title: Hepatotoxic botanicals - an evidence-based systematic review.
abstract: OBJECTIVE
  Herbal medicines have been increasingly used worldwide. However, the potential harms of these herbs have been noticed most recently following hepatotoxicity with ingestion of herbal remedies. The aim of this review is to evaluate the evidence of hepatotoxic effects linked to use of herbal preparations.
  
  
  METHODS
  Electronic search was performed by searching several databases: PubMed, HerbMed, Google Scholar, Scopus, Cochrane Database of Systematic Reviews and Cochrane Library using both Latin and common names of several herbs. Language was restricted to English and articles were selected for relevance reporting incidence of hepatotoxicity associated with use of herbal products in human.
  
  
  RESULTS
  From a total of 565 relevant reviews and articles, 254 met our inclusion criteria and were analyzed. Serious hepatotoxic events associated with various herbal products alone or in combination with other drugs have been reported. Linking to herbal constituents the spectrum of liver toxicity includes elevated liver enzymes, acute or chronic hepatitis, cholestasis, hepatic necrosis, fibrosis, and cirrhosis, as well as acute liver failure and hepatic veno-occlusive disease.
  
  
  CONCLUSIONS
  The hepatotoxicity of herbs was extensively acknowledged. As the use of natural medicine increases, the risk of liver toxicity and drug interaction increase as well. Accordingly, herbal remedies have been known as hepatotoxins causing several liver damages. Further scientific studies with high and good quality are needed to identify toxic compounds and understand the exact mechanism of hepatotoxicity-induced by herbs. The adverse effects of herbal products must be fully reported as well as extensive education of healthcare providers must be provided in order to reduce danger of alternative medicines.
authors.affiliation: University of Alberta.
authors.forename: Reem J
authors.initials: RJ
authors.lastname: Abdualmjid
authors.forename: Consolato
authors.initials: C
authors.lastname: Sergi
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D004347:Drug Interactions; D006801:Humans; D008099:Liver / Q000187:drug effects*; D028321:Plant Preparations / Q000009:adverse effects*; D010946:Plants, Medicinal / Q000009:adverse effects*
chemical_list: D028321:Plant Preparations