Aconitum carmichaeli (chuanwu )
Aconitum kusnezoffi (caowu)
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A component of some Chinese Herbal Medicines. Causes aconitine poisoning.
| Chan TY et al. Poisoning by Chinese Herbal Medicines in Hong Kong: a hospital study Vet-Hum-Toxicol. 1994 Dec; 36(6):546-7 |
Aflatoxins – contaminant of plant materials grown/stored in humid areas.
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Food contaminant and potent hepato-carcinogen (liver cancer-causing agent). Occurs as a mycotoxin from growth of Aspergillus flavus mould on stored nuts and other foods.
| Henry SH et al. Policy forum: Public Health. Reducing Liver Cancer-Global control of Aflatoxin. Science. 286(5449):2453-4 1999 Dec 24 |
Amanita
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A mushroom type fungus sometimes mistaken for ordinary mushroom. Fulminant hepatic failure documented.
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Stickel F. Egerer G. Seitz HK. Hepatotoxicity of botanicals [Review] [112 refs] Public Health Nutrition. 3(2):113-24, 2000 Jun.
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Atractylis gummifera (African remedy)
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Toxicity of this plant is well known in Mediterranean countries. It causes diffuse hepatic necrosis.
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Axadirachza indica (margosa oil)
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Possibly be implicated in causing symptoms of Reye’s Syndome and steatosis
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Journal of Hepatology 1997; 26 (Suppl.1):47-51
Farrell GC, Weltman M. Drug Induced Liver Disease. In: Gitnick(Ed) Current Hepatolofy, vol 16. Chicago; Mosby-Yearbook Medical publishers, 1996; 143-208
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Bajiaolian
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Contains a toxin called podophyllotoxin which caused abnormal LFTs
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Kao WF. Hung DZ. Tsai WJ. Lin KP. Deng JF. Podophyllotoxin intoxication: toxic effect of Bajiaolian in herbal therapeutics. Human & Experimental Toxicology. 11(6):480-7, 1992 Nov.
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Berberis vulgaris
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Hepatotocicity suspected but not conclusively proven
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Black cohosh
(Actaea racemosa, syn. Cimicifuga racemosa)
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Implicated in a case of fulminant hepatic failure requiring liver transplant
Black cohosh is a North American plant promoted as a remedy for menopausal symptoms
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Whiting PW. Clouston A. Kerlin P.
Title Black cohosh and other herbal remedies associated with acute hepatitis. [Review] [30 refs]
Medical Journal of Australia. 177(8):440-3, 2002 Oct 21
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Callilepsis laureola
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Cases of fatal liver failure have been reported following ingestion.
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Carrot juice – beta carotene
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Ingestion of large amounts of carrot juice has been associated with increased risk of lung cancer and hepatic damage.
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Leo MA. Lieber CS. Alcohol, vitamin A, and beta-carotene: adverse interactions, including hepatotoxicity and carcinogenicity. American Journal of Clinical Nutrition. 69(6):1071-85, 1999 Jun.
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Cassia augustifolia (Senna)
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Commonly used and generally considered a safe laxative, implicated in one reported case of hepatotoxicity in a patient using high doses
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Chelidonium majus (Greater Celandine)
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Chelidonium majus is a constituent of some “liver tonics” and traditional herbal preparations
It can cause hepatitis and hepatic fibrosis.
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Benninger J. Schneider HT. Schuppan D. Kirchner T. Hahn EG. Acute hepatitis induced by greater celandine (Chelidonium majus). Gastroenterology. 117(5):1234-7, 1999 Nov.and other reports
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Chaparral – see Larrea
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Chinese Herbal Medicine (TCM) – unspecified ingredients
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Occasional toxicity reported; agent(s) not yet identified eg 11 cases of liver damage reported 1991-93 associated with Chinese herbal medicine for skin disease. Identification of toxic components in TCM is rendered difficult by the fact that they are often adulterated with substitute herbs or contaminated with heavy metals.
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Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Comfrey – see Symphytum
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Crotalaria
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Contains hepatotoxic pyrolizidine alkaloids.
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Dai-saiko-to (Da-Chai-Huang-Tan),
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Paradoxically used for liver disease. It causes acute and possibly chronic hepatitis
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Kamiyama T. Nouchi T. Kojima S. Murata N. Ikeda T. Sato C. Autoimmune hepatitis triggered by administration of an herbal medicine. [Review] [11 refs] American Journal of Gastroenterology. 92(4):703-4, 1997 Apr.
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Dictamnus dasycarpus
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Component of Traditional Chinese Medicine implicated in 6 cases of hepatotoxicity, including 2 fatalities
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McRae CA. Agarwal K. Mutimer D. Bassendine MF. Hepatitis associated with Chinese herbs. [Review] [28 refs] European Journal of Gastroenterology & Hepatology. 14(5):559-62, 2002 May
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Echinacea
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Prolonged use (more than 8 weeks) implicated in hepatotoxicity. Should not be used in conjunction with anabolic steroids, amiodorone, methotrexate or ketoconazole.
