Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause
Bokan G, Glamočanin T, Mavija Z, Vidović B, Stojanović A, Björnsson ES, Vučić V
Pharmaceuticals (Basel, Switzerland) · 13 citations
How it was studied
- Design
- Case report (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- COST Action CA17112—Prospective European Drug Induced Liver Injury Network (ProEuroDILINet)
- Government
- Ministry of Science, Technological Development, and Innovation of the Republic of Serbia
Based on 2 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2023-08-10 · Pharmaceuticals (Basel) · vol. 16 · issue 8 · p. 1129
- Publisher
- Multidisciplinary Digital Publishing Institute
- Cited
- 23 citations · more than 95% of similar papers · 4.7× the field average
- Impact
- Top 10% most cited in its field
- References
- 32 works
- Access
- Open access (journal) · CC-BY
- Research areas
- Drug-Induced Hepatotoxicity and Protection · Phytochemicals and Medicinal Plants · Poisoning and overdose treatments
- Keywords
- Medicine, Withania somnifera, Liver injury, Herb, Traditional medicine, Liver function tests, Alanine transaminase, Liver function, Internal medicine, Medicinal herbs, Pathology, Alternative medicine
7 authors
From BA, RS, IS
- Goran Bokan · correspondingUniversity clinical center of Republika Srpska
- Tanja GlamočaninUniversity of Banja Luka; University clinical center of Republika Srpska
- Zoran MavijaUniversity of Banja Luka; University clinical center of Republika Srpska
- Bojana B. VidovićUniversity of Belgrade
- Ana StojanovićUniversity Hospital Medical Center Bezanijska kosa
- Einar Stefan Bjornsson · correspondingReykjavík University; University of Iceland; National University Hospital of Iceland
Abstract
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 Withania somnifera (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.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).
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