School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, USA.
Ann Pharmacother. 2013 Jul-Aug;47(7-8):e33. doi: 10.1345/aph.1R405. Epub 2013 Jun 11.
To report a case of cholestatic jaundice as a result of combination herbal and designer supplement use.
A 50-year-old Hispanic male presented to the hospital with a 1-week history of significant painless jaundice; total bilirubin on admission was 29.4 mg/dL. He reported use of both herbal (creatine and whey protein) and designer (Incredible Bulk and Spartan 45) supplements concurrently for approximately 2 months. Upon admission, all supplements were discontinued and multiple laboratory and diagnostic tests were ordered. On day 6 of his hospital admission, a liver biopsy was performed, the results of which indicated drug-induced hepa to toxicity. On day 9 he was discharged with prescriptions for ursodeoxycholic acid and hydroxyzine. Three months post hospital discharge, the patient continued to be supplement-free and bilirubin had decreased substantially.
Anabolic-androgenic steroids are capable of causing hepatotoxicity, and multiple cases reported in the literature support this. A case report described hepato toxicity secondary to both creatine and whey protein consumption, and several reports have described liver damage secondary to designer supplement use. To our knowledge, this is the first case to describe hepatotoxicity as a result of combination herbal and designer supplement use. The Roussel Uclaf Causality Assess ment Method (RUCAM) score for drug-induced hepatotoxicity indicated a highly probable correlation between the use of combination supplements and cholestatic jaundice.
Health care professionals need to be aware of complications associated with designer supplement use and should be able to identify patients who would benefit from education on herbal and designer supplement use.
报告 1 例因联合使用草药和设计补充剂导致胆汁淤积性黄疸的病例。
一名 50 岁的西班牙裔男性因 1 周无痛性黄疸病史就诊；入院时总胆红素为 29.4mg/dL。他报告说，大约 2 个月来同时使用了草药（肌酸和乳清蛋白）和设计补充剂（Incredible Bulk 和 Spartan 45）。入院时，所有补充剂均被停用，并进行了多项实验室和诊断性检查。入院第 6 天，进行了肝活检，结果表明药物性肝毒性。入院第 9 天，他出院，开了熊去氧胆酸和羟嗪的处方。出院后 3 个月，患者继续不服用补充剂，胆红素显著下降。
合成代谢-雄激素类固醇能够引起肝毒性，文献中有多例报告支持这一点。有一例报告描述了肌酸和乳清蛋白摄入引起的肝毒性，还有几例报告描述了使用设计补充剂引起的肝损伤。据我们所知，这是首例描述因联合使用草药和设计补充剂导致胆汁淤积性黄疸的病例。药物性肝毒性的 Roussel Uclaf 因果关系评估方法（RUCAM）评分表明，联合使用补充剂与胆汁淤积性黄疸之间存在高度可能的相关性。
医疗保健专业人员需要了解与设计补充剂使用相关的并发症，并能够识别出从草药和设计补充剂使用教育中受益的患者。
