Non-prescription supplement-induced hepatitis with hyperferritinemia and mutation (H63D) in the HFE gene

Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series

BACKGROUND

No online current list of potentially life-threatening, hepatotoxic herbs and dietary supplements based on PubMed case reports exists in a summarized tabular form.

METHODS

Documented case reports of herbs or dietary supplements (DS; includes herbs) appearing to contribute to liver injury were used to create an online "DS Toxic Table" of potentially hepatotoxic herbs and dietary supplements (PubMed, 1966 to June, 2016, and cross-referencing). The spectrum of DS induced liver injuries (DSILI) included elevated liver enzymes, hepatitis, steatosis, cholestasis, hepatic necrosis, hepatic fibrosis, hepatic cirrhosis, veno-occlusive disease, acute liver failure requiring a liver transplant, and death.

RESULTS

Over the past 50 years, approximately 21 herbs (minus germander and usnic acid that are no longer sold) and 12 dietary supplements (minus the nine no longer sold and vitamin A & niacin due to excess intake) posed a possible risk for liver injures in certain individuals. The herbs with the most number of reported publications (but not cases studies) in descending order, were germander, black cohosh, kava extract, and green tea extract.

CONCLUSION

These online DS Toxic Tables will contribute to continued Phase IV post marketing surveillance to detect possible liver toxicity cases and serve to forewarn consumers, clinicians, and corporations.

Herbal hepatotoxicity: a tabular compilation of reported cases

BACKGROUND

Herbal hepatotoxicity is a field that has rapidly grown over the last few years along with increased use of herbal products worldwide.

AIMS

To summarize the various facets of this disease, we undertook a literature search for herbs, herbal drugs and herbal supplements with reported cases of herbal hepatotoxicity.

METHODS

A selective literature search was performed to identify published case reports, spontaneous case reports, case series and review articles regarding herbal hepatotoxicity.

RESULTS

A total of 185 publications were identified and the results compiled. They show 60 different herbs, herbal drugs and herbal supplements with reported potential hepatotoxicity, additional information including synonyms of individual herbs, botanical names and cross references are provided. If known, details are presented for specific ingredients and chemicals in herbal products, and for references with authors that can be matched to each herbal product and to its effect on the liver. Based on stringent causality assessment methods and/or positive re-exposure tests, causality was highly probable or probable for Ayurvedic herbs, Chaparral, Chinese herbal mixture, Germander, Greater Celandine, green tea, few Herbalife products, Jin Bu Huan, Kava, Ma Huang, Mistletoe, Senna, Syo Saiko To and Venencapsan(®). In many other publications, however, causality was not properly evaluated by a liver-specific and for hepatotoxicity-validated causality assessment method such as the scale of CIOMS (Council for International Organizations of Medical Sciences).

CONCLUSIONS

This compilation presents details of herbal hepatotoxicity, assisting thereby clinical assessment of involved physicians in the future.

Acute liver injury associated with the use of herbal preparations containing glucosamine: three case studies

The use of complementary and alternative medicines is becoming increasingly popular in Western society. As a result the number of reported adverse reactions is increasing. Glucosamine is a herbal remedy commonly used to ease joint pain in osteoarthritis, and only two previous reports of hepatotoxicity have been published in the scientific literature. The present report describes three patients who developed acute liver injury following exposure to glucosamine; one patient made a complete recovery on cessation of ingestion, the second developed chronic hepatitis and the third died following progression to fulminant hepatic failure. A diagnosis of glucosamine-induced hepatotoxicity was made based on the temporal relationship between onset of liver injury and glucosamine ingestion, exclusion of all other potential aetiologies and, in the two surviving cases, improvement in condition on withdrawal of the supplement.

Recent status of drug-induced liver injury

Drug-induced liver injury is an major cause of acute liver injury and the incidence of drug-induced liver injury seems to be increasing with an increase in the number of new drugs available. The diagnostic scale of drug-induced liver injury was been modified by the International Consensus Meeting during Digestive Disease Week, Japan 2004, which includes the score of the drug-lymphocyte stimulation test and eosinophilia. Although the modified diagnostic scale is useful, and widely used in Japan, there will be many issues to be investigated in the future. According to a recent survey of drug-induced liver injury cases in Japan, drug-induced liver injury from dietary supplements are increasing, as has been observed in foreign countries. More research is needed to elucidate the mechanisms of drug metabolism and the pathophysiology of liver injury by various drugs to prevent drug-induced liver injury.