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.
Teschke
Rolf
R
Department of Internal Medicine II, University of Frankfurt/Main and University of Duesseldorf, Germany. rolf.teschke@gmx.de
Bahre
Ruediger
R
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