Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network
Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro V
Liver international : official journal of the International Association for the Study of the Liver · 74 citations
How it was studied
- Design
- Case report (classified by our AI screen)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Cancer Institute
- Government
- National Institute of Diabetes and Digestive and Kidney Diseases
- Government
- NIDDK NIH HHS
- Grants
- National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK-065201); National Institute of Diabetes and Digestive and Kidney Diseases (U01-DK083020); National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK-065184); National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK 065176); National Institute of Diabetes and Digestive and Kidney Diseases (U24‐DK065176); National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK-065211); National Institute of Diabetes and Digestive and Kidney Diseases (U01DK100928); National Institute of Diabetes and Digestive and Kidney Diseases (U01-DK083027)
Based on 3 listed funder(s).
Publication
- Published
- 2020-01-28 · Liver Int · vol. 40 · issue 4 · pp. 825–829
- Publisher
- Wiley
- Cited
- 117 citations · more than 99% of similar papers · 12.9× the field average
- Impact
- Top 10% most cited in its field
- References
- 23 works
- Access
- Open access (repository copy)
- Research areas
- Phytochemicals and Medicinal Plants · Drug-Induced Hepatotoxicity and Protection · Poisoning and overdose treatments
- Keywords
- Withania somnifera, Liver injury, Medicine, Lethargy, Drug, Internal medicine, Jaundice, Liver function tests, Gastroenterology, Pharmacology, Pathology, Alternative medicine
- MeSH
- humans, withania, plant extracts, adult, middle aged, europe, iceland, female, male, young adult, chemical and drug induced liver injury, chemical and drug induced liver injury, chronic
8 authors
From IS, US
- Helgi Kristinn Björnsson · correspondingReykjavík University; National University Hospital of Iceland
- Einar Stefan BjornssonReykjavík University; National University Hospital of Iceland
- Bharathi AvulaUniversity of Mississippi
- Ikhlas Ahmed KhanUniversity of Mississippi
- Jon Gunnlaugur JonassonReykjavík University; National University Hospital of Iceland
- Marwan GhabrilIndiana University School of Medicine; Indiana University – Purdue University Indianapolis
Abstract
Background & aims
Ashwagandha (Withania somnifera) is widely used in Indian Ayurvedic medicine. Several dietary supplements containing ashwagandha are marketed in the US and Europe, but only one case of drug-induced liver injury (DILI) due to ashwagandha has been published. The aim of this case series was to describe the clinical phenotype of suspected ashwagandha-induced liver injury.
Methods
Five cases of liver injury attributed to ashwagandha-containing supplements were identified; three were collected in Iceland during 2017-2018 and two from the Drug-Induced Liver Injury Network (DILIN) in 2016. Other causes for liver injury were excluded. Causality was assessed using the DILIN structured expert opinion causality approach.
Results
Among the five patients, three were males; mean age was 43 years (range 21-62). All patients developed jaundice and symptoms such as nausea, lethargy, pruritus and abdominal discomfort after a latency of 2-12 weeks. Liver injury was cholestatic or mixed (R ratios 1.4-3.3). Pruritus and hyperbilirubinaemia were prolonged (5-20 weeks). No patient developed hepatic failure. Liver tests normalized within 1-5 months in four patients. One patient was lost to follow-up. One biopsy was performed, showing acute cholestatic hepatitis. Chemical analysis confirmed ashwagandha in available supplements; no other toxic compounds were identified. No patient was taking potentially hepatotoxic prescription medications, although four were consuming additional supplements, and in one case, rhodiola was a possible causative agent along with ashwagandha.
Conclusions
These cases illustrate the hepatotoxic potential of ashwagandha. Liver injury is typically cholestatic or mixed with severe jaundice and pruritus, but self-limited with liver tests normalizing in 1-5 months.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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