Pseudohyperaldosteronism from liquorice-containing laxatives

Scali, M.; Pratesi, C.; Zennaro, Maria Christina; Zampollo, V.; Armanini, Decio

doi:10.1007/bf03349639

Cited by 19 publications

(7 citation statements)

References 3 publications

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“…In addition, some drugs are flavored with liquorice, such as some laxatives [24]. Although pure black liquorice is not available in the USA, liquorice is widely added to foods as a flavoring agent in small quantities.…”

Section: Discussionmentioning

confidence: 99%

Low Doses of Liquorice Can Induce Hypertension Encephalopathy

et al. 2000

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Prolonged ingestion of liquorice is a well-known cause of hypertension due to hypermineralocorticoidism. We describe 2 cases of hypertension encephalopathy (in addition to the classical symptoms of hypertension, hypokalemia and suppression of the renin-aldosterone system) which resulted in pseudohyperaldosteronism syndrome due to the regular daily intake of low doses of liquorice. Glycyrrhizic acid, a component of liquorice, produces both hypermineralocorticism and the onset of encephalopathy through the inhibition of 11β-hydroxysteroid dehydrogenase. Hypertension encephalopathy due to the daily intake of low doses of liquorice, however, has not been previously documented. It is proposed that some people could be susceptible to low doses of glycyrrhizic acid because of a 11β-hydroxysteroid dehydrogenase deficiency.

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Section: Discussionmentioning

confidence: 99%

Low Doses of Liquorice Can Induce Hypertension Encephalopathy

et al. 2000

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“…Simultaneously, licorice-flavored alcoholic beverages such as sambuca, pernod, anisette, pastis, araki, herbsaint, and Belgian beer are also quite common and substantially served worldwide. Licorice extract is also frequently used as a flavoring agent to mask the bitter taste of medicines such as some laxatives (Scali et al, 1990). Licorice extract and its phytochemicals are also important ingredients of dietary supplement formulations used for hangover alleviation (Kishida & Kitano, 2011), muscle building (Kim et al, 2012a), cardiovascular protection (Riccioni et al, 2012), body-weight control (Lee et al, 2011), as healthcare chocolate (Shunying et al, 2011), and so on.…”

Section: As Flavor Additive In the Beveragesmentioning

confidence: 99%

A review on phytochemicals, pharmacological activities, drug interactions, and associated toxicities of licorice (Glycyrrhizasp.)

et al. 2021

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Since the beginning, human beings have consistently been using plants and their components for the prevention and treatment of various ailments. However, in the last few decades, plant-based medicines and health supplements are gaining more acceptability and rapid popularity. Licorice (Glycyrrhiza sp.) is a terrestrial herb belonging to the family Fabaceae and primarily cultivated in European, Middle Eastern, and South Asian countries. Ethnomedicinal uses of licorice have frequently been described in the world's renowned medical systems, including Ayurveda, Unani, Chinese, Korean, Japanese, African, and European traditional medical systems. To date, 30 species of licorice are known, and among them, G. glabra, G. inflata, and G. uralensis are significantly explored for nutritional and pharmacological benefits. The wide range of commercially available products, including herbal preparations, health supplements, cosmetics, and food and feeds preparations use licorice as active ingredient. Glabridin, licochalcone A, glycyrrhizin, and 18-glycyrrhetinic acid are the notable phytochemicals isolated from licorice and immensely explored for biological and pharmacological activities. Nevertheless, the excessive intake of licorice has also been associated with a wide spectrum of adverse effects on human health. Among them, several are reported to be mediated by modulation of drug-metabolizing cytochrome P-450 enzymes. In the present review, we provide a comprehensive description of the current knowledge of licorice, including historical development, phytoconstituents, species-specific marker metabolites, herb-drug interaction, pharmacological uses, food additive application, and toxicities. We believe this review will provide excellent information to physicians, researchers, and personnel of different scientific regulatory bodies.

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“…It was evident that most of the published complications are linked to the aldosterone-like action of licorice. The two main categories of complications were licoriceinduced hypertension [Mumoli and Cei, 2008;Scali et al 1990;Holmes et al 1970;De Klerk et al 1997] and hypokalemic myopathy [Yaguchi et al 2008;Maresca et al 1988;Caradonna et al 1992;Lin et al 2003a;Lin et al 2003b;Gross et al 1966;Tancevski et al 2008]. In reports of licorice-induced hypertension, prognosis was favorable with good response after cessation of licorice and starting antihypertensive medications.…”

Section: Licorice-related Complicationsmentioning

confidence: 99%

“…It was evident that most of the published complications are linked to the aldosterone-like action of licorice. The two main categories of complications were licorice-induced hypertension [Mumoli and Cei, 2008; Scali et al . 1990; Holmes et al .…”

Section: Licorice-related Complicationsmentioning

confidence: 99%

Licorice abuse: time to send a warning message

Omar

Komarova

Elghonemi

et al. 2012

Therapeutic Advances in Endocrinology

195

160

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Licorice extract has always been recognized as a sweetener and a thirst quencher. Its nutritive value is overrated by many who consume significant amounts and are prone to complications. Glycyrrhetic acid, the active metabolite in licorice, inhibits the enzyme 11-ß-hydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid effect and the tendency towards the elevation of sodium and reduction of potassium levels. This aldosterone-like action is the fundamental basis for understanding its health benefits and the wide spectrum of adverse effects. Herein, we present a comprehensive review of licorice along with the reported complications related to excess intake. Despite its apparent use in a few clinical scenarios, the daily consumption of licorice is never justified because its benefits are minor compared to the adverse outcomes of chronic consumption. The review highlights the importance of investigating the dietary habits and herbal remedies which are being used worldwide on cultural and habitual bases rather than reliable scientific evidence. Licorice is a US Food and Drug Administration (FDA) approved food supplement used in many products without precise regulations to prevent toxicity. Increased awareness among the public is required through TV commercials, newspapers, internet sites, magazines and product labels regarding the upper limit of ingestion and health hazards associated with excess intake. We hope that this review will serve as a warning message that should be transmitted from physicians to patients to avoid excessive licorice intake as well as a message to the FDA to start regulating the use of this substance.

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Pseudohyperaldosteronism from liquorice-containing laxatives

Cited by 19 publications

References 3 publications

Low Doses of Liquorice Can Induce Hypertension Encephalopathy

Low Doses of Liquorice Can Induce Hypertension Encephalopathy

A review on phytochemicals, pharmacological activities, drug interactions, and associated toxicities of licorice (Glycyrrhizasp.)

Licorice abuse: time to send a warning message

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