Herbal- and Dietary-Supplement-Induced Liver Injury: A Review of the Recent Literature

Abstract

Herbal-induced liver injury (HILI) continues to increase in prevalence each year due to the ongoing popularity of herbal supplements and complementary and alternative medicines. A detailed literature review of case reports and clinical studies published from March 2021 to March 2023 was performed. We discuss the epidemiology and diagnosis of HILI as well as the current and proposed laws and regulations. The 2021 ACG guidelines and 2022 AASLD practice guidelines for the diagnosis and management of drug and herbal-induced liver injury are discussed. We describe updates to previously reported etiologies of HILI such as ayurveda, ashwagandha, turmeric, kratom, green tea extract, and garcinia cambogia. Newly described supplements resulting in HILI, such as tinospora cordifolia, horse chestnut, alkaline water, and more, are described. We discuss newly and previously identified hepatoprotective herbal supplements as they have been reported in the study of animal models and human liver cells. This review suggests the need for ongoing research on the causes and mechanisms of HILI to ensure its proper diagnosis, prevention, and treatment in the future. The goal of this review is to provide novice and expert readers with knowledge regarding the possible etiologies of HILI and a general overview.

Evaluating the Safety of Herbal Medicine on Renal Function: A Comprehensive Analysis from Six Randomized Controlled Trials Conducted with Four Formulations from Traditional Korean Medicine

“…However, alongside their therapeutic potentials, concerns regarding the safety of these herbal compounds, particularly in terms of hepatotoxicity and nephrotoxicity, have emerged [1,2]. Recently, numerous studies have focused on the safety level of herbal medicine for liver function [3][4][5]. Meanwhile, the incidence rate of herb-induced liver injury (HILI) has been estimated to be around 0.6% among 1001 inpatients in 10 Korean-medicine hospitals [6].…”