Herbal Hepatotoxicity

Herbal supplements are being used more and more frequently due to media hype and to some of the great benefits they have been shown to provide. They are also a nice alternative to individuals looking to self medicate, or to save on health care costs. There seems to be a misconception to the general public that herbs are somehow safer than other drugs because they are natural. While some herbs may provide beneficial outcomes, they can become dangerous by themselves or in combination with other pharmaceuticals since they are not as tightly mandated by the FDA as other drugs are. The public should make themselves aware of potential drug reactions when using herbal supplements in order to protect themselves from possible complications such as hepatotoxicity. Nurses also need to become aware of possible drug/herb reactions in order to teach patients about the potential hazards of self medicating. Patients should always give their physicians a full list of herbal supplements they are taking as a first line of defense against complications and nurses should remember to ask details about herbal supplements when getting a medical history report because many people do not think of the herbs they consume as "medications" that they are taking.

One example of a possibly deadly combination of herbal supplements and medication that can cause hepatotoxicity is acetaminophen in combination with the herbs Echinacia and kava or the herbs that have salicylate (willow and meadowsweet). Echinacia is used for a variety of medicinal purposes such as burns, urinary tract infections, colon cancer and many others so it is used by a large number of Americans who are looking for a way to self medicate. Although it has many beneficial side effects, it's use with acetaminophen can prove to be fatal. There have been no real experimental studies to make this evidence concrete yet health care professionals should be aware of the growing trend of this drug/herb reaction. Kava also is used for a number of different purposes such as anxiety, muscles spasms and depression but also has the same potential for hepatotoxicity as does Echinacia when used in combination with acetaminophen or even alone. There has been a report in the United States of a young woman who required a liver transplant after using Kava. Willow and meadowsweet should also be monitored for their potential hepatotoxicity effects.

Green tea extract is a common over the counter herbal supplement used for weight loss purposes and has also been shown to create hepatotoxicity in humans.

While it is apparent that herbal supplements do provide some benefits to people, they should be taken with caution as we are still learning about possible side effects of hepatotoxicity when some are used alone or in combination with other common medications such as acetaminophen.





Green tea extract (Green Lite): suspected association with hepatotoxicity. (2007). Canadian Adverse Reaction Newsletter, Retrieved March 29, 2009, from CINAHL Plus with Full Text database.

Abebe, W. (2002, December). Herbal medication: potential for adverse interactions with analgesic drugs. Journal of Clinical Pharmacy & Therapeutics, 27(6), 391-401. Retrieved March 29, 2009, from CINAHL Plus with Full Text database.