Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases

Teschke, Rolf; Zhang, Li; Long, Hongzhu; Schwarzenboeck, Alexander; Schmidt-Taenzer, Wolfgang; Genthner, A; Wolff, Albrecht; Frenzel, Christian; Schulze, Johannes; Eickhoff, Axel

doi:10.1016/s1665-2681(19)30796-3

Cited by 75 publications

(81 citation statements)

References 90 publications

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“…Considering the worldwide publications preferentially in the English language, there were two reports on TCM HILI during the period from 1984 to 1993 [180]. This was followed by 20 publications from 1994 to 2003 and 55 reports from 2004 to 2013.…”

Section: Tcm Herbs With Published Claims Of Hepatotoxic Potentialmentioning

confidence: 99%

“…This was followed by 20 publications from 1994 to 2003 and 55 reports from 2004 to 2013. With 28 publications for the period from 2004 to 2008 and with 27 reports from 2009 to 2013, the publication frequency was stable in recent years [180]. The variability of countries from which the reports originated is high [53].…”

Section: Tcm Herbs With Published Claims Of Hepatotoxic Potentialmentioning

confidence: 99%

“…There is no question that the conventional use of these beverages including green tea does not harm the liver. In the past, however, weight loss aids were supplemented by green tea concentrated as extracts and carried the risk of liver injury [60,134,135,136,137,138,139,140,141,142,143,144,180]. According to the manufacturers, the weight loss aids Chaso and Onshido contained green tea and other herbs [93].…”

Section: Narratives Of Tcm Hili Casesmentioning

confidence: 99%

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Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

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Background: Traditional Chinese Medicine (TCM) with its focus on herbal use is popular and appreciated worldwide with increased tendency, although its therapeutic efficacy is poorly established for most herbal TCM products. Treatment was perceived as fairly safe but discussions emerged more recently as to whether herb induced liver injury (HILI) from herbal TCM is a major issue; Methods: To analyze clinical and case characteristics of HILI caused by herbal TCM, we undertook a selective literature search in the PubMed database with the search items Traditional Chinese Medicine, TCM, alone and combined with the terms herbal hepatotoxicity or herb induced liver injury; Results: HILI caused by herbal TCM is rare and similarly to drugs can be caused by an unpredictable idiosyncratic or a predictable intrinsic reaction. Clinical features of liver injury from herbal TCM products are variable, and specific diagnostic biomarkers such as microsomal epoxide hydrolase, pyrrole-protein adducts, metabolomics, and microRNAs are available for only a few TCM herbs. The diagnosis is ascertained if alternative causes are validly excluded and causality levels of probable or highly probable are achieved applying the liver specific RUCAM (Roussel Uclaf Causality Assessment Method) as the most commonly used diagnostic tool worldwide. Case evaluation may be confounded by inappropriate or lacking causality assessment, poor herbal product quality, insufficiently documented cases, and failing to exclude alternative causes such as infections by hepatotropic viruses including hepatitis E virus infections; Conclusion: Suspected cases of liver injury from herbal TCM represent major challenges that deserve special clinical and regulatory attention to improve the quality of case evaluations and ascertain patients’ safety and benefit.

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Section: Tcm Herbs With Published Claims Of Hepatotoxic Potentialmentioning

confidence: 99%

Section: Tcm Herbs With Published Claims Of Hepatotoxic Potentialmentioning

confidence: 99%

Section: Narratives Of Tcm Hili Casesmentioning

confidence: 99%

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Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

et al. 2016

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“…The scientific debate on natural medication and its integration with the conventional or mainstream medicine has continued for many years in western society[43]. Safety of natural medication is concerned with treatment of liver problems[44,45]. A formula composed of two or more drugs has been demonstrated as more beneficial for disease treatment, but the selection of individual herbs in the formula must be strictly guided by the principles underlying Chinese herbal medicine.…”

Section: Discussionmentioning

confidence: 99%

Cautiously using natural medicine to treat liver problems

Xiong¹,

Guan²

2017

WJG

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Natural medicine is a system of therapy that administrates natural agents and their derivatives to treat human diseases. This medicine has been used to treat many kinds of human diseases for thousands of years. The treatment protocols of natural medicine are integrative in nature, and are required to utilize the most appropriate therapies to address the needs of the individual patient. Because of the relative convenience, safety and efficacy, natural medicine is now increasing worldwide. Naturopathic doctors are licensed in many areas of the world and regulated partly by law in these areas, which is quite different from various other forms of complementary and alternative medicine. Liver diseases, such as hepatitis, liver cirrhosis and liver carcinoma, are serious health problems worldwide. Nearly half of the natural agents used in treatment of liver diseases today are natural products and their derivatives. Although natural medicine is beneficial and safe, physicians should pay close attention to the potential side-effects of the naturopathic agents, which lead to liver injury, interstitial pneumonia and acute respiratory failure. Therefore, when administrating naturopathic protocols to patients for the treatment of liver diseases, we should try our best to prevent and avoid as much as possible the negative impact of these medicines. This article highlights the current practice and recommended improvement of natural medicines in the treatment of liver diseases and gives some specific examples to emphasize the prevention and management of adverse reactions of the natural agents and suggests that natural medicine should be cautiously used to treat liver problems.

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“…Evidence is emerging from Asia, in particular China, where in a cohort of 21789 patients with DILI found that alternative medicines were one of the two most common etiologies reported[94]. It is estimated that 15% of DILI cases may be attributed to herbs and other traditional Chinese medicines[95]. In South Korea, DILI incidence was 12 per 100000 persons, with 70% due to herbal and folk remedies[80,96].…”

Section: Epidemiological Issuesmentioning

confidence: 99%

Drug-induced liver injury: Do we know everything?

Alempijević

Zec

Milosavljević

2017

WJH

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Interest in drug-induced liver injury (DILI) has dramatically increased over the past decade, and it has become a hot topic for clinicians, academics, pharmaceutical companies and regulatory bodies. By investigating the current state of the art, the latest scientific findings, controversies, and guidelines, this review will attempt to answer the question: Do we know everything? Since the first descriptions of hepatotoxicity over 70 years ago, more than 1000 drugs have been identified to date, however, much of our knowledge of diagnostic and pathophysiologic principles remains unchanged. Clinically ranging from asymptomatic transaminitis and acute or chronic hepatitis, to acute liver failure, DILI remains a leading causes of emergent liver transplant. The consumption of unregulated herbal and dietary supplements has introduced new challenges in epidemiological assessment and clinician management. As such, numerous registries have been created, including the United States Drug-Induced Liver Injury Network, to further our understanding of all aspects of DILI. The launch of LiverTox and other online hepatotoxicity resources has increased our awareness of DILI. In 2013, the first guidelines for the diagnosis and management of DILI, were offered by the Practice Parameters Committee of the American College of Gastroenterology, and along with the identification of risk factors and predictors of injury, novel mechanisms of injury, refined causality assessment tools, and targeted treatment options have come to define the current state of the art, however, gaps in our knowledge still undoubtedly remain.

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Traditional Chinese Medicine and herbal hepatotoxicity: a tabular compilation of reported cases

Cited by 75 publications

References 90 publications

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs

Cautiously using natural medicine to treat liver problems

Drug-induced liver injury: Do we know everything?

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