ABSTRACT
Herbal hepatotoxicity is increasingly recognized as herbal medicines become more popular
in industrialized societies. Some herbal products may potentially benefit people with
liver disease; however, these benefits remain generally unproved in humans, and a
greater awareness of potential adverse effects is required. Herbal use is often not
disclosed, and this may result in a diagnostic delay and perpetuation or exacerbation
of liver injury. Female gender may predispose to hepatotoxicity, and concomitant agents
that induce cytochrome P450 enzymes may also increase individual susceptibility. The
range of liver injury includes minor transaminase elevations, acute and chronic hepatitis,
steatosis, cholestasis, zonal or diffuse hepatic necrosis, hepatic fibrosis and cirrhosis,
veno-occlusive disease, and acute liver failure requiring transplantation. In addition
to the potential for hepatotoxicity, drug-drug interactions between herbal medicines
and conventional agents may affect the efficacy and safety of concurrent medical therapy.
This review focuses on emerging hepatotoxins and patterns of liver injury, potential
risk factors for herbal hepatotoxicity, and herb-drug interactions. Appropriate reporting
and regulatory systems to monitor herbal toxicity are required, in conjunction with
ongoing scientific evaluation of the potential benefits of phytotherapy.
KEYWORDS
Herbal medicine - Chinese herbal drugs - liver injury - drug-drug interactions
