Hepatic injury induced by the consumption of Valeriana officinalis and Passiflora incarnata, a case report
DOI:
https://doi.org/10.59093/27112330.92Keywords:
chemical and drug induced liver injury, phytotherapy , toxicity, valerian, passiflora.Abstract
Homeopathic and phytotherapeutic medicines containing herbal products are increasingly used, however the potential for adverse effects on users and healthcare personnel is unknown. We report the case of a 34-year-old woman who consulted for abdominal pain and nausea, accompanied by hepatocellular pattern on liver function tests. Multiple etiologies were ruled out and it was considered that it could be a drug-induced liver injury secondary to the consumption of medications she had been taking a week prior for dysmenorrhea, and phytotherapeutics that she had been taking for several years, which were all discontinued. Twelve days after her discharge, she was readmitted due to similar symptoms; a liver profile with a hepatocellular pattern was again documented. Upon further questioning, the patient mentioned a chronic intake of Valeriana officinalis and Passiflora incarnata, which she resumed upon discharge. After ruling out the differential diagnoses, it was concluded that the symptoms of the patient were induced by the consumption of these herbal products. During hospitalization, their consumption was suspended, with normalization of the liver profile. It is important that consumers are informed about the potential risks of herbal products, their effects from long-term use, and the implications of self-medication.
Downloads
References
World Health Organization (WHO). WHO traditional medicine strategy 2014-2023. Ginebra, Suiza: WHO. Acceso 27 de junio de 2023. Disponible en https://www.who.int/publications/i/item/9789241506096.
Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol 2014;4:177. https://doi.org/10.3389/fphar.2013.00177.
Der Marderosian AH. Understanding homeopathy. J Am Pharm Assoc (Wash) 1996;Ns36:317-321. https://doi.org/10.1016/s1086-5802(16)30063-8.
Ernst E. Harmless herbs? A review of the recent literature. Am J Med 1998;104:170-178. https://doi.org/10.1016/s0002-9343(97)00397-5.
Fisher AA, Purcell P, Le Couteur DG. Toxicity of Passiflora incarnata J Toxicol Clin Toxicol 2000;38:63-66. https://doi.org/10.1081/clt-100100919.
Whiting PW, Clouston A, Kerlin P. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002;177:440-443. https://doi.org/10.5694/j.1326-5377.2002.tb04886.x.
World Health Organization (WHO). WHO Guidelines on safety monitoring of herbal medicines in pharmacovigilance systems. Ginebra, Suiza: WHO; 2004. Acceso 10 de mayo de 2023. Disponible en https://apps.who.int/iris/bitstream/handle/10665/43034/9241592214_eng.pdf.
Shaw D, Graeme L, Pierre D, Elizabeth W, Kelvin C. Pharmacovigilance of herbal medicine. J Ethnopharmacol 2012;140:513-518. https://doi.org/10.1016/j.jep.2012.01.051.
Instituto Nacional de Vigilancia de Medicamentos y Alimentos (Invima). Invima-Alerta Nro. 006-2020. Alerta sanitaria de Lotes F715, F726, F782, F837 y F843 del producto Caléndula officinalis (DOLOLED). 2020. Acceso 10 de mayo de 2023. Disponible en https://app.invima.gov.co/alertas/ckfinder/userfiles/files/ALERTAS%20SANITARIAS/medicamentos_pbiologicos/2020/Enero/Alerta-No-006-2020-Lotes-F715-F726-F782-F837-y-F843-del-producto-Calendula-officinalis-DOLOLED.pdf.pdf.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). LiverTox: Clinical and research information on drug-induced liver injury. Roussel Uclaf Causality Assessment Method (RUCAM) in drug induced liver injury. Bethesda, Maryland: LiverTox; 2019. Acceso 10 de mayo de 2023. Disponible en https://www.ncbi.nlm.nih.gov/books/NBK548272/.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). LiverTox: Clinical and research information on drug-induced liver injury. Passionflower. Bethesda, Maryland: LiverTox; 2019. Acceso 10 de mayo de 2023. Disponible en https://www.ncbi.nlm.nih.gov/books/NBK548020/.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). LiverTox: Clinical and research information on drug-induced liver injury. Valerian. Bethesda, Maryland: LiverTox; 2020. Acceso 10 de mayo de 2023. Disponible en https://www.ncbi.nlm.nih.gov/books/NBK548255/.
Pakseresht S, Boostani H, Sayyah M. Extract of valerian root (Valeriana officinalis L.) vs. placebo in treatment of obsessive-compulsive disorder: a randomized double-blind study. J Complement Integr Med 2011;8:/j/jcim.2011.2018.issue-2011/1553-3840.1465/1553-3840.1465.xml.
Shinjyo N, Waddell G, Green J. Valerian root in treating sleep problems and associated disorders-a systematic review and meta-analysis. J Evid Based Integr Med 2020;25:2515690x20967323. https://doi.org/10.1177/2515690x20967323.
