The Development of a Database for Herbal and Dietary Supplement Induced Liver Toxicity

Abstract

The growing use of herbal dietary supplements (HDS) in the United States provides compelling evidence for risk of herbal-induced liver injury (HILI). Information on HDS products was retrieved from MedlinePlus of the U.S. National Library of Medicine and the herbal monograph of the European Medicines Agency. The hepatotoxic potential of HDS was ascertained by considering published case reports. Other relevant data were collected from governmental documents, public databases, web sources, and the literature. We collected information for 296 unique HDS products. Evidence of hepatotoxicity was reported for 67, that is 1 in 5, of these HDS products. The database revealed an apparent gender preponderance with women representing 61% of HILI cases. Culprit hepatotoxic HDS were mostly used for weight control, followed by pain and inflammation, mental stress, and mood disorders. Commonly discussed mechanistic events associated with HILI are reactive metabolites and oxidative stress, mitochondrial injury, as well as inhibition of transporters. HDS–drug interactions, causing both synergistic and antagonizing effects of drugs, were also reported for certain HDS. The database contains information for nearly 300 commonly used HDS products to provide a single-entry point for better comprehension of their impact on public health.

Prolonged interval of total bilirubin decline is an early independent predictive factor of chronic persistent drug‐induced liver injury

“…A previous report from a Spanish registry showed that cardiovascular drugs and central nervous system drugs were likely to cause chronic DILI, the commonest insulting chemical components were amoxicillin/clavulanate, bentazepam, atorvastatin, and captopril . Contrary to what people commonly believe, that herbal products are always safe, the present study showed that herbal products are the most common reason for DILI in China . However, the same as other studies of liver injury induced by traditional Chinese medicine, we also could not distinguish the ingredients in herbal products because of their heterogeneity …”

“…7,13 Contrary to what people commonly believe, that herbal products are always safe, the present study showed that herbal products are the most common reason for DILI in China. [26][27][28] However, the same as other studies of liver injury induced by traditional Chinese medicine, we also could not distinguish the ingredients in herbal products because of their heterogeneity. 2,13,26 We found the time intervals of ALT, AST, TBIL, ALP, and GGT declining from the peak to half of their peak were significantly longer in chronic DILI for the first time.…”

Clinicopathological features of Bu Gu Zhi‐induced liver injury, a long‐term follow‐up cohort study

“…Recent studies from the USA and Europe have revealed that middle‐aged women are more likely to be affected by herbal and dietary supplement (HDS)‐induced liver injury. A significant proportion of them have a hepatocellular injury pattern (R > 5) with jaundice and greater disease severity . BGZ is a HDS and, until now, 37 cases of BGZILI have been reported, mainly in the Chinese literature .…”

“…However, the duration of hospitalization was significantly longer in the severe group. (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) .343…”

“…The severe cases had significantly more complaints such as fatigue, dark urine and jaundice; significantly higher onset/peak AST, AST: ALT ratio and onset/peak TB levels; a slower course of normalization of serum bilirubin; and longer duration of hospitalization.Recent studies from the USA and Europe 1 have revealed that middle-aged women are more likely to be affected by herbal and dietary supplement (HDS)-induced liver injury. A significant proportion of them have a hepatocellular injury pattern (R > 5) with jaundice and greater disease severity 1,4,8,[37][38][39]. BGZ is a HDS and, until now, 37 cases of BGZILI have been reported, mainly in the Chinese literature 23,28,29,40.…”