Concern has been expressed about the internal use of sage due to the presence of thujone.¹¹ Even when consumed in small amounts for long periods of time, thujone may cause increased heart rate and mental confusion. Very high amounts (several times greater than one receives if taking sage as instructed above), may lead to convulsions. If one takes sage internally, it is best to limit use to the recommended amounts and to periods of no more than one to two weeks. Extracts of sage made with alcohol are likely to be higher in thujone than those made with water. Sage oil should never be consumed without being first diluted in water. Sage should not be used internally during pregnancy. These concerns do not extend to the use of sage as a gargle or mouth rinse. Sage should be avoided when fever is present.