Severe hepatotoxicity by Indian Ayurvedic herbal products: a structured causality assessment.
The case of a 64 year old female patient is presented who has treated herself for 9 months with various Indian Ayurvedic herbal products for her vitiligo and experienced a causally related severe hepatotoxicity (ALT, 601 U/L; AST, 663 U/L; Bilirubin, 5.0 mg/dL). After discontinuation, a rapid improvement was observed. Causality assessment with the updated CIOMS (Council for International Organizations of Medical Sciences) scale showed a probable causality (+8 points) for Bakuchi tablets containing extracts from Psoralea corylifolia leaves with psoralens as ingredients, as the primary candidate causing the hepatotoxic reaction. The degree of probability was lower with +6 points for other used herbs: Khadin tablets containing extracts from Acacia catechu leaves; Brahmi tablets containing Eclipta alba or Bacopa monnieri; and Usheer tea prepared from Vetivexia zizaniodis. The case is the first report of Indian Ayurvedic herbal products being potentially hepatotoxic in analogy to some other herbs.
Department of Internal Medicine II, University of Frankfurt/Main and University of Duesseldorf, Germany. rolf.teschke@gmx.de
Rolf
R
Teschke
Ruediger
R
Bahre
D000045:Acacia; D034681:Bacopa; D015984:Causality; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000453:epidemiology; D036601:Eclipta; D005260:Female; D029001:Herbal Medicine; D006801:Humans; D007194:India; D008875:Middle Aged; D010936:Plant Extracts / Q000627:therapeutic use / Q000633:toxicity*; D014820:Vitiligo / Q000188:drug therapy
D010936:Plant Extracts