Hepatic injury in 12 patients taking the herbal weight loss AIDS Chaso or Onshido.
BACKGROUND
The Chinese herbal dietary supplements Chaso and Onshido are marketed for weight loss in Japan. The safety of these weight loss aids is unknown.


OBJECTIVE
To describe patients who developed liver injury while taking Chaso or Onshido.


METHODS
Case series.


METHODS
Keio University Hospital, Tokyo, Japan, and other hospitals in Japan.


METHODS
6 patients who took Chaso and 6 patients who took Onshido before presenting with liver injury.


METHODS
Pathologic, clinical, and laboratory evaluations and chemical analysis of the herbal weight loss aids.


RESULTS
All 12 patients developed acute liver injury characterized by a marked increase in serum liver chemistry values (mean alanine aminotransferase level, 1978 U/L [range, 283 to 4074 U/L]) after ingesting these products. Two patients developed fulminant hepatic failure: 1 patient required liver transplantation, and the other patient died. N-nitroso-fenfluramine, a variant of the appetite-depressant drug fenfluramine, was present in these products.


CONCLUSIONS
The use of the weight loss aids Chaso and Onshido may be associated with acute liver injury. N-nitroso-fenfluramine is a possible hepatotoxic ingredient.
D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D019587:Dietary Supplements / Q000009:adverse effects*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D005277:Fenfluramine / Q000009:adverse effects*; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010936:Plant Extracts / Q000009:adverse effects*; D015431:Weight Loss
D004365:Drugs, Chinese Herbal; D010936:Plant Extracts; D005277:Fenfluramine