title: Hepatotoxicity due to hydroxycut: a case series.
abstract: OBJECTIVE
  Muscletech Hydroxycut (Iovate Health Sciences Research, Oakville, Ontario, Canada) was a popular weight-loss supplement that was recalled by the manufacturer in May 2009 on the basis of reports of hepatotoxicity associated with this supplement. We sought to characterize the clinical presentation of Hydroxycut-associated liver injury and to adjudicate these cases for causal association with Hydroxycut.
  
  
  METHODS
  We assessed the causality and grading of severity of liver injury using methodology developed by the Drug-Induced Liver Injury Network (DILIN) study.
  
  
  RESULTS
  Eight patients who developed liver injury after taking Hydroxycut treated at different medical centers were identified. All were hospitalized, and three of eight patients required liver transplantation. Nine other cases with adequate clinical information were obtained from the FDA MedWatch database, including one fatal case of acute liver failure. Usual symptoms were jaundice, fatigue, nausea, vomiting, and abdominal pain. Most patients exhibited a hepatocellular pattern of injury. Adjudication for causality revealed eight cases as definite, five highly likely, two probable, and two were considered to be possible.
  
  
  CONCLUSIONS
  Hydroxycut has been clearly implicated as a cause for severe liver injury that may lead to acute liver failure and death. Weight-loss supplements represent a class of dietary supplements that should be regarded as capable of causing severe hepatic toxicity when the usual causes of identified liver injury cannot be otherwise elucidated.
authors.affiliation: Division of Gastrointestinal and Liver Diseases, University of Southern California, Keck School of Medicine, 1510 San Pablo Street, 2/F, Los Angeles, CA 90033, USA. tselingf@usc.edu
authors.forename: Tse-Ling
authors.initials: TL
authors.lastname: Fong
authors.forename: Karl C
authors.initials: KC
authors.lastname: Klontz
authors.forename: Alejandro
authors.initials: A
authors.lastname: Canas-Coto
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Casper
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Durazo
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Davern
authors.forename: Paul
authors.initials: P
authors.lastname: Hayashi
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Seeff
mesh_terms: D000293:Adolescent; D000328:Adult; D019440:Anti-Obesity Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D028321:Plant Preparations / Q000009:adverse effects*; D012720:Severity of Illness Index
chemical_list: D019440:Anti-Obesity Agents; D028321:Plant Preparations; C512049:hydroxycut