Posted 07 November 2016
Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 3 of 6. Food Chem Toxicol. 2016 Jul 8. pii: S0278-6915(16)30221-6. doi: 10.1016/j.fct.2016.07.001.
No current list of potentially life-threatening, hepatotoxic herbs and dietary supplements based on PubMed case studies exists in a summarized tabular form.
Documented case reports of herbs or dietary supplements appearing to contribute to liver injury were used to create a “Harmful Herb and Dietary Supplement List” of potentially hepatotoxic herbs and dietary supplements (PubMed, 1966 to May, 2015, and cross-referencing). The spectrum of herbal induced liver injuries (HDSILI) researched included elevated liver enzymes, hepatitis, steatosis, cholestasis, hepatic necrosis, hepatic fibrosis, hepatic cirrhosis, veno-occlusive disease, acute liver failure requiring a liver transplant, and death.
Over the past 50 years, approximately 19 herbs (minus germander and usnic acid that are no longer sold) and 13 dietary supplements (minus the six no longer sold and vitamin A & niacin due to excess) posed a possible risk for liver injures in certain individuals. The top three herbs with the most number of reported publications (but not cases studies) in descending order, were germander, black cohosh, kava extract, and green tea extract.
These online tables will contribute to continued Phase IV post marketing surveillance to detect possible liver toxicity cases and serve to forewarn consumers, clinicians, and corporations.