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Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury
Open accessAbstract
In recent years, cases of liver damage caused by ashwagandha herbal supplements have been reported from different parts of the world (Japan, Iceland, India, and the USA). Here, we describe the clinical phenotype of suspected ashwagandha-induced liver injury and the potential causative mechanism. The patient was admitted to the hospital because of jaundice. In the interview, it was reported that he had been taking ashwagandha for a year. Laboratory results showed an increase in total bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), (gamma-glutamyl transpherase (GGT), alkaline phosphatase (ALP), total cholesterol, triglycerides, and ferritin. Based on clinical symptoms and additional tests, the patient was diagnosed with acute hepatitis and referred to a facility with a higher reference rate to exclude drug-induced liver injury. An R-value was assessed, indicative of hepatocellular injury. The result of the 24 h urine collection exceeded the upper limit of normal for copper excretion in urine twice. The clinical condition improved after intensive pharmacological treatment and four plasmapheresis treatments. This case is another showing the hepatotoxic potential of ashwagandha to cause cholestatic liver damage mixed with severe jaundice. In view of several documented cases of liver damage caused by ashwagandha and the unknown metabolic molecular mechanisms of substances contained in it, attention should be paid to patients reporting the use of these products in the past and presenting symptoms of liver damage.
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“Since the first report, a total of 14 cases (excluding the current series) of ashwagandha-induced liver injury are available.17–26”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [25]
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“Reports of ashwagandha-induced liver injury have been notable in medical literature since 2017.”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [25]
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Cites
Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network
Navarro, V. J., Barnhart, H., Bonkovsky, H. L., Davern, T., Fontana, R. J., Grant, L., Reddy, R. K., Seeff, L. B., Serrano, J., Sherker, A. H., et al. (2014) · Hepatology · doi:10.1002/hep.27317 · Cited by 418 · cited 1×
“Identifying the main cause of liver damage in patients taking herbal preparations is extremely difficult, as they are often a mixture of different ingredients in which identifying a single causative factor can be problematic [41].”
Hepatotoxicity by Dietary Supplements: A Tabular Listing and Clinical Characteristics
García-Cortés, M., Robles-Díaz, M., Ortega-Alonso, A., Medina-Caliz, I., & Andrade, R. (2016) · International Journal of Molecular Sciences · doi:10.3390/ijms17040537 · Cited by 179
Björnsson, H. K., Björnsson, E. S., Avula, B., Khan, I. A., Jonasson, J. G., Ghabril, M., Hayashi, P. H., & Navarro, V. (2020) · Liver International · doi:10.1111/liv.14393 · Cited by 125 · cited 2×
“All of them developed jaundice, had elevated liver enzymes, and were diagnosed with drug-induced liver damage, which regressed after eight months [30].”
BackgroundRoy Chengappa, K., Gannon, J., & Forrest, P. (2014) · Journal of Ayurveda and Integrative Medicine · doi:10.4103/0975-9476.146566 · Cited by 37
Research works printed but not linked: 37
- Navarro, 2014, Hepatotoxicity Induced by Herbal and Dietary Supplements, Semin. Liver Dis., 34, 172, 10.1055/s-0034-1375958 · DOI
- Khan, 2022, A Comprehensive Review on the Use of Herbal Dietary Supplements in the USA, Reasons for Their Use, and Review of Potential Hepatotoxicity, Livers, 2, 119, 10.3390/livers2030011 · DOI
