Case series and review of Ayurvedic medication induced liver injury

Abstract

Background Complementary and alternative medicine use among Americans is prevalent. Originating in India, Ayurvedic medicine use in the United States has grown 57% since 2002. CAM accounts for a significant proportion of drug induced liver injury in India and China, but there have been only three reports of drug induced liver injury from Ayurvedic medications in the U.S. We report three cases of suspected Ayurvedic medication associated liver injury seen at a Southern California community hospital and review literature of Ayurvedic medication induced liver injury. Case presentations Three patients presented with acute hepatocellular injury and jaundice after taking Ayurvedic supplements for 90–120 days. First patient took Giloy Kwath consisting solely of Tinospora cordifolia. Second patient took Manjishthadi Kwatham and Aragwadhi Kwatham, which contained 52 and 10 individual plant extracts, respectively. Third patient took Kanchnar Guggulu, containing 10 individual plant extracts. Aminotransferase activities decreased 50% in < 30 days and all 3 patients made a full recovery. Roussel Uclaf Causality Assessment Method (RUCAM) scores were 7–8, indicating probable causality. These products all contained ingredients in other Ayurvedic and traditional Chinese medicines with previously reported associations with drug induced liver injury. Conclusions These patients highlight the risk of drug induced liver injury from Ayurvedic medications and the complexity of determining causality. There is a need for a platform like LiverTox.gov to catalog Ayurvedic ingredients causing liver damage.

Herbal Immune Booster-Induced Liver Injury in the COVID-19 Pandemic - A Case Series

“…10-12 Rege et al have described an immune protective mechanism with oral administration of TC in improving surgical outcome of patients with obstructive jaundice. 13 Barring one isolated case of acute hepatocellular injury due to the use of TC, 14 there have been no reports of TC related liver injury. Liver biopsy was not performed in the reported case.…”

Acute Liver Failure: Indian Perspective

“…In the latter countries, CAM is consumed as a weight‐reducing agent available as food supplements, whereas in India, often it has been used for various ailments such as dermatological problems, arthritis of various etiologies, and many chronic nonspecific disorders as well, as in advanced cancers (particularly in rural India, as well as because of unaffordability of expensive modern western medicine/surgery and failure of later form of treatment) and for simple well‐being. However, recently from the United States and Iceland, ayurvedic drug–induced DILI has been reported, which had a mixed pattern (hepatitic and cholestatic) of liver injury and recovered within 1 to 5 months, but ALF as a result of ayurvedic medicines from these countries has yet to be reported 9,10 . A recent case series and review on ayurvedic drug–induced DILI from the United States mentions that, from 2002 to 2021, consumption of ayurvedic medicine in the United States has increased by 57% 9 .…”

“…However, recently from the United States and Iceland, ayurvedic drug–induced DILI has been reported, which had a mixed pattern (hepatitic and cholestatic) of liver injury and recovered within 1 to 5 months, but ALF as a result of ayurvedic medicines from these countries has yet to be reported 9,10 . A recent case series and review on ayurvedic drug–induced DILI from the United States mentions that, from 2002 to 2021, consumption of ayurvedic medicine in the United States has increased by 57% 9 . The later report implicated Giloy Kwath ( Tinospora cordifolia ), combination of Manjishthadi Kwatham and Aragwadhadi Kwatham (containing 52 and 10 individual plant extracts, respectively), and Kanchnar Guggul (containing 10 individual plant extracts) as the ayurvedic medicine causing DILI in the reported case series 9 .…”

Tinospora Cordifolia (Giloy) and Autoimmune-like Liver Injury – A Classic Case of Primum Non Nocere, “First, Do No Harm”

“…Chronic hepatitis was the commonest finding, with interface hepatitis notable in 70.4%, and those with hepatic necrosis on biopsy had higher mortality. More importantly, Giloy was found in eight different herbal formulations retrieved for analysis( 5 , 6 ). Nagral et al replicate similar findings in their paper but do not comment on necrosis and its pattern among those who survived or died.…”