Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network.

Autor: Björnsson HK; Landspitali University Hospital, Reykjavik, Iceland., Björnsson ES; Landspitali University Hospital, Reykjavik, Iceland., Avula B; National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA., Khan IA; National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA., Jonasson JG; Landspitali University Hospital, Reykjavik, Iceland., Ghabril M; Indiana University School of Medicine, Indianapolis, IN, USA., Hayashi PH; University of North Carolina, Chapel Hill, NC, USA., Navarro V; Einstein Healthcare Network, Sidney Kimmel Medical College, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2020 Apr; Vol. 40 (4), pp. 825-829. Date of Electronic Publication: 2020 Feb 11.
DOI: 10.1111/liv.14393
Abstrakt: 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.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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