Scientific and Regulatory Perspectives in Herbal and Dietary Supplement Associated Hepatotoxicity in the United States

Avigan, Mark; Mozersky, Robert P.; Seeff, Leonard B.

doi:10.3390/ijms17030331

Cited by 90 publications

(102 citation statements)

References 156 publications

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“…This contrasts with intrinsic DILI, such as that seen with acetaminophen, where the relationship between high doses of the drug and liver injury is predictable 10. Herbal-related DILI has been increasing in frequency over the last decade in the USA, accounting for 20% of DILI cases in 2013,9 and an even higher proportion of cases in countries where herbal use is more common 63 64. Known risk factors for idiosyncratic DILI, including advanced age, female gender, alcohol consumption and the consumption of more than 100 mg/day of the offending agent,10 64 could likely have been met in this case, with the exception of alcohol use, since the majority of US turmeric DS deliver more than 100 mg of curcuminoids 6.…”

Section: Discussionmentioning

confidence: 99%

Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use

et al. 2018

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Turmeric dietary supplement sales, which accounted for US$69 million in spending in 2016, have been increasing exponentially in the USA, making this one of the most popular botanical supplements sold in the USA. Herbal supplement use, which is generally regarded as safe by consumers, is not usually reported to healthcare providers. We reported here on a case of autoimmune hepatitis, occurring in a 71-year-old woman taking turmeric dietary supplements for the maintenance of cardiovascular health, which resolved rapidly following discontinuation of the turmeric supplements. Of particular note, turmeric use was not documented in the patient's medical records and the potential causative role of the turmeric supplementation was ultimately identified by the patient rather than the healthcare providers. To our knowledge, this is the first documented report of turmeric supplement-induced autoimmune hepatitis.

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Section: Discussionmentioning

confidence: 99%

Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use

et al. 2018

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“…In the U.S. (and other countries) chlorophyll products are sold as dietary supplements, which are not regulated by the FDA. Therefore, no product quality and efficacy evaluation is require prior to marketing 81 .…”

Section: Contribution Of Hemorrhagic or Thrombotic Riskmentioning

confidence: 99%

Warfarin-chlorophyll herb-drug interactions

Siriwatanametanon¹

2017

Pharm Sci Asia

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Warfarin is one of the most commonly prescribed anticoagulants for preventing the formation of blood clots to reduce the risk of heart attack, stroke, deep vein thrombosis, and other serious conditions. Warfarin belongs to a group of vitamin K antagonists that has a narrow therapeutic index, slow onset of action and significant drug-drug, herb-drug interactions. Its unpredictable doseresponse relationship can increase risks of bleeding complications or inadequate anticoagulation. Consumption of foods and nutritional supplements rich in vitamin K can interfere with warfarin treatment because vitamin K can reduce the warfarin's effectiveness and potentially increase the risk of blood clots. There are chlorophyll products that are claimed to be beneficial to health when taken as a supplement in solid or liquid forms. Chlorophyll products are now increasingly distributed all over the world. These products make patients and healthcare providers confused about how they affect the effectiveness of warfarin treatment because they are derived from green vegetables, which have been known to cause significant herb-drug interactions. This review provides some information about chlorophylls and chlorophyll products that can potentially interact with warfarin, and some forms, such as chlorophyll drops or chlorophyll water, that can be taken safely because they contain the lowest amount of vitamin K.

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“…Liver injury by drugs, herbs, and dietary supplements (HDS) was comprehensively reviewed in 2016 and 2017, with extensive information provided in a HDS case series published in 2017 . These topics were also discussed in a special issue on “Drug, Herb, and Dietary Supplement Hepatotoxicity” in 2016 . Liver injuries related to herbs and dietary supplements (DS) represent a major clinical and regulatory challenge.…”

Section: Introductionmentioning

confidence: 99%

Is obesity rather than the dietary supplement used for weight reduction the cause of liver injury?

et al. 2018

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Acute liver injury has been attributed to dietary supplements (DS) used for weight loss, but their causal role was much questioned, and obesity as an alternative cause of the liver injury remained unclear. A comprehensive search of the Medline database was conducted with terms that included “DS,” “liver injury,” “obesity,” “obesity‐related liver diseases,” and “nonalcoholic steatohepatitis.” For each term, we focused on the first 50 publications. We undertook a manual search to identify additional reports. Underlying liver diseases and other health issues are common in patients taking DS for weight reduction. These include obesity or morbid obesity, as well as complex metabolic disorders complicated by excess morbidity and mortality due to associated liver diseases. Among these are nonalcoholic fatty liver disease with potential progression to nonalcoholic steatohepatitis and cirrhosis, often classified as cryptogenic with a rare risk of hepatocellular carcinoma. With the exception of hepatocellular carcinoma, these obesity‐related liver diseases were observed to varying degrees in patients, and some even required a liver transplant. This raises the question whether the liver injury that occurred in these patients is due to DS consumed for weight loss or to the underlying obesity‐related liver diseases. This analysis showed that, in many instances, the causal role of obesity has been neglected. Obesity‐associated liver diseases should be considered as differential diagnosis of liver injury in obese patients using DS.

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Scientific and Regulatory Perspectives in Herbal and Dietary Supplement Associated Hepatotoxicity in the United States

Cited by 90 publications

References 156 publications

Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use

Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use

Warfarin-chlorophyll herb-drug interactions

Is obesity rather than the dietary supplement used for weight reduction the cause of liver injury?

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