Herbal hepatotoxicity: current status, examples, and challenges

Calitz, Carlemi; Plessis, Lissinda H. Du; Gouws, Chrisna; Steyn, Dewald; Steenekamp, Jan; Muller, Christo J. F.; Hamman, Josias H.

doi:10.1517/17425255.2015.1064110

Cited by 49 publications

(34 citation statements)

References 141 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For some herbal medicines including herbal TCM products, safety concerns have been expressed regarding rare adverse reactions that were not always transient but occasionally resulted in a severe clinical course and fatality [2,7,12,28,29]; attempts to ignore severe adverse reactions should be resisted [55]. Under these conditions, manufacturers and regulatory agencies are obliged to provide good product quality of efficient herbal products including herbal TCM, ascertaining consumer safety [12,50,60,61].…”

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

“…Because safety aspects are an outstanding problem (Table 1) [2,28,29,60] and due to variable and disputable product quality [13,62,63,64,65], herbal TCM products require a more strict regulatory surveillance in China and elsewhere [8,12,50]. Some efforts appear promising [12], provided the principles of current Good Agricultural Practices (cGAP) and current Good Manufacturing Practices (cGMP) are fulfilled [8,12,50,60].…”

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

“…Herbal products are manufactured for human use and require quality and safety standards; lacking these is a major issue and often communicated in several critical reports within the last years [3,28,29,50,60,122,209,265,266,267,268,269,270,271,272]. Similar problems are evident for most herbs used in the context of TCM [8,12,15,17,62,63,64,65,66,67,119,120,121,122,123,124,181,185,229,230,231,232,233], which were discussed by the Chinese FDA, presenting details of the current status and future perspectives of the pharmacovigilance practice and risk control of TCM drugs in China [12].…”

Section: Diagnostic Challengesmentioning

confidence: 99%

“…As opposed to artemisinin and its derivatives, which lack proven hepatotoxic adverse reactions, there is major clinical concern that the use of various TCM herbs or herbal products may be associated with the risk of toxic liver disease [7,28,29]. Herb induced liver injury (HILI) from herbal TCM may be severe and rarely leads to acute liver failure (ALF), which is often life-threatening unless liver transplantation is performed.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

View full text Add to dashboard Cite

Background: Traditional Chinese Medicine (TCM) with its focus on herbal use is popular and appreciated worldwide with increased tendency, although its therapeutic efficacy is poorly established for most herbal TCM products. Treatment was perceived as fairly safe but discussions emerged more recently as to whether herb induced liver injury (HILI) from herbal TCM is a major issue; Methods: To analyze clinical and case characteristics of HILI caused by herbal TCM, we undertook a selective literature search in the PubMed database with the search items Traditional Chinese Medicine, TCM, alone and combined with the terms herbal hepatotoxicity or herb induced liver injury; Results: HILI caused by herbal TCM is rare and similarly to drugs can be caused by an unpredictable idiosyncratic or a predictable intrinsic reaction. Clinical features of liver injury from herbal TCM products are variable, and specific diagnostic biomarkers such as microsomal epoxide hydrolase, pyrrole-protein adducts, metabolomics, and microRNAs are available for only a few TCM herbs. The diagnosis is ascertained if alternative causes are validly excluded and causality levels of probable or highly probable are achieved applying the liver specific RUCAM (Roussel Uclaf Causality Assessment Method) as the most commonly used diagnostic tool worldwide. Case evaluation may be confounded by inappropriate or lacking causality assessment, poor herbal product quality, insufficiently documented cases, and failing to exclude alternative causes such as infections by hepatotropic viruses including hepatitis E virus infections; Conclusion: Suspected cases of liver injury from herbal TCM represent major challenges that deserve special clinical and regulatory attention to improve the quality of case evaluations and ascertain patients’ safety and benefit.

show abstract

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

Section: Herbal Traditional Chinese Medicine Its History Philosomentioning

confidence: 99%

Section: Diagnostic Challengesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Many herbal medicines exhibit pharmacological activities and toxic effects by chemical substances as secondary metabolites. Some herbal medicines have been associated with hepatotoxicity, which is reversible upon discontinuation of the treatment by patients [1].…”

Section: Introductionmentioning

confidence: 99%

A Case Report of Liver and Renal Function Changes in Stroke Patients Taking Long-term Herbal Medicine

Kim¹,

Kim²,

Go³

et al. 2017

J Int Korean Med

View full text Add to dashboard Cite

In general, herbal medicines have been considered as safe by the general public, since they are naturally occurring and have been applied in treatment for over thousands of years. As the use of herbal medicine is rapidly increasing globally, the potential toxicity of herbal drugs, in particular drug-induced liver injury (DILI), has now become a serious medical issue. According to the literature, the authors analyzed and discussed the hepatotoxicity problem of Chinese herbal medicines (CHM), including global overview on herbal-induced liver injury (HILI), current research progress on toxic CHM, diagnosis and treatment of HILI, and modern approaches and technologies of study of hepatotoxicity. As to promote the recognition of HILI and tackle the issue, a guideline for the diagnosis and treatment of HILI has recently been drafted by Chinese scientists. As suggested by the guideline, the hepatotoxicity issue of CHM, as a matter of fact, is overestimated. Up to date, the investigation of hepatotoxicity of CHM is now booming with worldwide application of CHM. This review therefore provides useful information for investigating hepatotoxicity of herbal medicine and characterizing DILI caused by CHM. In addition, authors describe in which way further efforts should be made to study the rationale of CHM and liver injury.

show abstract

Drug‐induced Hepatotoxicity

Larrey

Ursic‐Bedoya

Meunier

2017

Schiff's Diseases of the Liver

View full text Add to dashboard Cite

Herbal hepatotoxicity: current status, examples, and challenges

Abstract: Increasing evidence of herbal hepatotoxicity has become available through case reports; however, several factors contribute to challenges associated with causality assessment and pre-emptive testing as well as diagnosis of herb-induced liver injury.

Cited by 49 publications

References 141 publications

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

A Case Report of Liver and Renal Function Changes in Stroke Patients Taking Long-term Herbal Medicine

Drug‐induced Hepatotoxicity

Contact Info

Product

Resources

About