Pattanittum P, Kunyanone N, Brown J, Sangkomkamhang US, Barnes J, Seyfoddin V, et al. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev 2016;3:Cd002124. https://doi.org/10.1002/14651858.CD002124.pub2.
Hassani S, Alipour A, Darvishi Khezri H, Firouzian A, Emami Zeydi A, Gholipour Baradari A, et al. Can Valeriana officinalis root extract prevent early postoperative cognitive dysfunction after CABG surgery? A randomized, double-blind, placebo-controlled trial. Psychopharmacology (Berl) 2015;232:843-850. https://doi.org/10.1007/s00213-014-3716-x.
Garcia-Borreguero D, Ferini-Strambi L, Kohnen R, O'Keeffe S, Trenkwalder C, Högl B, et al. European guidelines on management of restless legs syndrome: report of a joint task force by the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society. Eur J Neurol 2012;19:1385-1396. https://doi.org/10.1111/j.1468-1331.2012.03853.x.
Miyasaka LS, Atallah AN, Soares BG. Valerian for anxiety disorders. Cochrane Database Syst Rev 2006:Cd004515. https://doi.org/10.1002/14651858.CD004515.pub2.
Janda K, Wojtkowska K, Jakubczyk K, Antoniewicz J, Skonieczna-Żydecka K. Passiflora incarnata in neuropsychiatric disorders-a systematic review. Nutrients 2020;12:3894. https://doi.org/10.3390/nu12123894.
Elsas SM, Rossi DJ, Raber J, White G, Seeley CA, Gregory WL, et al. Passiflora incarnata L. (Passionflower) extracts elicit GABA currents in hippocampal neurons in vitro, and show anxiogenic and anticonvulsant effects in vivo, varying with extraction method. Phytomedicine 2010;17:940-949. https://doi.org/10.1016/j.phymed.2010.03.002.
Miyasaka LS, Atallah AN, Soares BG. Passiflora for anxiety disorder. Cochrane Database Syst Rev 2007:Cd004518. https://doi.org/10.1002/14651858.CD004518.pub2.
Kim M, Lim HS, Lee HH, Kim TH. Role Identification of Passiflora Incarnata Linnaeus: A Mini Review. J Menopausal Med 2017;23:156-159. https://doi.org/10.6118/jmm.2017.23.3.156.
Hoban CL, Byard RW, Musgrave IF. Analysis of spontaneous adverse drug reactions to echinacea, valerian, black cohosh and ginkgo in Australia from 2000 to 2015. J Integr Med 2019;17:338-343. https://doi.org/10.1016/j.joim.2019.04.007.
van Hunsel F, van de Koppel S, Skalli S, Kuemmerle A, Teng L, Wang JB, et al. Analysis of hepatobiliary disorder reports associated with the use of herbal medicines in the global suspected ADR database vigibase. Front Pharmacol 2019;10:1326. https://doi.org/10.3389/fphar.2019.01326.
Cohen DL, Del Toro Y. A case of valerian-associated hepatotoxicity. J Clin Gastroenterol 2008;42:961-962. https://doi.org/10.1097/MCG.0b013e3180500348.
Koenig G, Callipari C, Smereck JA. Acute liver injury after long-term herbal "liver cleansing" and "sleep aid" supplement use. J Emerg Med 2021;60:610-614. https://doi.org/10.1016/j.jemermed.2021.01.004.
Lourdusamy V, Albers C, Malespin M, Kemmer N, Agrawal S, Syed R. 2267 Drug-induced autoimmune hepatitis from valerian root tea. Am J Gastroenterol 2019;114:S1268. https://doi.org/10.14309/01.ajg.0000598600.20051.0f.
Bergagnini I, Kadosh D, Nguyen A, Swaminath A. 2244 Getting to the root of the matter: A case of valerian root-induced hepatitis and pancreatitis. Am J Gastroenterol 2019;114:S1254-S1255. https://doi.org/10.14309/01.ajg.0000598508.64641.c6.
Girón-Pelaez D, Marulanda-Fernández H, Otero-Rengino W. Conceptos emergentes: Injuria hepática inducida por productos herbales (HILI). Revisión de tema. Rev Colom Gastroenterol 2019;34:61-68. https://doi.org/10.22516/25007440.355.
Al-Majed AA, Al-Yahya AA, Al-Bekairi AM, Al-Shabanah OA, Qureshi S. Studies on the cytological and biochemical effects of valerian in somatic and germ cells of Swiss albino mice. Food Chem Toxicol 2006;44:1830-1837. https://doi.org/10.1016/j.fct.2006.06.001.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Hepatología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Hepatología’s authorship policy is based on the criteria established by the International Committee of Medical Journal Editors (ICMJE) to credit a person for their work while assigning them responsibility for its publication.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
