title: Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series.
abstract: BACKGROUND
  No online current list of potentially life-threatening, hepatotoxic herbs and dietary supplements based on PubMed case reports exists in a summarized tabular form.
  
  
  METHODS
  Documented case reports of herbs or dietary supplements (DS; includes herbs) appearing to contribute to liver injury were used to create an online "DS Toxic Table" of potentially hepatotoxic herbs and dietary supplements (PubMed, 1966 to June, 2016, and cross-referencing). The spectrum of DS induced liver injuries (DSILI) included elevated liver enzymes, hepatitis, steatosis, cholestasis, hepatic necrosis, hepatic fibrosis, hepatic cirrhosis, veno-occlusive disease, acute liver failure requiring a liver transplant, and death.
  
  
  RESULTS
  Over the past 50 years, approximately 21 herbs (minus germander and usnic acid that are no longer sold) and 12 dietary supplements (minus the nine no longer sold and vitamin A & niacin due to excess intake) posed a possible risk for liver injures in certain individuals. The herbs with the most number of reported publications (but not cases studies) in descending order, were germander, black cohosh, kava extract, and green tea extract.
  
  
  CONCLUSIONS
  These online DS Toxic Tables will contribute to continued Phase IV post marketing surveillance to detect possible liver toxicity cases and serve to forewarn consumers, clinicians, and corporations.
authors.affiliation: Department of Complementary and Alternative Medicine, John A. Burns School of Medicine, 651 Ilalo Street, MEB 223, University of Hawaii at Manoa, Honolulu, HI, 96813, USA. Electronic address: amybrown@hawaii.edu.
authors.forename: Amy Christine
authors.initials: AC
authors.lastname: Brown
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D019587:Dietary Supplements / Q000592:standards / Q000633:toxicity*; D006801:Humans; D008099:Liver / Q000187:drug effects*; D010936:Plant Extracts / Q000032:analysis / Q000633:toxicity*
chemical_list: D010936:Plant Extracts
keywords: Dietary supplement; Hepatitis; Hepatotoxicity; Herb; Liver; Toxicity