Drug-induced liver injury due to “natural products” used for weight loss: A case report

Abstract

Ta k i n g h e r b a l -e x t r a c t s t o l o s e w e i g h t i s a n underestimated health hazard. Often, these products contain active agents that can cause acute liver damage. In this case report, a 22-year-old female patient, who presented with a feature of cholestatic syndrome, was so sure that the "natural products" were not dangerous that she did not inform her physicians that she had taken them, making their task that much more challenging. Clinical presentation m i m i c k e d a c u t e c h o l e c y s t i t i s a n d t h e p a t i e n t underwent a cholecystectomy. Surgery was without any consequences and complications, although it did not completely cure the illness. She later admitted to having taken herbal remedies and this led to the correct diagnosis of phytotherapy-related hepatotoxicity and a successful therapeutic approach. The true incidence of phytotherapy-related hepatotoxicity and its pathogenic mechanisms are largely unknown. It is important to increase the awareness of both clinicians and patients about the potential dangers of herbal remedies.

Herbal hepatotoxicity: a tabular compilation of reported cases

“…Strahl et al ., 1998 , Greving et al ., 1998 , Benninger et al ., 1999 , Crijns et al ., 2002 , Hardeman et al ., 2003 , Stickel et al ., 2003 , BfArM, 2005 , Rifai et al ., 2006 , Conti et al ., 2008 , Moro et al ., 2009 , Tarantino et al ., 2009 , EMA, 2010 , Teschke et al ., 2011, 2012 …”

Resveratrol Nanoemulsion: A Promising Protector Against Ethinylestradiol-Induced Hepatic Cholestasis in Female Rats

“…In the present study, MMP-2 and -9 were found to be up-regulated, suggesting that both MMPs are indeed involved in EE-treated rats, which necessitates further investigations into their functions in the disease. Besides intrahepatic cholestasis of pregnancy, cholestasis is reportedly the major syndrome of hepatotoxicity, in particular those induced by ingestion of harmful herbal products [56,57]. MMPs are also thought to contribute to hepatotoxicity, supported by reports demonstrating the protective effects against hepatotoxicity exerted through down-egulation of MMP-9 [58].…”

Suicide attempt with herbal weight loss product: A adolescent patient

“…3,9 Özel-likle yeşil çay ekstresi içeren zayıflama ürünleri ile akut karaciğer yetmezliği olguları bildirilmiştir. 1,2 Bitkisel zayıflama ürünlerinin içeriklerinde yer aldığı belirtilen maddeler dışında, tiroid hormonları, diüretik-ler, laksatifler, kafein, sempatomimetikler ve sibutramin gibi çok çeşitli ilaç etken maddeleri bulunabildiği araştır-malarla gösterilmiştir. [10][11][12] Bitkisel zayıflama ürünlerinin içeriğinde belirtilmeyen bu aktif ilaçlar çeşitli yan etkilere, hatta ölüme bile neden olabilmektedirler.…”

“…Bu ürünler cilt, karaciğer, gastrointestinal, pulmoner, kardiyovaskü-ler, endokrin, renal, hematolojik, nörolojik olmak üzere bir çok sistemde istenmeyen etkiler oluşturabilmektedir-ler. [1][2][3] Adolesan yaş grubunda intihar girişimi, gelişmiş ve gelişmekte olan ülkelerde, önemli bir tıbbi ve sosyal problemdir ve sıklıkla ilaçlar kullanılmaktadır. 4 Fakat bitkisel içerikli zayıflama ürünü ile intihar girişimi bildiğimiz kadarıyla literatürde daha önce bildirilmemiştir.…”