Some of the herbal supplements associated with hepatic injury

Product	Other names/toxins	Clinical manifestations	Pathologic findings
Chaparral leaf	Laurie tridentata	ALT 10 to 20x normal; AST 7 to 10x normal; elevated bilirubin and prothrombin time; reversible; dose dependent	Acute and chronic liver injury: portal inflammation with bile duct proliferation; lobular necrosis and collapse
	"Creosote bush"
	"Grease wood"
	Nordi-hydroguaiaretic acid (HDGA)
Jin Bu Huan	Lycopodium serratum	ALT/AST 10 to 20x normal; elevated bilirubin and prothrombin time; reversible	Acute and chronic liver injury: focal hepatic necrosis; eosinophilia; steatosis; bridging fibrosis and necrosis
Jin Bu Huan	Levo-tetrahydropalmatine
Germander	Teucrium chamaedrys	ALT/AST 5 to 10x normal; elevated bilirubin; reversible	Acute and chronic liver injury: hepatocellular necrosis; portal inflammation; fibrosis
Germander	Teucrium polium	ALT/AST 5 to 10x normal; elevated bilirubin; reversible
Kava	Piper methysticum rhizoma	ALT/AST 10 to 20X normal; elevated bilirubin, prothrombin time; can be fatal	Hepatic necrosis; cholestasis, lobular hepatitis
Mistletoe	Viscum album	ALT/AST 5 to 10x normal; elevated bilirubin; reversible	Acute and chronic hepatitis: hepatocellular injury
Skullcap	Scutellaria spp	ALT/AST 5 to 10x normal; elevated bilirubin; reversible	Acute hepatitis; hepatocellular injury
Toxic alkaloids	Symphytum (Comfrey)	ALT/AST 3 to 10x normal; elevated bilirubin; generally reversible; can be fatal; dose dependent	Hepatic venoocclusive disease; acute inflammation
	Senecio spp
	Crotalaria spp
	Heliotropium spp
	Maté (Paraquay) tea
	Ackee Fruit
	Atractylis gummifera
	Callilepsis laureola
	Cassia angustifolia (Senna)
	Cocaine (Erythroxylon coca)
	Sassafras albidum
	Borago officinalis
Pennyroyal	Squawmint oil	ALT/AST 10 to 20x normal; associated with renal failure	Acute liver injury related to depletion of hepatic glutathione
	Hedeoma pulegoides
	Mentha pulegium
	Toxic terpenes, especially isopropylidene

Adapted from: Bashir RM, Lewis JH. Gastroenterol Clin North Am 1995; 24:957.

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Some of the herbal supplements associated with hepatic injury