Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre. Rua Sarmento Leite, 245, Porto Alegre, RS, Brazil.
Graduate Program in Multiprofessional Residence in Intensive Care of Federal University of Health Sciences of Porto Alegre and Irmandade Santa Casa de Misericórdia de Porto Alegre. Rua Sarmento Leite, 245, Porto Alegre, RS, Brazil.
Phytomedicine. 2019 Mar 15;56:21-26. doi: 10.1016/j.phymed.2018.08.011. Epub 2018 Aug 9.
Self-medication and the belief that herbal products are free of health risks are common in Brazil. The kava (Piper methysticum), known for its anxiolytic action, has a widespread popular use. Hepatotoxicity of kava is reported, including cases of liver transplantation and death. The kava had its use prohibited or restricted in countries like Germany, France, among others. Toxicity may be related to overdosage; however, factors such as botanical characteristics of the plant, the harvesting, storage, and production process may be associated with the development of hepatotoxic substances, such as triggering idiosyncratic reactions.
In this case, there is a suspicion that the toxicide is intrinsic to the drug; however, the possibility of adulterants and contaminants must be ruled out.
This study reports the case of a patient who, after using the herbal kava for 52 days, evolved into acute liver failure and liver transplantation.
The data were collected directly with the patient and compared with their clinical records. Causality was determined through the RUCAM algorithm. In addition, a phytochemical analysis of the drug used was performed.
According to the patient's report, there is no evidence of overdosage. Results from RUCAM algorithm infer causality between liver damage and the use of kava. The analysis chemical constituents did not find any possible contaminants and major changes in the active compounds. Seven months after transplantation, the patient is well and continues to be followed up by a medical team.
Our investigation indicates that there was kava-induced hepatotoxicity at standard dosages. In Brazil, self-medication by herbal medicines is frequent and many patients and health professionals do not know the risks associated with their use. Diagnosing and notifying cases in which plants and herbal medicine induce liver damage is of paramount importance to increase the knowledge about DILI and to prevent or treat similar cases quickly.
在巴西，自我用药和认为草药产品没有健康风险的观念很常见。卡瓦（Piper methysticum）具有抗焦虑作用，因此被广泛使用。卡瓦已被报道具有肝毒性，包括肝移植和死亡病例。德国、法国等国家已禁止或限制卡瓦的使用。毒性可能与过量有关；然而，植物的植物学特征、收获、储存和生产过程等因素也可能与肝毒性物质的发展有关，例如引发特发性反应。
在这种情况下，怀疑有毒物质是药物本身固有的；然而，必须排除掺杂物和污染物的可能性。
本研究报告了一名患者的病例，该患者在使用草药卡瓦 52 天后发展为急性肝衰竭并进行了肝移植。
数据直接从患者处收集，并与他们的临床记录进行比较。通过 RUCAM 算法确定因果关系。此外，还对所用药物进行了植物化学分析。
根据患者的报告，没有证据表明存在过量用药。RUCAM 算法的结果推断出肝损伤与卡瓦使用之间的因果关系。化学成分分析未发现任何可能的污染物和活性化合物的重大变化。移植后 7 个月，患者情况良好，继续由医疗团队进行随访。
我们的调查表明，在标准剂量下存在卡瓦引起的肝毒性。在巴西，自我用药和草药药物的使用很常见，许多患者和医疗保健专业人员不知道与使用相关的风险。诊断和通知植物和草药引起肝损伤的病例对于提高对 DILI 的认识以及快速预防或治疗类似病例至关重要。
