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Clinical and causality assessment in herbal hepatotoxicity.
Expert Opin Drug Saf 2013; 12(3):339-66EO

Abstract

INTRODUCTION

Herbal hepatotoxicity represents a poorly understood, neglected and multifaceted disease with numerous confounding variables and missing established causality in the majority of cases. This review discusses overt shortcomings in its clinical and causality assessment and suggests improvements.

AREAS COVERED

A selective literature search of PubMed using the terms herbal hepatotoxicity, herb-induced liver injury, drug hepatotoxicity and drug-induced liver injury was performed to identify published case reports, spontaneous case reports, case series and review articles regarding hepatotoxicity due to herbs, herbal drugs and herbal dietary supplements. Covered areas focused on confounding variables related to the documentation of the herbal product and the clinical course, hepatotoxicity and reexposure criteria, temporal association, comedication and alternative causes with special attention to preexisting diseases of the liver, bile ducts and the pancreas. Of particular interest were recent discussions of approaches designed and validated for hepatotoxicity causality, such as the scale of CIOMS (Council for International Organizations of Medical Sciences).

EXPERT OPINION

The authors call for substantial improvements in data quality of herbal products and case characteristics and strongly recommend using the CIOMS scale to assess causality in suspected herbal hepatotoxicity.

Authors+Show Affiliations

Academic Teaching Hospital of Goethe University of Frankfurt/Main, Department of Internal Medicine II, Klinikum Hanau, Leimenstrasse 20, D-63450 Hanau, Germany. rolf.teschke@gmx.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23458441

Citation

Teschke, Rolf, et al. "Clinical and Causality Assessment in Herbal Hepatotoxicity." Expert Opinion On Drug Safety, vol. 12, no. 3, 2013, pp. 339-66.
Teschke R, Schwarzenboeck A, Eickhoff A, et al. Clinical and causality assessment in herbal hepatotoxicity. Expert Opin Drug Saf. 2013;12(3):339-66.
Teschke, R., Schwarzenboeck, A., Eickhoff, A., Frenzel, C., Wolff, A., & Schulze, J. (2013). Clinical and causality assessment in herbal hepatotoxicity. Expert Opinion On Drug Safety, 12(3), pp. 339-66. doi:10.1517/14740338.2013.774371.
Teschke R, et al. Clinical and Causality Assessment in Herbal Hepatotoxicity. Expert Opin Drug Saf. 2013;12(3):339-66. PubMed PMID: 23458441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and causality assessment in herbal hepatotoxicity. AU - Teschke,Rolf, AU - Schwarzenboeck,Alexander, AU - Eickhoff,Axel, AU - Frenzel,Christian, AU - Wolff,Albrecht, AU - Schulze,Johannes, Y1 - 2013/03/05/ PY - 2013/3/6/entrez PY - 2013/3/6/pubmed PY - 2013/10/29/medline SP - 339 EP - 66 JF - Expert opinion on drug safety JO - Expert Opin Drug Saf VL - 12 IS - 3 N2 - INTRODUCTION: Herbal hepatotoxicity represents a poorly understood, neglected and multifaceted disease with numerous confounding variables and missing established causality in the majority of cases. This review discusses overt shortcomings in its clinical and causality assessment and suggests improvements. AREAS COVERED: A selective literature search of PubMed using the terms herbal hepatotoxicity, herb-induced liver injury, drug hepatotoxicity and drug-induced liver injury was performed to identify published case reports, spontaneous case reports, case series and review articles regarding hepatotoxicity due to herbs, herbal drugs and herbal dietary supplements. Covered areas focused on confounding variables related to the documentation of the herbal product and the clinical course, hepatotoxicity and reexposure criteria, temporal association, comedication and alternative causes with special attention to preexisting diseases of the liver, bile ducts and the pancreas. Of particular interest were recent discussions of approaches designed and validated for hepatotoxicity causality, such as the scale of CIOMS (Council for International Organizations of Medical Sciences). EXPERT OPINION: The authors call for substantial improvements in data quality of herbal products and case characteristics and strongly recommend using the CIOMS scale to assess causality in suspected herbal hepatotoxicity. SN - 1744-764X UR - https://www.unboundmedicine.com/medline/citation/23458441/Clinical_and_causality_assessment_in_herbal_hepatotoxicity_ L2 - http://www.tandfonline.com/doi/full/10.1517/14740338.2013.774371 DB - PRIME DP - Unbound Medicine ER -