- Galati, 2006, Cellular and in Vivo Hepatotoxicity Caused by Green Tea Phenolic Acids and Catechins, Free. Radic. Biol. Med., 40, 570, 10.1016/j.freeradbiomed.2005.09.014 · DOI
- Kim, 2013, Garcinia Cambogia Attenuates Diet-Induced Adiposity but Exacerbates Hepatic Collagen Accumulation and Inflammation, World J. Gastroenterol., 19, 4689, 10.3748/wjg.v19.i29.4689 · DOI
- Galanty, 2015, In Vitro Antimicrobial Activity of Extracts and Compounds Isolated from Cladonia Uncialis, Nat. Prod. Res., 29, 2302, 10.1080/14786419.2015.1005616 · DOI
- Su, 2014, Usnic Acid Protects LPS-Induced Acute Lung Injury in Mice through Attenuating Inflammatory Responses and Oxidative Stress, Int. Immunopharmacol., 22, 371, 10.1016/j.intimp.2014.06.043 · DOI
- Han, 2004, Usnic Acid-Induced Necrosis of Cultured Mouse Hepatocytes: Inhibition of Mitochondrial Function and Oxidative Stress, Biochem. Pharmacol., 67, 439, 10.1016/j.bcp.2003.09.032 · DOI
- Lee, 2017, Ephedrine-Induced Mitophagy via Oxidative Stress in Human Hepatic Stellate Cells, J. Toxicol. Sci., 42, 461, 10.2131/jts.42.461 · DOI
- Stickel, 2003, Hepatitis Induced by Kava (Piper Methysticum Rhizoma), J. Hepatol., 39, 62, 10.1016/S0168-8278(03)00175-2 · DOI
- Nerurkar, 2004, In Vitro Toxicity of Kava Alkaloid, Pipermethystine, in HepG2 Cells Compared to Kavalactones, Toxicol. Sci., 79, 106, 10.1093/toxsci/kfh067 · DOI
- Trivedi, 2017, Metabolite Profiling in Withania Somnifera Roots Hydroalcoholic Extract Using LC/MS, GC/MS and NMR Spectroscopy, Chem. Biodivers., 14, e1600280, 10.1002/cbdv.201600280 · DOI
- Rajasekar, 2011, Estimation of Alkaloid Content of Ashwagandha (Withania Somnifera) with HPLC Methods, J. Exp. Sci., 2, 39
- Mishra, 2000, Scientific Basis for the Therapeutic Use of Withania Somnifera (Ashwagandha): A Review, Altern. Med. Rev., 5, 334
- Choudhary, 2017, Body Weight Management in Adults Under Chronic Stress Through Treatment With Ashwagandha Root Extract: A Double-Blind, Randomized, Placebo-Controlled Trial, J. Evid. Based Complement. Altern. Med., 22, 96, 10.1177/2156587216641830 · DOI
- Mirjalili, 2009, Steroidal Lactones from Withania Somnifera, an Ancient Plant for Novel Medicine, Molecules, 14, 2373, 10.3390/molecules14072373 · DOI
- Abbas, 1993, New Withanolids from Withania Spp., J. Nat. Prod., 56, 1000, 10.1021/np50097a003 · DOI
- Widodo, N., Priyandoko, D., Shah, N., Wadhwa, R., and Kaul, S.C. (2010). Selective Killing of Cancer Cells by Ashwagandha Leaf Extract and Its Component Withanone Involves ROS Signaling. PLoS ONE, 5. · DOI
- Widodo, 2007, Selective Killing of Cancer Cells by Leaf Extract of Ashwagandha: Identification of a Tumor-Inhibitory Factor and the First Molecular Insights to Its Effect, Clin. Cancer Res., 13, 2298, 10.1158/1078-0432.CCR-06-0948 · DOI
- Palliyaguru, 2016, Withania Somnifera: From Prevention to Treatment of Cancer, Mol. Nutr. Food Res., 60, 1342, 10.1002/mnfr.201500756 · DOI
- Mukherjee, 2021, Withania somnifera (L.)—Modern perspectives of an ancient Rasayana from Ayurveda, J. Ethnopharmacol., 264, 113157, 10.1016/j.jep.2020.113157 · DOI
- Mikolai, 2009, In Vivo Effects of Ashwagandha (Withania Somnifera) Extract on the Activation of Lymphocytes, J. Altern. Complement. Med., 15, 423, 10.1089/acm.2008.0215 · DOI
- Gupta, 2003, Withania Somnifera (Ashwagandha) Attenuates Antioxidant Defense in Aged Spinal Cord and Inhibits Copper Induced Lipid Peroxidation and Protein Oxidative Modifications, Drug Metab. Drug Interact., 19, 211, 10.1515/DMDI.2003.19.3.211 · DOI
- Sultana, 2012, Effects of Ashwagandha (Withania Somnifera) Root Extract On Some Serum Liver Marker Enzymes (AST, ALT) In Gentamicin Intoxicated Rats, J. Bangladesh Soc. Physiol., 7, 1, 10.3329/jbsp.v7i1.11152 · DOI
- Stickel, 2015, Hepatotoxicity of Herbal and Dietary Supplements: An Update, Arch. Toxicol., 89, 851, 10.1007/s00204-015-1471-3 · DOI
