title: Herbal hepatotoxicity: current status, examples, and challenges.
abstract: BACKGROUND
  Herbal medicines have commonly been considered safe by the general public due to their natural origin and long history of traditional uses. In contrast to this belief, many plants produce toxic substances as secondary metabolites that are sometimes not easily distinguishable from the pharmacological active compounds. Some herbal medicines have been associated with adverse effects and toxic effects, including hepatotoxicity, which have been reversed upon discontinuation of the herbal medicine by the patient.
  
  
  METHODS
  This review reflects on selected herbal medicines that are associated with hepatotoxic effects including a description of the phytochemicals that have been linked to liver injury where available. Although case studies are discussed where patients presented with hepatotoxicity due to use of herbal medicines, results from both in vitro and in vivo studies that have been undertaken to confirm liver injury are also included.
  
  
  CONCLUSIONS
  Increasing evidence of herbal hepatotoxicity has become available through case reports; however, several factors contribute to challenges associated with causality assessment and pre-emptive testing as well as diagnosis of herb-induced liver injury.
authors.affiliation: a 1 North-West University, Centre of Excellence for Pharmaceutical Sciences , Private Bag X6001, Potchefstroom, 2520, South Africa +27 18 299 4035 ; +27 87 231 5432 ; sias.hamman@nwu.ac.za.
authors.forename: Carlemi
authors.initials: C
authors.lastname: Calitz
authors.affiliation: a 1 North-West University, Centre of Excellence for Pharmaceutical Sciences , Private Bag X6001, Potchefstroom, 2520, South Africa +27 18 299 4035 ; +27 87 231 5432 ; sias.hamman@nwu.ac.za.
authors.forename: Lissinda
authors.initials: L
authors.lastname: du Plessis
authors.affiliation: a 1 North-West University, Centre of Excellence for Pharmaceutical Sciences , Private Bag X6001, Potchefstroom, 2520, South Africa +27 18 299 4035 ; +27 87 231 5432 ; sias.hamman@nwu.ac.za.
authors.forename: Chrisna
authors.initials: C
authors.lastname: Gouws
authors.affiliation: a 1 North-West University, Centre of Excellence for Pharmaceutical Sciences , Private Bag X6001, Potchefstroom, 2520, South Africa +27 18 299 4035 ; +27 87 231 5432 ; sias.hamman@nwu.ac.za.
authors.forename: Dewald
authors.initials: D
authors.lastname: Steyn
authors.affiliation: a 1 North-West University, Centre of Excellence for Pharmaceutical Sciences , Private Bag X6001, Potchefstroom, 2520, South Africa +27 18 299 4035 ; +27 87 231 5432 ; sias.hamman@nwu.ac.za.
authors.forename: Jan
authors.initials: J
authors.lastname: Steenekamp
authors.affiliation: b 2 Diabetes Discovery Platform, South African Medical Research Council , P.O. Box 19070, Tygerberg, 7505, South Africa.
authors.forename: Christo
authors.initials: C
authors.lastname: Muller
authors.affiliation: a 1 North-West University, Centre of Excellence for Pharmaceutical Sciences , Private Bag X6001, Potchefstroom, 2520, South Africa +27 18 299 4035 ; +27 87 231 5432 ; sias.hamman@nwu.ac.za.
authors.forename: Sias
authors.initials: S
authors.lastname: Hamman
mesh_terms: D000818:Animals; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D006801:Humans; D008517:Phytotherapy / Q000009:adverse effects*; D028321:Plant Preparations / Q000009:adverse effects*; D010946:Plants, Medicinal / Q000737:chemistry; D018675:Toxicity Tests / Q000379:methods
chemical_list: D028321:Plant Preparations
keywords: complementary and alternative medicine; herb induced liver injury; herbal medicine; phytochemical; traditional herbal medicine