Are herbals more hepatotoxic than prescription medications?

Excerpt

In this issue, Huang et al. report the results of a prospective study of 1297 Taiwanese patients with liver injury attributed to either herbal and dietary supplements (HDS) (HDS-induced liver injury; HILI) or conventional prescription medications (DILI) [1]. DILI is a notoriously difficult diagnosis to establish even when there is only a single purified suspect drug since the onset of liver injury is largely independent of the dose or duration of use and may be associated with varying phenotypes and severity of liver injury. With an incidence of only 1 in 10,000 to 1 in 100,000 medication exposed individuals, idiosyncratic DILI is believed to be mediated via rare genetic polymorphisms involving host metabolic and/ or adaptive immune pathways. HILI accounted for 22% of the Taiwanese cases and was associated with significantly higher MELD scores at presentation and mortality during follow-up (12.6% vs 8.0%). Of note, the latency of HDS product use to liver injury onset was also significantly longer compared to the DILI cases (38 vs 28 days) which may be due to delayed recognition of the herbal product as a cause of liver injury or reluctance of HDS consumers to seek medical care [2]. The latter hypothesis has previously been implicated for the consistently poorer outcomes seen in acute liver failure patients attributed to HDS products compared to conventional medications in the United States [3, 4]. The authors also found that crude “home grown” HDS products were the most commonly implicated type of herbal products and independently associated with a higher mortality rate compared to those who consumed processed, commercial HDS products that are federally regulated and prescribed by licensed providers in Taiwan. …