The use of herbal supplements has increased considerably over the last decade. We report a case of an elderly woman who began taking Move Free Advanced for arthritis, which in addition to glucosamine and chondroitin, ...The use of herbal supplements has increased considerably over the last decade. We report a case of an elderly woman who began taking Move Free Advanced for arthritis, which in addition to glucosamine and chondroitin, contained two herbal ingredients, Chinese skullcap and Black Catechu. Our patient presented with significant cholestasis and hepatitis which significantly improved after discontinuation of the supplement. Since neither the patient nor the treating physician recognized this supplement as a potential hepatotoxin, she resumed taking the supplement and again suffered from considerable hepatotoxicity. Liver biopsy at that time was consistent with acute drug induced liver injury. She, once again, recovered after discontinuation of the supplement. Review of the literature confirms that Chinese skullcap has been implicated as a possible hepatotoxic agent which was demonstrated in this case.展开更多
BACKGROUND The surge in traditional herbal dietary supplement(HDS)popularity has led to increased drug-induced liver injuries(DILI).Despite lacking evidence of efficacy and being prohibited from making medical claims,...BACKGROUND The surge in traditional herbal dietary supplement(HDS)popularity has led to increased drug-induced liver injuries(DILI).Despite lacking evidence of efficacy and being prohibited from making medical claims,their acceptance has risen over sevenfold in the last two decades,with roughly 25%of United States(US)adults using these supplements monthly.An estimated 23000 emergency room visits annually in the US are linked to HDS side effects.NIH-funded research suggests HDS contribute to 7-20%of DILI cases,with similar trends in Europe—Spain reporting 2%and Iceland up to 16%.Patients with acute liver failure from HDS undergo liver transplantation more frequently than those from prescription medicines.Here we describe a case of drug-induced autoimmune hepatitis due to Skullcap supplements,this association appears to be the first documented instance in literature.CASE SUMMARY A middle-aged Caucasian woman,previously healthy,presented with sudden jaundice.Four months earlier,her liver enzymes were normal.She mentioned recent use of Skullcap mushroom supplements.Tests for chronic liver disease were negative.The first liver biopsy indicated severe resolving drug-induced liver injury.Despite treatment,she was readmitted due to worsening jaundice.Followup tests raised concerns about autoimmune hepatitis.A subsequent biopsy confirmed this diagnosis.The patient responded as expected to stopping the medication with improvement in liver enzymes.CONCLUSION This scenario highlights an uncommon instance of DILI caused by Skullcap supplements.It's crucial for hepatologists to recognize this connection due to the increasing prevalence of herbal supplements.展开更多
Objective: A sensitive HPLC-DAD detection method was established for the comparative analysis of the four active compounds(including baicalin, baicalein, wogonoside and wogonin) of Baikal Skullcap and its classical TC...Objective: A sensitive HPLC-DAD detection method was established for the comparative analysis of the four active compounds(including baicalin, baicalein, wogonoside and wogonin) of Baikal Skullcap and its classical TCM prescriptions according to different clinical curative effects. And analyze the relationship between compatibility of medicines, content and clinical curative effect.Methods: Water extracts were analyzed by high-performance liquid chromatography-diode array detection(HPLC-DAD), using an Agilent extend-C_(18)(4.6 mm×250 mm,5μm) column by using solvent A(0.2% phosphoric acid water) and solvent B(methanol) in the ratio of 52:48(v/v) at a flow rate of 1 ml/min. The column temperature was maintained at 25°C and the detection wavelength was set at 280 nm.Results: In quantitative analysis, the four selected markers showed good regression(R^2>0.999) within test ranges. The average recoveries were between 99.75~100.60% and their RSD values were between 0.97%~1.71%. The proportions of the four chemical compounds for different efficacy were 33.51~35.76: 6.78~6.87: 3.45~3.64: 1; 18.6~23.64: 3.63~4.27: 1.36~1.53: 1; 29.94~31.78: 5.14~5.23: 3.28~3.56: 1; 33.99~41.91:5.83~7.42: 2.83~3.39: 1.Conclusion: Clinical practice of thousands of years have proved that the curative effect of Traditional Chinese Medicine depends on the compatibility of different kinds of medicine material crude slices. According to this study we found that different compatibility of medicines leads to different proportions of the chemical compounds. We assume that there is a certain correlation between therapeutical effect of TCM and compatibility of medicines.展开更多
文摘The use of herbal supplements has increased considerably over the last decade. We report a case of an elderly woman who began taking Move Free Advanced for arthritis, which in addition to glucosamine and chondroitin, contained two herbal ingredients, Chinese skullcap and Black Catechu. Our patient presented with significant cholestasis and hepatitis which significantly improved after discontinuation of the supplement. Since neither the patient nor the treating physician recognized this supplement as a potential hepatotoxin, she resumed taking the supplement and again suffered from considerable hepatotoxicity. Liver biopsy at that time was consistent with acute drug induced liver injury. She, once again, recovered after discontinuation of the supplement. Review of the literature confirms that Chinese skullcap has been implicated as a possible hepatotoxic agent which was demonstrated in this case.