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Miller LG. Herbal medicinals: selected clinical considerations focussing on known or potential drug-herb interactions.
Arch. Intern. Med. 1998 Nov 9; 158 (20): 2200-11
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Ephedra sinica
(Ma huang)
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Chinese herbal supplement promoted for body building – suspected of causing hepatitis and a range of other symptoms
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Wettach GE. Falvey SG. A mysterious blood pressure increase in a drilling Naval reservist. Military Medicine. 167(6):521-3, 2002 Jun.
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Germander
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See Teucrium
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Glycyrrhizin – found in chinese herbal medicine skin tonics
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Causes vanishing bile duct syndrome
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Farrell GC, Weltman M. Drug Induced Liver Disease. In: Gitnick(Ed) Current Hepatolofy, vol 16. Chicago; Mosby-Yearbook Medical publishers, 1996; 143-208
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Goji
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Hedeoma pulegioides,
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Hepatotocicity suspected but not conclusively proven
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Heliotropium lasocarpium
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Contains hepatotoxic pyrolizidine alkaloids
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Jin Bu Huan
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See Lycopodium
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Kava (Piper methysticum)
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Kava is a psychoactive drink used extensively in the South Pacific area. It has been implicated in hepatotoxicity in susceptible individuals.
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1. Heiligenstein and Guenther 1998
2. Spillane et al 1997
3. Strahl et al. Necrotising hepatitis after taking herbal remedies. Dtsch-Med-Wochenshr. 1998 Nov 20; 123 (47):1410-4
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Kombucha (Kambucha) tea
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Abnormal liver function tests reported
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Larrea tridentata (Chapparal, creosote bush, grease wood)
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Causes hepatic necrosis and chronic hepatitis.
One documented case of liver failure in a 60 year old woman requiring liver transplantation.
18 case reports of hepatotoxicity
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1. Lee AU, Farrell GC. Drug Induced Liver Disease. Curr.Opin. Gastroenterol. 1997; 13: 199-205
Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
2. Gordon DW et al. Chaparral ingestion. The broadening spectrum of liver injury caused by herbal medication. JAMA. 1995 Feb 8; 273(6): 489-90
3. Sheik NM etal. Chaparral associated hepatotoxicity. Arch. Intern, Med. 157(8): 913-9, 1997 Apr28
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Lycopodium serratum (Jin Bu Huan)
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Uses for sedation/analgesia. The active ingredient has structural similarity to hepatotoxic pyrolizadine alkaloids.
Can cause acute/chronic hepatitis, fibrosis, and steatosis.
Implicated in 11 documented cases of hepatotoxity
| Picciotti A, Campo N, Brizzolara R et al. Chronic hepatitis induced by Jin Bu Huan. J Hepatol. 1998;28:165-7.
McRae CA. Agarwal K. Mutimer D. Bassendine MF. Hepatitis associated with Chinese herbs. [Review] [28 refs] [Journal Article. Review. Review of Reported Cases] European Journal of Gastroenterology & Hepatology. 14(5):559-62, 2002 M
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Ma huang, see Ephedra
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Margosa oil – see Axadirachza
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Mentha pulegium
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Hepatotocicity suspected but not conclusively proven
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Mistletoe – see Viscum
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Noni Juice
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Pennyroyal
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Pennyroyal was identifed as the toxic agent responsible for Hepatic and neurologic injury in two infants given home brewed mint teas to treat colic.
Pennyroyal has traditionally been used as an abortive agent despite known hepatotoxic effects.
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
Bakerink JA. Gospe SM Jr. Dimand RJ. Eldridge MW. Multiple organ failure after ingestion of pennyroyal oil from herbal tea in two infants. Pediatrics. 98(5):944-7, 1996 Nov.
Anderson IB. Mullen WH. Meeker JE. Khojasteh-BakhtSC. Oishi S. Nelson SD. Blanc PD. Pennyroyal toxicity: measurement of toxic metabolite levels in two cases and review of the literature [see comments]. [Review] [46 refs] Annals of Internal Medicine. 124(8):726-34, 1996 Apr 15.
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Petasites hybridus (butterbur)
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Butterbur contains potentially hepatotoxic and carcinogenic pyrrolizidine alkaloids. However a modern extraction method minimises the quantity of these in extracts of butterbur being used for research of efficacy of this herb for migraine and tension headaches.
Authors of the review cited identify four cases of reversible cholestatic hepatitis that they believe to have been associated with long-term administration of butterbur (incidence of 1:175.000).
