Bokan Goran, Glamočanin Tanja, Mavija Zoran, Vidović Bojana, Stojanović Ana, Björnsson Einar S, Vučić Vesna
Internal Medicine Clinic, Department of Gastroenterology and Hepatology, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
Pharmaceuticals (Basel). 2023 Aug 10;16(8):1129. doi: 10.3390/ph16081129.
Herb-induced liver injury (HILI) caused by herbal supplements, natural products, and products used in traditional medicine are important for differential diagnoses in patients with acute liver injury without an obvious etiology. The root of (L.) Dunal, commonly known as ashwagandha, has been used in Ayurvedic medicine for thousands of years to promote health and longevity. Due to various biological activities, ashwagandha and its extracts became widespread as herbal supplements on the global market. Although it is generally considered safe, there are several reported cases of ashwagandha-related liver injury, and one case ended with liver transplantation. In this paper, we review all reported cases so far. Additionally, we describe two new cases of ashwagandha hepatotoxicity. In the first case, a 36-year-old man used ashwagandha capsules (450 mg, three times daily) for 6 months before he developed nausea, pruritus, and dark-colored urine. In the second case, a 30-year-old woman developed pruritus after 45 days of using ashwagandha capsules (450 mg). In both cases, serum bilirubin and liver enzymes (aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) were increased. The liver injury pattern was hepatocellular (R-value 11.1) and mixed (R-value 2.6), respectively. The updated Roussel Uclaf Causality Assessment Method (RUCAM) (both cases with a score of seven) indicated a "probable" relationship with ashwagandha. Clinical and liver function improvements were observed after the discontinuation of ashwagandha supplement use. By increasing the data related to ashwagandha-induced liver injury, these reports support that consuming ashwagandha supplements is not without its safety concerns.
由草药补充剂、天然产物及传统医学所用产品引起的草药性肝损伤（HILI）对于病因不明的急性肝损伤患者的鉴别诊断很重要。南非醉茄（Withania somnifera (L.) Dunal）的根，通常被称为印度人参，在阿育吠陀医学中已使用了数千年，用于促进健康和长寿。由于其多种生物活性，印度人参及其提取物作为草药补充剂在全球市场上广泛传播。尽管一般认为其安全，但有几例报告的与印度人参相关的肝损伤病例，其中一例以肝移植告终。在本文中，我们回顾了迄今为止所有报告的病例。此外，我们描述了两例新的印度人参肝毒性病例。在第一例中，一名36岁男性在服用印度人参胶囊（450毫克，每日三次）6个月后出现恶心、瘙痒和深色尿。在第二例中，一名30岁女性在服用印度人参胶囊（450毫克）45天后出现瘙痒。在这两例中，血清胆红素和肝酶（天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和碱性磷酸酶（ALP））均升高。肝损伤模式分别为肝细胞型（R值11.1）和混合型（R值2.6）。更新后的鲁塞尔·乌克拉夫因果关系评估方法（RUCAM）（两例评分均为七分）表明与印度人参有“可能”的关系。停用印度人参补充剂后观察到临床和肝功能改善。通过增加与印度人参引起的肝损伤相关的数据，这些报告支持服用印度人参补充剂并非没有安全问题。
