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Hasegawa, Junichi; Suyama, Yoshiko; Kinugawa, Toru; Morisawa, Tsuyoshi; Kishimoto, Yosuke

doi:10.1023/a:1007708025567

Cited by 18 publications

(4 citation statements)

References 7 publications

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“…Although several cases demonstrating a potential association between pseudoaldosteronism and reversible secondary cardiomyopathy have been reported, to the best of our knowledge, this is the first case showing a potential association between licorice‐induced pseudoaldosteronism and TCM onset. 13 , 14 Therefore, further investigations regarding the relationship between pseudoaldosteronism and TCM are warranted.…”

Section: Discussionmentioning

confidence: 99%

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Yoshida

Yamamoto

Inoue

et al. 2022

Clinical Case Reports

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Takotsubo cardiomyopathy (TCM) is an acute reversible ventricular dysfunction that often causes QT interval prolongation, which can lead to a fatal arrhythmia. 1 Glycyrrhiza uralensis (licorice in English; kanzo in Japanese) is one of the components of Kampo drugs, which are often used for the treatment of various diseases in older patients (Figure 1A-1C). Long-term use of licorice can initiate pseudoaldosteronism, mainly manifesting as severe hypokalemia leading to QT interval prolongation. 2 Yokukansan (TJ-54), which consists of seven dried herbs, including licorice, is reportedly effective for dementia, insomnia, and schizophrenia (Figure 1D). 3,4 Moreover, polypharmacy, an unresolved issue in the aging population, is associated with drug side effects, including fatal arrhythmia due to QT interval prolongation. 5 We herein report a cautionary case of licorice-induced pseudoaldosteronism that precipitated the onset of TCM and subsequent fatal arrhythmia in an octogenarian patient on polypharmacy. | CASE REPORTAn 84-year-old woman with a history of old cerebral infarction and Alzheimer-type dementia was brought to our emergency department because of anorexia and body weakness that persisted for 1 week, progressively worsening dyspnea at rest, and subsequent somnolence. The patient had a history of long-term use of several medications for her comorbidities: aspirin (100 mg/day) for old

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Section: Discussionmentioning

confidence: 99%

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Yoshida

Yamamoto

Inoue

et al. 2022

Clinical Case Reports

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“…Mild to severe AH with secondary organ impairment (i.e., hypertensive encephalopathy [ 19 , 26 , 51 , 72 , 73 , 83 ], hypertensive retinopathy [ 31 , 81 ], acute kidney injury [ 47 , 49 , 66 , 79 ], MACEs [ 11 , 24 , 25 , 42 , 43 , 45 , 54 , 59 , 88 , 97 , 99 , 100 ], pulmonary edema [ 22 , 94 ]) were commonly described. Sigurjònsdottir et al showed a linear dose-response relationship between liquorice intake and BP increase [ 130 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Liquorice was lethal in only two cases [ 88 , 97 ]. Hasegawa et al reported a patient developing heart failure resembling dilated cardiomyopathy [ 24 ]. Acute heart failure with pulmonary edema has been described [ 22 , 94 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Liquorice Toxicity: A Comprehensive Narrative Review

Ceccuzzi,

Rapino,

Perna

et al. 2023

Nutrients

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Background: Renowned since ancient times for its medical properties, liquorice is nowadays mainly used for flavoring candies or soft drinks. Continuous intake of large amounts of liquorice is a widely known cause of pseudo-hyperaldosteronism leading to hypertension and hypokalemia. These manifestations are usually mild, although in some cases may generate life-threatening complications, i.e., arrhythmias, muscle paralysis, rhabdomyolysis, and coma. In addition, liquorice has an important estrogenic-like activity. Methods: We summarized the current knowledge about liquorice and reviewed 104 case reports in both the English and Italian languages from inception to June 2023 concerning complications due to an excess of liquorice intake. Results: In contrast to most published data, female sex and old age do not appear to be risk factors. However, hypertension and electrolyte imbalance (mainly hypokalemia) are prevalent features. The detection of glycyrrhetinic acid in blood is very uncommon, and the diagnosis is essentially based on an accurate history taking. Conclusions: Although there is not a significant mortality rate, liquorice toxicity often requires hospitalization and therefore represents a significant health concern. Major pharmaceutical drug regulatory authorities should solicit public awareness about the potentially dangerous effects caused by excessive use of liquorice.

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“…In consequence of the elevated BP some patients developed hypertensive encephalopathy or cerebrovascular accidents [77,78,79]. Acute heart failure, pulmonary edema [80,81,82] or generalized edema [83,84,85] can be caused by the sodium retaining effect of licorice (Figure 3a). Interestingly, the occurrence of edema associated with hypertension seems to be characteristic for the ‘licorice syndrome’.…”

Section: Pharmacological Effects Of Licoricementioning

confidence: 99%

Bioactive Candy: Effects of Licorice on the Cardiovascular System

Deutch

Grimm

Wehland

et al. 2019

Foods

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Licorice, today chiefly utilized as a flavoring additive in tea, tobacco and candy, is one of the oldest used herbs for medicinal purposes and consists of up to 300 active compounds. The main active constituent of licorice is the prodrug glycyrrhizin, which is successively converted to 3β-monoglucuronyl-18β-glycyrrhetinic acid (3MGA) and 18β-glycyrrhetinic acid (GA) in the intestines. Despite many reported health benefits, 3MGA and GA inhibit the 11-β-hydrogenase type II enzyme (11β-HSD2) oxidizing cortisol to cortisone. Through activation of mineralocorticoid receptors, high cortisol levels induce a mild form of apparent mineralocorticoid excess in the kidney and increase systemic vascular resistance. Continuous inhibition of 11β-HSD2 related to excess licorice consumption will create a state of hypernatremia, hypokalemia and increased fluid volume, which can cause serious life-threatening complications especially in patients already suffering from cardiovascular diseases. Two recent meta-analyses of 18 and 26 studies investigating the correlation between licorice intake and blood pressure revealed statistically significant increases both in systolic (5.45 mmHg) and in diastolic blood pressure (3.19/1.74 mmHg). This review summarizes and evaluates current literature about the acute and chronic effects of licorice ingestion on the cardiovascular system with special focus on blood pressure. Starting from the molecular actions of licorice (metabolites) inside the cells, it describes how licorice intake is affecting the human body and shows the boundaries between the health benefits of licorice and possible harmful effects.

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Cited by 18 publications

References 7 publications

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Liquorice Toxicity: A Comprehensive Narrative Review

Bioactive Candy: Effects of Licorice on the Cardiovascular System

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