![]() ![]() Additionally, although more than 50 traditional Chinese medicines (TCM) have been associated with hepatic injury, 203 causality has been established for only about half of these compounds. 202 Similarly, the LiverTox database compiled by the National Institutes of Health and National Library of Medicine reviews 50 of the best known HDS for potential hepatotoxicity and has concluded that nearly 40% have no evidence to implicate them in clinical hepatotoxicity (see Table 89.7). 193-197, 201 Other implicated agents lack sufficient evidence to support their hepatotoxicity. Several dozen HDS compounds are listed as potentially hepatotoxic, including several that are no longer sold (including germander and usnic acid-containing products) and others that have undergone reformulations (e.g., Hydroxycut) ( Table 89.7). DILI Network between 20 193 and exceeding 50% in some Chinese and other Asian series. 163, 167, 193-197 Indeed, the percentage of cases of hepatotoxicity due to HDS in DILI registries has risen steadily in the 2000s, increasing from 7% to 20% of cases in the U.S. 10, 159, 160 Silymarin ( Silybum marianum, milk thistle) is the most commonly used herbal preparation among these patients, 10and although it appears to be quite safe, 189 if ineffective, 190-192 an increasing number of reports of hepatotoxicity from several other classes of herbal, dietary, weight-reduction, and body-building supplements (collectively referred to as HDS) have paralleled the rise in use of CAM therapies in both the USA and other Western nations. The increasing use of CAM preparations is well described in patients with liver disease (see Chapter 131). Mark Feldman MD, in Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 2021 Herbal, Dietary, Weight-Loss, and Body-Building Supplements For internal applications, comfrey has been used as infusions and extracts for the treatment of gastritis, gastroduodenal ulcers, and lung congestion ( Roeder, 1995). Humans have widely consumed comfrey as a vegetable and taken comfrey formulations of tea or tablets. A herbal practitioner survey of the external use of comfrey in the United Kingdom indicated that comfrey is rated most effective for fractures, wounds, post-surgery healing, and problems with tendon, ligament, and muscle while it is less effective for treating boils, hemorrhoids, and varicose veins ( Frost et al., 2014). Several randomized, controlled trials have demonstrated the efficacy of topical comfrey preparations in the treatment of muscle and joint pain ( Staiger, 2012). Comfrey is applied externally in the form of extracts, ointments, or compress pastes of comfrey leaves and roots to treat joint inflammatory disorders, wounds, bone fractures, gout, hematomas, and thrombophlebitis. Comfrey has been used both internally and externally as a herbal medicine for more than 2000 years in many countries ( Rode, 2002). (the major comfrey species), Symphytum asperum Lepech, Symphytum x uplandicum Nyman, Symphytum tuberosum L., and Symphytum caucasicum Bieb ( Mei et al., 2010b). Lei Guo, in Nutraceuticals (Second Edition), 2021 Therapeutic use of comfreyĬomfrey belongs to the plant family Boraginaceae and there are at least five species referred to as comfrey, including Symphytum officinale L. Sometimes there is also damage to the lungs. They can produce veno-occlusive disease of the liver with clinical features like abdominal pain with ascites, hepatomegaly, splenomegaly, anorexia, nausea, vomiting, and diarrhea. Certain representatives of this class and the plants in which they occur are hepatotoxic, as well as mutagenic and carcinogenic. Symphytum officinale contains pyrrolizidine alkaloids, which are the subject of a separate monograph. Herbal medicines that provide more than 1 mg internally or more than 100 mg externally per day, when used as directed, are not permitted herbal medicines that provide 0.1–1 mg internally or 10–100 mg externally per day, when used as directed, may be applied only for a maximum of 6 weeks per year, and they should not be used during pregnancy or lactation. ![]() The German Federal Health Office has restricted the availability of botanical medicines containing unsaturated pyrrolizidine alkaloids. Symphytum officinale (black wort, boneset, bruise wort, comfrey, knitback, knitbone, slippery root) contains pyrrolizidine alkaloids, such as lasiocarpine and symphytine, and their N-oxides, and has repeatedly been associated with hepatotoxicity.Ĭomfrey products have been withdrawn from the market in several countries, including the USA and the UK. Aronson MA, DPhil, MBChB, FRCP, HonFBPhS, HonFFPM, in Meyler's Side Effects of Drugs, 2016 Symphytum officinale ![]()
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