Web is Better: Liver Toxicity from Herbs

A recent review article (Clin Gastroenterol Hepatol 2014; 1069-76) provides a good overview of herbs and liver injury; however, the NIH website http://livertox.nih.gov/ is more comprehensive.

The article notes the difficulty in assessing liver injury from herbs and dietary supplements due to the permissive regulatory environment and underreporting.

Specific products reviewed include the following:

  • Weight loss supplements: hydroxycut, herbalife, green tea, usnic acid
  • “Health-promoting” herbs: black cohosh, comfrey, kava
  • Joint health supplements: flavocoxid, glucosamine
  • Bodybuilding supplements: anabolic steroids

The article explains issues with regard to causality and the regulatory issues. However, for each of these products, I found them on the livertox website. So, that is where I would start if I needed to look up herb-induced liver injury.  Reporting of adverse events can occur through FDA website: http://www.fda.gov/safety/medwatch/default.htm or through hotline: 800-FDS-1088.

A related reference –Bad Way to Lose Weight: “SlimQuickTM-Associated Hepatotoxicity Resulting in Fulminant Liver Failure and Orthotopic Liver Transplantation” ACG Case Rep J 2014;1(4):220–222. http://dx.doi.org/10.14309/crj.2014.59. Published: July 8, 2014

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Liver toxicity -where to look online

Increasingly physicians as well as families gather medical information online.  Physicians, like patients, benefit when they know that a website is highly regarded by experts in the field.  This month’s Hepatology (2013: 57: 873-74) provides an introduction to the website LiverTox (www.livertox.nih.gov) (Search Livertox Database).

This website provides comprehensive and “evidence-based information on drug, dietary supplement, and herbal-induced liver injury that is freely accessible to physicians, researchers, and the public.”  The website includes about 650 different medications, supplements, and herbals; more than 12,000 annotated references are available.  In addition, the website allows clinicians to submit a case report as well as allow submission to the FDA Adverse Event Reporting System (AERS).

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