Assessment of Prescribed Herbal Medicine on Liver Function in Korea: A Prospective Observational Study

Yun, Young-ju; Nah, Seong‐Su; Park, Jae-Hyun; Jung, Seul-Ki; Paeck, Eun-Kyung; Park, Jae-Hyung; Lee, Eui-Joon; Kim, Sehyun; Park, Hae-Mo; Lee, Sundong; Kim, Ji-Yong; Hong, Seung‐Jae; Choe, Bong-Keun; Chung, Joo-Ho

doi:10.1089/acm.2008.0053

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…The incidence of idiosyncratic liver injury among persons who use HDS is variable. Based on limited data, the incidence of hepatotoxicity from Chinese herbs appears to be low (less than 1%) . Melchart et al .…”

Section: Epidemiologymentioning

confidence: 99%

Review article: herbal and dietary supplement hepatotoxicity

Bunchorntavakul

Reddy

2012

Aliment Pharmacol Ther

271

191

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Summary Background Herbal and dietary supplements are commonly used throughout the World. There is a tendency for underreporting their ingestion by patients and the magnitude of their use is underrecognised by Physicians. Herbal hepatotoxicity is not uncommonly encountered, but the precise incidence and manifestations have not been well characterised. Aims To review the epidemiology, presentation and diagnosis of herbal hepatotoxicity. This review will mainly discuss single ingredients and complex mixtures of herbs marketed under a single label. Methods A Medline search was undertaken to identify relevant literature using search terms including ‘herbal’, ‘herbs’, ‘dietary supplement’, ‘liver injury’, ‘hepatitis’ and ‘hepatotoxicity’. Furthermore, we scanned the reference lists of the primary and review articles to identify publications not retrieved by electronic searches. Results The incidence rates of herbal hepatotoxicity are largely unknown. The clinical presentation and severity can be highly variable, ranging from mild hepatitis to acute hepatic failure requiring transplantation. Scoring systems for the causality assessment of drug‐induced liver injury may be helpful, but have not been validated for herbal hepatotoxicity. Hepatotoxicity features of commonly used herbal products, such as Ayurvedic and Chinese herbs, black cohosh, chaparral, germander, greater celandine, green tea, Herbalife, Hydroxycut, kava, pennyroyal, pyrrolizidine alkaloids, skullcap, and usnic acid, have been individually reviewed. Furthermore, clinically significant herb–drug interactions are also discussed. Conclusions A number of herbal medicinal products are associated with a spectrum of hepatotoxicity events. Advances in the understanding of the pathogenesis and the risks involved are needed to improve herbal medicine safety.

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Section: Epidemiologymentioning

confidence: 99%

Review article: herbal and dietary supplement hepatotoxicity

Bunchorntavakul

Reddy

2012

Aliment Pharmacol Ther

271

191

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“…In Korea, Yun et al [7] and Park et al [15] reported that there some herbs, for example Ephedra sinica Stapf, Scutellaria baicalensis Georgi, Dictamnus dasycarpus Turcz., Aconitum carmichaeli Debx (= Aconitum chinense Sieb. et Zucc .…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, concerns about hepatotoxicity caused by herbal medicines have been raised in several papers, but remains controversial. [3–6] Indeed, several other studies [7–10] have reported that herbal medicines are safe and, with respect to liver function, are more helpful than harmful. Given the growing prevalence of combined therapies of conventional and herbal medicines, a large-scale retrospective study was performed in Germany.…”

Section: Introductionmentioning

confidence: 99%

Influence of combined therapy with conventional and herbal medicines on liver function in 138 inpatients with abnormal liver transaminase levels

Shin

Kim

Nam

2016

BMC Complement Altern Med

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BackgroundTo evaluate the influence of combined therapy of conventional and herbal medicines on liver function.MethodsThis study was a retrospective chart review. A total of 138 patients with abnormal liver transaminase levels at the time of admission were included in this study. We evaluated the influence of combined therapy of conventional and herbal medicines on liver transaminase levels over a period of at least 2 weeks at Kyung Hee University Korean Medical Hospital. Analyses were performed using SPSS version 17.0 for Windows. Paired T-tests were used to examine the significance of differences in AST, ALT, and GGT levels at the time of admission and discharge.ResultsWe found that combined therapy reduced levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT) to a statistically significant level. Specifically, there were 48, 66, 104 subjects who exhibited abnormal AST, ALT and GGT levels at admission, which was reduced to 13, 37, and 64 subjects after combined therapy, respectively. Some subjects exhibited worsening levels of liver transaminases after combined therapy, so we used the χ2 test to analyze the influence of combined therapy with conventional and herbal medicines on liver function according to initial liver transaminase levels. According to this analysis, ALT and GGT levels may be more important than AST levels in estimating the influence of combined therapy on patients with abnormal liver transaminase levels.ConclusionsBased on this retrospective chart review, combined therapy of conventional and herbal medicines would be considered relatively safe. Thus, if patients have abnormal ALT or GGT levels, caution should be taken when suggesting combined therapy with conventional and herbal medicines.

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“…A total of 1699 patients (756 males and 943 females) were involved in these studies, and 1263 inpatients (3 studies) and 436 outpatients (3 studies). Two studies were conducted in multiple clinics (Jeong et al, 2012;Yun et al, 2009). The study characteristics are summarized in Table 1.…”

Section: Final Data Analyzedmentioning

confidence: 99%

“…Summary for incidence of herbal DILI in Korea Yun et al (2009). Outpatients on 12 Oriental clinics total: 237 (M: 78/F: 159) Total: 0.42% (1 patient, M: 1/F: 0) male/female: 1.28%/0%Paeck et al (2006) Outpatients on an Oriental clinic total: 160 (M: 120/F: 40) Total: 0% (None) 71% (12 patients, M: 10/F: 2) n male/female: 1.32%/0.21% χ² test was conducted between male and female.…”

mentioning

confidence: 99%