Table 1.
Reports of myopathies associated with use of herbal drugs
| Sex, age (years) | Product; dosage; indication | Concomitant medications and notes | Reported ADRs; time to onset | Action taken; outcome |
|---|---|---|---|---|
| F, 53 | Colestat®, contains red yeast rice (Monascus purpureus); 1 tablet a day; hypercholesterolaemia | None | Increase of CPK§ (288 IU l−1), ALT and AST and GGT 2 months | Drug withdrawn; complete recovery |
| M, 49 | Statinat crinos®, contains red yeast rice (Monascus purpureus); 5 mg, 1 tablet a day; hypercholesterolaemia | None | Increase of CPK§ (386 IU l−1), total cholesterol, ALT and AST; 2 months | Drug withdrawn; complete recovery |
| F, 43 | Red yeast rice (Monascus purpureus) 400 mg, 1 tablet/3 times a day; hypercholesterolaemia | None | Increase of CPK§ (401 IU l−1), muscle pain; 6 months | Drug withdrawn; complete recovery |
| F, 60 | Armolipid plus®, contains red yeast rice (Monascus purpureus 200 mg + berberine extract Berberis aristata 500 mg); 1 tablet a day; hypercholesterolaemia | None; statin-intolerant | Increase of CPK§ (356 IU l−1), AST# 37 IU l−1, ALT# 28 IU l−1; 6 months | Drug withdrawn; reaction unresolved |
| M, 30* | Liquorice, (Glycyrrhiza glabra); 30g day−1 orally; nutrient | None | Increase of CPK, rhabdomyolysis; 1 month | Drug withdrawn; complete recovery |
| M, 73* | Herbadulx regola®, contains liquorice (Glycyrrhiza glabra); 2 tablets a day; laxative | Simvastatin, atenolol, cardioaspirin, lansoprazole, ursodesossicolic acid, lisinopril, nitrodur (from 8 years) | Rhabdomyolysis, increase of CPK§ (8000 IU l−1), blood nitrogen† 6.0 mg dl−1; 20 days | Drug withdrawn; reaction unresolved |
| M, 81* | Liquorice (Glycyrrhiza glabra) concentrate juice; 2–3 g day−1, chronic hypotension | β-blockers, anxiolytics | Hypertension, hypokalaemia, hypernatraemia, increase of CPK, 3 months | Drug withdrawn, anthialdosterone therapy, supplementation; complete recovery |
#
normal range: 10–35 IU l−1;
§
normal range: 24–195 IU l−1;
†
normal range: 0.2–6.0 mg dl−1;
*
Hospitalization due to ADR. ADR, adverse drug reaction; ALT, alanine aminotrasferase; AST, glutaryl aminotransferase; CPK, creatinine phosphokinase; GGT, gamma glutaril transpeptidase; LDH, lactate dehydrogenase.