- Navarro, 2017, Liver Injury from Herbal and Dietary Supplements, Hepatology, 65, 363, 10.1002/hep.28813 · DOI
- Acharya, 2021, Acute Liver Failure: Indian Perspective, Clin. Liver Dis., 18, 143, 10.1002/cld.1135 · DOI
- Avula, 2020, Ashwagandha as a Cause for Liver Injury, Liver Int., 40, 2035, 10.1111/liv.14551 · DOI
- Danan, G., and Teschke, R. (2015). RUCAM in Drug and Herb Induced Liver Injury: The Update. Int. J. Mol. Sci., 17. · DOI · Paper page
- Siddiqui, 2021, DNA Damage by Withanone as a Potential Cause of Liver Toxicity Observed for Herbal Products of Withania Somnifera (Ashwagandha), Curr. Res. Toxicol., 2, 72, 10.1016/j.crtox.2021.02.002 · DOI · Paper page
- Rai, 2016, Anticancer Activities of Withania Somnifera: Current Research, Formulations, and Future Perspectives, Pharm. Biol., 54, 189, 10.3109/13880209.2015.1027778 · DOI
- Kaul, S.C., Ishida, Y., Tamura, K., Wada, T., Iitsuka, T., Garg, S., Kim, M., Gao, R., Nakai, S., and Okamoto, Y. (2016). Novel Methods to Generate Active Ingredients-Enriched Ashwagandha Leaves and Extracts. PLoS ONE, 11. · DOI
- Dar, 2016, Unique Medicinal Properties of Withania Somnifera: Phytochemical Constituents and Protein Component, Curr. Pharm. Des., 22, 535, 10.2174/1381612822666151125001751 · DOI
- Vaishnavi, K., Saxena, N., Shah, N., Singh, R., Manjunath, K., Uthayakumar, M., Kanaujia, S.P., Kaul, S.C., Sekar, K., and Wadhwa, R. (2012). Differential Activities of the Two Closely Related Withanolides, Withaferin A and Withanone: Bioinformatics and Experimental Evidences. PLoS ONE, 7. · DOI
- Zimmerman, 2000, Drug-Induced Liver Disease, Clin. Liver Dis., 4, 73, 10.1016/S1089-3261(05)70097-0 · DOI · Paper page
- (2022, May 13). A Case of Drug-Induced Liver Injury with Prolonged Severe Intrahepatic Cholestasis Induced by Ashwagandha. Available online: https://www.jstage.jst.go.jp/article/kanzo/58/8/58_448/_article/-char/en. · DOI · Paper page
- Weber, 2021, Ashwagandha-Induced Liver Injury: Self-Reports on Commercial Websites as Useful Adjunct Tools for Causality Assessment, Am. J. Gastroenterol., 116, 2151, 10.14309/ajg.0000000000001369 · DOI · Paper page
- Ireland, 2021, Drug-Induced Hepatocellular Injury Due to Herbal Supplement Ashwagandha, J. R. Coll. Physicians Edinb., 51, 363, 10.4997/jrcpe.2021.409 · DOI · Paper page
Cited by
Sorted by citations
Ashwagandha-induced liver injury—A case series from India and literature review
Philips, C. A., Valsan, A., Theruvath, A. H., Ravindran, R., Oommen, T. T., Rajesh, S., Bishnu, S., Augustine, P., & India, O. B. O. T. L. R. C. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000270 · Cited by 62
Metadata
- Authors
- Lubarska, M., Hałasiński, P., Hryhorowicz, S., Mahadea, D. S., Łykowska-Szuber, L., Eder, P., Dobrowolska, A., & Krela-Kaźmierczak, I.
- Affiliations
- Poznan University of Medical Sciences (PL)
- Institute of Human Genetics (PL)
- Department of Gastroenterology, Dietetics and Internal Diseases, University of Medical Sciences Poznan, Przybyszewskiego 49, 60-355 Poznan, Poland
- Corresponding author
- Hryhorowicz, Szymon
- ORCID
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2023-02-22
- Volume
- 20
- Issue
- 5
- Pages
- 3921
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC10002162
- OpenAlex
- W4321599286
- Cited by
- 46
- References
- 4
- Citations by year
- 2026: 18 · 2025: 9 · 2024: 15 · 2023: 4
- FWCI
- 7.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Plant Toxicity and Pharmacological Properties
- Keywords
- Withania somnifera, drug-induced liver injury, cholestatic liver injury, jaundice, acute hepatitis, copper excretion, plasmapheresis, hepatocyte injury, R-value
- MeSH terms
- Alanine Transaminase, Aspartate Aminotransferases, Humans, Jaundice, Liver, Liver Diseases, Male, Plant Extracts, Chemical and Drug Induced Liver Injury, Chemical and Drug Induced Liver Injury, Chronic
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