文摘BACKGROUND The surge in traditional herbal dietary supplement(HDS)popularity has led to increased drug-induced liver injuries(DILI).Despite lacking evidence of efficacy and being prohibited from making medical claims,their acceptance has risen over sevenfold in the last two decades,with roughly 25%of United States(US)adults using these supplements monthly.An estimated 23000 emergency room visits annually in the US are linked to HDS side effects.NIH-funded research suggests HDS contribute to 7-20%of DILI cases,with similar trends in Europe—Spain reporting 2%and Iceland up to 16%.Patients with acute liver failure from HDS undergo liver transplantation more frequently than those from prescription medicines.Here we describe a case of drug-induced autoimmune hepatitis due to Skullcap supplements,this association appears to be the first documented instance in literature.CASE SUMMARY A middle-aged Caucasian woman,previously healthy,presented with sudden jaundice.Four months earlier,her liver enzymes were normal.She mentioned recent use of Skullcap mushroom supplements.Tests for chronic liver disease were negative.The first liver biopsy indicated severe resolving drug-induced liver injury.Despite treatment,she was readmitted due to worsening jaundice.Followup tests raised concerns about autoimmune hepatitis.A subsequent biopsy confirmed this diagnosis.The patient responded as expected to stopping the medication with improvement in liver enzymes.CONCLUSION This scenario highlights an uncommon instance of DILI caused by Skullcap supplements.It's crucial for hepatologists to recognize this connection due to the increasing prevalence of herbal supplements.
基金supported by"the Fundamental Research Funds for the Central public welfare research institutes"(NO:ZXKT15037)"comprehensive large platform of Institute of Chinese Materia Medica China Academy of Chinese Medical Sciences"(NO:Z131 100006513017)
文摘Objective: A sensitive HPLC-DAD detection method was established for the comparative analysis of the four active compounds(including baicalin, baicalein, wogonoside and wogonin) of Baikal Skullcap and its classical TCM prescriptions according to different clinical curative effects. And analyze the relationship between compatibility of medicines, content and clinical curative effect.Methods: Water extracts were analyzed by high-performance liquid chromatography-diode array detection(HPLC-DAD), using an Agilent extend-C_(18)(4.6 mm×250 mm,5μm) column by using solvent A(0.2% phosphoric acid water) and solvent B(methanol) in the ratio of 52:48(v/v) at a flow rate of 1 ml/min. The column temperature was maintained at 25°C and the detection wavelength was set at 280 nm.Results: In quantitative analysis, the four selected markers showed good regression(R^2>0.999) within test ranges. The average recoveries were between 99.75~100.60% and their RSD values were between 0.97%~1.71%. The proportions of the four chemical compounds for different efficacy were 33.51~35.76: 6.78~6.87: 3.45~3.64: 1; 18.6~23.64: 3.63~4.27: 1.36~1.53: 1; 29.94~31.78: 5.14~5.23: 3.28~3.56: 1; 33.99~41.91:5.83~7.42: 2.83~3.39: 1.Conclusion: Clinical practice of thousands of years have proved that the curative effect of Traditional Chinese Medicine depends on the compatibility of different kinds of medicine material crude slices. According to this study we found that different compatibility of medicines leads to different proportions of the chemical compounds. We assume that there is a certain correlation between therapeutical effect of TCM and compatibility of medicines.
