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 underrecognized by Physicians.

Herbal hepatotoxicity is not uncommonly encountered, but the precise incidence and manifestations have not been well characterized.

Dr Reddy and colleagues from Philadelphia USA reviewed the epidemiology, presentation and diagnosis of herbal hepatotoxicity.

 

The researchers mainly investigated single ingredients and complex mixtures of herbs marketed under a single label.

A number of herbal medicinal products are associated with a spectrum of hepatotoxicity events

Alimentary Pharmacology & Therapeutics

The researchers undertook a Medline search to identify relevant literature using search terms including ‘herbal’, ‘herbs’, ‘dietary supplement’, ‘liver injury’, ‘hepatitis’ and ‘hepatotoxicity’.

Furthermore, the team 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 research team found that 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. 

The team individually reviewed 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.

The research team also discuss clinically significant herb–drug interactions.

Dr Reddy team concludes, "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."