title: Greater Celandine hepatotoxicity: a clinical review.
abstract: Herbal hepatotoxicity is a rare and poorly described disease because reported cases are mostly scattered and lack an appropriate causality assessment. We now describe in detail the clinical picture of herbal hepatotoxicity by extracts of Greater Celandine (GC), syn. Chelidonium majus L. from the Papaveraceae family, which contain more than 20 ingredients including various biologically active isoquinoline alkaloids. For this purpose, we analyzed and reviewed published cases of 16 patients from various European countries. In all patients, herbal hepatotoxicity was of probable and highly probable causality for GC, using the original and updated scale of CIOMS (Council for International Organizations of Medical Sciences). GC associated hepatotoxicity usually has an acute clinical course exhibiting a hepatocellular pattern of injury and is correlated to an idiosyncratic reaction with its metabolic subtype. Jaundice combined with high values of serum aminotransferases was present in virtually all cases with favourable outcome despite severe clinical course. In conclusion, GC hepatotoxicity is a typical herbal hepatotoxicity with a sound causality track for GC, but there is uncertainty regarding the respective causative compound(s). The present detailed review of GC hepatotoxicity may serve as an example for clinical causality assessments of future cases of liver injury due to other herbs.
authors.affiliation: Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, Germany. rolf.teschke@gmx.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Teschke
authors.forename: Christian
authors.initials: C
authors.lastname: Frenzel
authors.forename: Xaver
authors.initials: X
authors.lastname: Glass
authors.forename: Johannes
authors.initials: J
authors.lastname: Schulze
authors.forename: Axel
authors.initials: A
authors.lastname: Eickhoff
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D028281:Chelidonium / Q000009:adverse effects* / Q000737:chemistry; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007565:Jaundice / Q000139:chemically induced; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010936:Plant Extracts / Q000008:administration & dosage / Q000009:adverse effects*; D010946:Plants, Medicinal; D018570:Risk Assessment; D012307:Risk Factors; D000637:Transaminases / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D010936:Plant Extracts; D000637:Transaminases