Herbal and dietary supplements are
commonly used throughout the World. There is a tendency for
underreporting their ingestion by patients and the magnitude of
their use is underrecognised by Physicians. Herbal hepatotoxicity is
not uncommonly encountered, but the precise incidence and
manifestations have not been well characterised.
To review the epidemiology, presentation
and diagnosis of herbal hepatotoxicity researchers have mainly
discussed single ingredients and complex mixtures of herbs marketed
under a single label.
A Medline search was undertaken to
identify relevant literature using search terms including 'herbal',
'herbs', 'dietary supplement', 'liver injury', 'hepatitis' and
'hepatotoxicity'. Furthermore, researchers scanned the reference
lists of the primary and review articles to identify publications
not retrieved by electronic searches.
The incidence rates of herbal
hepatotoxicity are largely unknown. The clinical presentation and
severity can be highly variable, ranging from mild hepatitis to
acute hepatic failure requiring transplantation.
Scoring systems for the causality assessment of drug-induced liver
injury may be helpful, but have not been validated for herbal
hepatotoxicity. Hepatotoxicity features of commonly used herbal
products, such as Ayurvedic and Chinese herbs, black cohosh,
chaparral, germander, greater celandine, green tea, Herbalife,
Hydroxycut, kava, pennyroyal, pyrrolizidine alkaloids, skullcap, and
usnic acid, have been individually reviewed. Furthermore, clinically
significant herb-drug interactions are also discussed.
A number of herbal medicinal products
are associated with a spectrum of hepatotoxicity events. Advances in
the understanding of the pathogenesis and the risks involved are
needed to improve herbal medicine safety.
For more information
Division of Gastroenterology and Hepatology, Department of Medicine,
Rajavithi Hospital, College of Medicine, Rangsit University,
Bangkok, Thailand; Division of Gastroenterology and Hepatology,
Department of Medicine, University of Pennsylvania, Philadelphia,
PA, USA.
Bunchorntavakul C.
Review article: herbal and dietary supplement hepatotoxicity
Aliment Pharmacol Ther 2012 Nov 5.
(MDN) |