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Kalin P. [The common butterbur (Petasites hybridus)--portrait of a medicinal herb]. [Review] [29 refs] [German] [Journal Article. Review. Review, Tutorial] Forschende Komplementarmedizin und Klassische Naturheilkunde. 10 Suppl 1:41-4, 2003 A
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Polygonum multiflora (Shou-Wu-Pian)
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Cholestatic hepatitis reported in woman taking this Chinese herbal medicine in the belief it acts against greying of the hair
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Park GJ. Mann SP. Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. Journal of Gastroenterology & Hepatology. 16(1):115-7, 2001 Jan
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Sassafras albidum (Sassafras)
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Suspected to be hepatotoxic – more data reqired to prove
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Scutellaria – see Sho- saiki-to
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Scutellaria is a component of Sho-Saiko-To
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Serenoa (Saw palmetto)
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An anti-androgenic compound used to treat prostate disorders, there is one report of it having possibly caused cholestatic hepatitis.
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Chitturi S, Farrell G, Herbal Hepatotoxcicity; an expanding but poorly defined problem. J Gastro & Hepat. (2000) 15,1093-1099
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Shou-Wu-Pian
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See Polygonum multiflora
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Sho-saiko-to
TJ-9
Syo-saiko-to
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Sho-Saiko-To is a herbal remedy comprising a mixture of 7 herbs, widely prescribed in China and Japan.
A small in vitro study suggested that this preparation could be beneficial in preventing disease progression in hepatitis C. However there is also literature suggesting it may have hepatotoxic effects.
One study reported 4 patients with hepatic necrosis following taking sho-saiko-to with a latent period of 1-3 months before symptoms became apparent.
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Farrel GC. Drug Induced Liver Disease. Edinburgh: Churchill-Livingstone, 1994 513-18
Yamashiki M. Nishimura A. Huang XX. Nobori T. Sakaguchi S. Suzuki H. Effects of the Japanese herbal medicine "Sho-saiko-to" (TJ-9) on interleukin-12 production in patients with HCV-positive liver cirrhosis. Developmental Immunology. 7(1):17-22, 1999
Itoh S. Marutani K. Nishijima T. Matsuo S. Itabashi M. Liver injuries induced by herbal medicine, syo-saiko-to (xiao-chai-hu-tang). Digestive Diseases & Sciences. 40(8):1845-8, 1995 Aug.
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Senecio
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Contains hepatotoxic pyrolizidine alkaloids. Causes hepatic veno-occlusive disease (Budd-Chiari syndrome)
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
2. Selzer G and Parker RGF. Senecio poisoning exhibiting as Chiari’s Syndrome. Am J Path 1951. 27: 885-907
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Skullcap – see Scutellaria
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Symphytum officinale (Comfrey)
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Symphytum uplandicum (Russian Comfrey)
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Contains hepatotoxic pyrolizidine alkaloids.
Causes hepatic veno-occlusive disease. Has been banned from sale in some countries, but can still be grown domestically.
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
2. Weston CFM. Et al. Veno-occlusive disease of the liver secondary to ingestion of comfrey. BMJ. 1987:295: 183
Yeong ML et al. Hepatoc veno-occlusive disease associated with comfrey ingestion. J Gasto & Hepatol. (1990) 5, 211-214
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Teucrium chamaedrys L (Germander)
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More than 30 cases of liver injury were reported and investigated in France following use of Germander as an adjuvant to weight control. Sale now banned in France. Dose dependent toxicity was then reproduced experimentally in mice.
Causes hepatic necrosis, fibrosis, cirrhosis.
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
Laliberte L and Villeneuve JP
Hepatitis after the use of germander., a herbal remedy.
CMAJ 1996 Jun1; 154 (11): 1689-92
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Teucrium polium
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Suspected as the cause of liver failure in one case.
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Mattei A. Rucay P. Samuel D. Feray C. Reynes M. Bismuth H. Liver transplantation for severe acute liver failure after herbal medicine (Teucrium polium) administration [letter]. Journal of Hepatology. 22(5):597, 1995 May.
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A case report in which other causes were excluded suggested that T capitatum consumed as part of a herb tea induced acute icteric hepatocellular necrosis which was reversed when the herb tea was withdrawn.
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Dourakis SP. Papanikolaou IS. Tzemanakis EN. Hadziyannis SJ. Acute hepatitis associated with herb (Teucrium capitatum L.) administration. [Case Reports. Journal Article] European Journal of Gastroenterology & Hepatology. 14(6):693-5, 2002 Jun
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Valeriana officinalis (Valerian)
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Isolated reports of hepatotoxicity following consumption of herbal remedies containing it
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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Viscum, Viscus album, (Mistletoe)
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Hepatotoxicity suspected but not proven conclusively
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Larrey, D. Hepatotoxicity of herbal remedies. Journal of Hepatology 1997; 26 (Suppl.1):47-51
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