Herb-induced Liver Injury—A Guide to Approach. Lessons from the Tinospora cordifolia (Giloy) Case Series Story

Nagral, Aabha; Rudra, Omkar S.; Menezes, Sherna; Menon, Sasikumar; Shailajan, Sunita; Mallakmir, Snehal; Reddy, Rajender

doi:10.1016/j.jceh.2022.11.001

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…& Thomson (TC) also documented to cause fulminant hepatitis. [19,20] However, the authors collected 4 plant samples and 2 commercial preparations that were consumed by their patients and subjected them to high-performance thin-layer chromatography phytochemical analysis and DNA barcoding studies, which confirmed the causative herb Giloy and not TC. [21] The largest series of Giloy-induced HILI, a nationwide multicenter study was reported by the Liver Research Club India (LIVERECI).…”

Section: Specific Herbs and Their Toxicitymentioning

confidence: 99%

A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine

Philips,

Theruvath

2024

Medicine

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Complementary and alternative medicine-related liver injuries are increasing globally. Alternative medicine, as an inclusive healthcare practice, is widely accepted in developing and underdeveloped countries. In this context, the traditional systems of medicine in India have been at the forefront, catering to the preventive and therapeutic spectrum in the absence of conclusive evidence for benefits and lack of data on safety. Contrary to popular belief, it is evident that apart from adverse events caused by contamination and adulteration of alternative medicines, certain commonly used herbal components have inherent hepatotoxicity. This narrative review updates our current understanding and increasing publications on the liver toxicity potential of commonly used herbs in traditional Indian systems of medicine (Ayush), such as Tinospora cordifolia (Willd.) Hook.f. & Thomson (Giloy/Guduchi), Withania somnifera (L.) Dunal (Ashwagandha), Curcuma longa L. (Turmeric), and Psoralea corylifolia L. (Bakuchi/Babchi). This review also highlights the importance of the upcoming liver toxicity profiles associated with other traditional herbs used as dietary supplements, such as Centella asiatica (L.) Urb., Garcinia cambogia Desr., Cassia angustifolia Vahl (Indian senna), and Morinda citrofolia L. (Noni fruit). Fortunately, most reported liver injuries due to these herbs are self-limiting, but can lead to progressive liver dysfunction, leading to acute liver failure or acute chronic liver failure with a high mortality rate. This review also aims to provide adequate knowledge regarding herbalism in traditional practices, pertinent for medical doctors to diagnose, treat, and prevent avoidable liver disease burdens within communities, and improve public health and education.

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Section: Specific Herbs and Their Toxicitymentioning

confidence: 99%

A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine

Philips,

Theruvath

2024

Medicine

View full text Add to dashboard Cite

show abstract

“…Knowledge of probable drug-related adverse effects on the liver, as well as a high level of awareness of DILI, improve the accuracy of history taking. 57 Three patterns of CAM-DILI, based on baseline serum alanine transaminase and alkaline phosphatase ratios from the first investigations, can help in categorizing the injury as hepatocellular, cholestatic, or mixed. This is called the R -ratio, which is a reliable tool that helps correlate biochemical and pathological injury patterns.…”

Section: Clinical Presentation Assessment and Outcomesmentioning

confidence: 99%

Complementary and alternative medicines and liver disease

Philips,

Theruvath,

Ravindran

et al. 2024

Hepatology Communications

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Complementary and alternative medicines (CAM) include conventional medical treatments. Patients worldwide use CAM at alarming rates; thus, reports of CAM-related DILI have been on the rise. The clinical presentations include asymptomatic liver test abnormalities, acute hepatitis with or without jaundice, acute cholestatic liver disease (bland or with hepatitis), acute liver failure, severe hepatitis with features of portal hypertension, and acute decompensation of known or unknown cirrhosis that can lead to acute-on-chronic liver failure. Acute hepatitis with or without necrosis, hepatocellular and canalicular cholestasis, herb-induced or CAM-triggered autoimmune hepatitis, granulomatous hepatitis, severe steatohepatitis, and vanishing bile duct syndrome are common liver biopsy findings in CAM-DILI. The presence of preexisting liver disease predicts severe liver injury, risk of progression to liver failure, and decreased transplant-free survival in patients with CAM-DILI. This review discusses global epidemiology and trends in CAM-DILI, clinical presentation, assessment and outcomes, commonly emerging threats in the context of hepatotoxic herbs, pragmatic assessment of “liver beneficial” herbs and health care myths, patient communication, regulatory framework, and future directions on research in CAM.

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A Prospective, Controlled, Pilot Study of Personalised Add-on Ayurveda Treatment in High-Risk Type II Diabetes COVID-19 Patients

Kumar,

Eranezhath,

Vishwanathan

et al. 2024

Journal of Herbal Medicine

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Herb-induced Liver Injury—A Guide to Approach. Lessons from the Tinospora cordifolia (Giloy) Case Series Story

Cited by 4 publications

References 25 publications

A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine

A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine

Complementary and alternative medicines and liver disease

A Prospective, Controlled, Pilot Study of Personalised Add-on Ayurveda Treatment in High-Risk Type II Diabetes COVID-19 Patients

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