –
 It is contra indicated in – Bronchial asthma, Duodenal
ulcer, Hyperacidity, Renal disorders.
 Because it stimualtes uterus, this herb should not be used
during pregnancy.
 It is not suitable to be used in cases of
depression.
 It is not ideal to use this in children and after delivery.
 It is not ideal to take this medicine along with Digoxin,
Levodopa.
Special care is needed when it is administered along with
other medicines for high BP. The combined effect may
lower the BP to a great extent.
 Its sleep enhancing effect may further increase if taken by
an alcoholic.
SGAM/RSBK/Dr Joban K Modha

56.
Religious Sentiments
SGAM/RSBK/Dr Joban K Modha

57.
Poisons, which remain in the body for
a long period of time and cause
intractable diseases, are known
as Garaviṣa.
(Shastri H, editor. Varanasi: Chaukhambha Samskrit
Sansthan; 2011. Astanga Hridayam; p. 902.)
SGAM/RSBK/Dr Joban K Modha

58.
SGAM/RSBK/Dr Joban K Modha

59.
SGAM/RSBK/Dr Joban K Modha

60.
SGAM/RSBK/Dr Joban K Modha

61.
Dispensing Errors in the Work
Area
• Labels on bins and shelves
 Separate by route of administration
(external/internal/injectable, etc.)
• Use auxiliary labels for externals
– Amoxicillin oral suspension for ear infection thought by
parents to be drops administered in child’s ear
• Review published safety alerts for look-alike/
sound-alike drugs and frequent dispensing errors
SGAM/RSBK/Dr Joban K Modha

62.
Last sip….
A look into original classical references
Knowledge of recipe and related ingredients
Thinking before acting
A thorough re-view/case study
Faith and confidence
Acceptance of truth
Self limitation and limitation of science
SGAM/RSBK/Dr Joban K Modha

63.
THANK YOU
SGAM/RSBK/Dr Joban K Modha