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In addition, self-medication is frequent, as they are available without a prescription, and plant extracts provided by retail herbal stores may also be mislabeled or adulterated (e.g., heavy metals, pharmaceuticals) . Psychiatric and neurological side effects included headaches and hypnotic effects and were mild. There were no reports on the side effects of damania (T. diffusa), the Mexican poppy (A. mexicana), and Tongkat Ali (E. longifolia). Few clinical reports and few data were found for the side effects of bitter orange (C. aurantium), muirapuama (P. olacoides), and kanna (S. tortuosum), and only preclinical reports were found for muirapuama. However, they did not come as a complete surprise, because these plants have been used for centuries or millennia in traditional medicines and modern medicine has considerably benefited from these ingredients and preparations . 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