International network for natural sciences – research journal
  • mendeley icon
  • linkedin icon
  • google plus icon
  • twitter icon
  • google scholar icon
  • facebook icon

Herbal and dietary supplements hepatotoxicity: Prevalence, Epidemiology and Key Issues

By: Shaima H. Albelwi, Haddad El Rabey

Key Words: Herbal, supplements, alternative, liver, toxicity.

Int. J. Biosci. 20(6), 95-102, June 2022.


Certification: ijb 2022 0012 [Generate Certificate]


Herbal and dietary supplements (HDS) are widely utilized worldwide as supplementary and alternative medicine modalities that can cause hepatotoxicity. HDS consists of nutrients, minerals, or additional plant materials and substances derived from such plant life. They’re being taken by oral route and intended to augment one’s diet and improve one’s health and properly-being. There’s a bent for false reporting the amount of food they consume through patients and the significance of their utilization is under-recognized by physicians, although no single causality evaluation method is ideal for hepatotoxicity caused by HDS.  The most extensively used method is the Roussel Uclaf Causality Assessment Method defining epidemiology, defining an acceptable nomenclature, and identifying culprit ingredients, predisposing host characteristics, and useful biomarkers are all things that need to be addressed for harm must all be priorities in the future.  Herbal medicines have long been thought to be safe by people because they’ve been utilized for thousands of years in disease treatment despite potential toxicity, particularly “drug-induced liver injury” (DILI). Despite the risk of side effects, herbal medications have become increasingly popular around the world due to a lack of regulatory oversight.

| Views 19 |

| Views 19 |

Herbal and dietary supplements hepatotoxicity: Prevalence, Epidemiology and Key Issues

Abdel-Qader DH, Albassam A, Ismael NS, Aljamal MS. 2020. Herbal medicine use in the Jordanian population: A nationally representative cross-sectional survey. Journal of Pharmacy & Pharmacognosy Research 8(6), 525-536, 2020 ISSN 0719-4250.

Agarwal VK, McHutchison JG, Hoofnagle JH. 2010. Important elements for the diagnosis of drug-induced liver injury. Clin Gastroenterol Hepatology 8, 463–70.

Aljofan M, Alkhamaiseh S. 2020. Prevalence and Factors Influencing Use of Herbal Medicines during Pregnancy in Hail, Saudi Arabia A cross-sectional study. Sultan Qaboos University Medical Journal 20(1), e71–76.

Al-Zughaibi OS, Filimban LA, Aldahlawi SA. 2016. Prevalence of herbal supplement use among adult dental patients in Makkah city, Saudi Arabia. International Journal of Oral Health Dentistry 2(4), 232-235.

Andrade RJ, Lucena MI, Fernandez MC. 2005. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology 129, 512–521.

Ballotin VR, Bigarella LG, Brandão ABM, Balbinot RA, Balbinot SS, Soldera J. 2021. Herb-induced liver injury: Systematic review and meta-analysis. World Journal of Clinical Cases 9(20), 5490-5513.

Benichou C, Danan G., Flahault A. 1993. Causality assessment of adverse reactions to drugs–II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge. J Clin Epidemiol 46, 1331–1336.

Benichou C. 1990. Criteria of drug-induced liver disorders. Report of an international consensus meeting. Journal of Hepatology 11, 272–6.

Bent S, Ko R. 2004. Commonly used herbal medicines in the United States: a review. American Journal Medicine 116, 478–485.

Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. 2013. Incidence, presentation, and outcomes in patients with druginduced liver injury in the general population of Iceland. Gastroenterol 144(7), 1419–1425.

Chalasani N, Fontana RJ, Bonkovsky HL. 2008. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 135, 1924–1934.

Dalton HR, Fellows HJ, Stableforth W. 2007. The role of hepatitis E virus testing in drug-induced liver injury. Aliment Pharmacology Therapeutics 26, 1429–35.

Davern TJ, Chalasani N, Fontana RJ. 2011. Acute hepatitis E infection accounts for some cases of suspected drug-induced liver injury. Gastroenterology 141, 1665–1672.

