Ashwagandha-induced liver injury-A case series from India and literature review
Philips CA, Philips CA, Valsan A, Theruvath AH, Ravindran R, Oommen TT, Rajesh S, Bishnu S, Augustine P, Liver Research Club India
Hepatology communications · 36 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Case report (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2023-09-27 · Hepatol Commun · vol. 7 · issue 10
- Publisher
- Lippincott Williams & Wilkins
- Cited
- 55 citations · more than 100% of similar papers · 17.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 30 works
- Access
- Open access (journal) · CC-BY-NC-ND
- Research areas
- Phytochemicals and Medicinal Plants · Drug-Induced Hepatotoxicity and Protection · Medical Case Reports and Studies
- Keywords
- Medicine, Liver injury, Chronic liver disease, Internal medicine, Liver disease, Traditional medicine
- MeSH
- humans, hepatitis, plant extracts, retrospective studies, india, male, acute-on-chronic liver failure, chemical and drug induced liver injury, chemical and drug induced liver injury, chronic
8 authors
From IN
- Cyriac Abby Philips · correspondingAmrita Institute of Medical Sciences and Research Centre; Rajagiri Hospital
- Arun ValsanRajagiri Hospital
- Arif Hussain TheruvathAmrita Institute of Medical Sciences and Research Centre
- R. D. RavindranAmrita Institute of Medical Sciences and Research Centre
- Tharun Tom OommenRajagiri Hospital
- S RajeshRajagiri Hospital
Abstract
Background
Ashwagandha herb is commonly used in Ayurveda and a "fad" dietary supplement for a host of indications based on low levels of evidence. Recently, ashwagandha was implicated in multiple reports of herb-induced liver injury (HILI), mainly from the United States. We present the first, and currently largest, series of ashwagandha-HILI from multiple centers in India.
Methods
We retrospectively analyzed the respective institutional electronic medical records for ashwagandha-HILI. Patients consuming ashwagandha as part of multiherbal formulations or along with other known hepatotoxic supplements or medicines were excluded. All patients underwent a detailed diagnostic workup to exclude competing causes reasonably. Where possible, the implicated herbal formulation was retrieved and subjected to chemical analysis.
Results
Out of 23 patients with liver injury from ashwagandha (January 2019 to December 2022), we report 8 patients with single-ingredient formulation-related HILI. Study cohort was male predominant, and cholestatic hepatitis was the commonest presentation. Five patients had underlying chronic liver disease; 3 presented with acute-on-chronic liver failure, and all 3 died on follow-up. In others, the liver injury was prolonged, nonetheless self-limiting. Liver biopsy revealed cholestatic features predominantly with hepatocellular necrosis and lymphocyte/eosinophil predominant portal-based inflammation. One patient progressed to chronic HILI. Chemical analysis revealed only natural phytochemicals without adulteration or contamination.
Conclusions
Ashwagandha-HILI presents with cholestatic hepatitis and can lead to the syndrome of acute-on-chronic liver failure with high mortality in those with pre-existing liver disease. Educating the public on avoiding the use of potentially toxic and unrecommended herbal supplements can help mitigate the avoidable liver disease burden in the community.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC-ND).
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