De Berardinis V, Moulis C. 2000. Maurice M, Human microsomal epoxide hydrolase is the target of germander-induced autoantibodies on the surface of human hepatocytes. Molecular Pharmacology 58(3), 542–551.

Estes JD, Stolpman D, Olyaei A. 2003. High prevalence of potentially hepatotoxic herbal supplement use in patients with fulminant hepatic failure. Archive of Surgery 138, 852–858.

Gynura LG, Wang JY, Li N. 2011. Hepatic sinusoidal obstruction syndrome associated with consumption of segetum. Journal of Hepatology 54(4), 666–673.

Ibanez L, Perez E, Vidal X, Laporte JR. 2002. Prospective surveillance of acute serious liver disease unrelated to infectious, obstructive, or metabolic diseases: epidemiological and clinical features, and exposure to drugs. Journal of Hepatology 37, 592–600.

Maria VA, Victorino RM. 1997. Development and  validation of a clinical scale for the diagnosis of drug induced hepatitis. Hepatology 26, 664–669.

Navarro VJ. 2009. Herbal and dietary supplement hepatotoxicity. Seminars in Liver Disease 29, 373–82.

Reuben A, Koch DG, Lee WM. 2010. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology 52, 2065–2076.

Rochon J, Protiva P, Seeff LB. 2008. Reliability of the Roussel Uclaf Causality Assessment Method for assessing causality in drug-induced liver injury. Hepatology 48, 1175 –1183.

Russo MW, Galanko JA, Shrestha R, Fried MW. 2004. Watkins P. Liver transplantation for acute liver failure from drug induced liver injury in the United States. Liver Transplantation 10, 1018–1023.

Schiano TD. 2003. Hepatotoxicity and complementary and alternative medicines. Clinical Liver Diseases 7, 453–473.

Schuppan D, Jia JD, Brinkhaus B, Hahn EG. 1999. Herbal products for liver diseases: a therapeutic challenge for the new millennium. Hepatology 30, 1099–1104.

Shapiro MA, Lewis JH. 2007. Causality assessment of drug-induced hepatotoxicity: promises and pitfalls. Clinical Liver Diseases 11, 477–505.

Soares PF, Fernandes MTCF, Souza A, Lopes CM. 2021. Causality imputation between herbal products and HILI: An algorithm evaluation in a systematic review. Annals of Hepatology 25, 100539.

Strader DB, Navarro VJ, Seeff LB. 2012. Hepatotoxicity of Herbal Preparations. Chapter 26. In: Boyer TD, Manns MP, Sanyal AJ, eds. Zakim and Boyer’s Hepatology 6th ed. Philadelphia, PA: Saunders-Elsevier 462-475.

Valdivia-Correa B, Gómez-Gutiérrez C, Uribe M, Méndez-Sánchez N. 2016. Herbal Medicine in Mexico: A Cause of Hepatotoxicity. A Critical Review International journal of molecular science. International Journal of Molecular. Science 17, 235.

Verma S, Thuluvath PJ. 2007. Complementary and alternative medicine in hepatology: A review of the evidence of efficacy. Clin Gastroenterol Hepatol; 5, 408–16.

Vinaya C, Maddukuri MD, Herbert L, Bonkovsky MD. 2014. Herbal and Dietary Supplement Hepatotoxicity. Clinical Liver Diseases 4 (1), 1-3.

Woo SM, Davis WD, Aggarwal S, Clinton JW, Kiparizoska S, Lewis JH. 2021. Herbal and dietary supplement induced liver injury: Highlights from the recent literature. World Journal of Hepatology 13(9), 1019-1024.

Shaima H. Albelwi, Haddad El Rabey.
Herbal and dietary supplements hepatotoxicity: Prevalence, Epidemiology and Key Issues.
Int. J. Biosci. 20(6), 95-102, June 2022.
Copyright © 2022
By Authors and International Network for
Natural Sciences (INNSPUB)
innspub logo
english language editing
    Publish Your Article
    Submit Your Article
Email Update