Table 3.
Data on drug or herb intake of the patients with herb-induced liver injury and hepatocellular patterns.
| 1 | 4 | 5 | 6 | 7 | 8 | 10 1 | |
|---|---|---|---|---|---|---|---|
| Causality assessment 2 | |||||||
| probable | Ayurvedic herb 3 (6) | - | ASA/Vitamin C (6) | - | Clarithromycin (6) | - | - |
| possible | Metoprolol (4) | Metformin (5) | Mentha piperita (3) | PS (4) | Eucalyptus globulus (3) | Venlafaxine (4) | Valeriana (4) |
| - | Paroxetine (5) | - | - | Multivitamins (3) | Valeriana (3) | Citalopram (3) | |
| - | Valeriana (4) | - | - | - | - | - | |
| - | Multivitamins (3) | - | - | - | - | - | |
| Time to onset from the beginning of drug/herb | |||||||
| 5–90 days | Ayurvedic herb | - | - | - | All | - | All |
| <5 or >90 days | Metoprolol | All | All | - | - | Valeriana | - |
| OR: Time to onset from cessation of drug/herb ≤15 days (except for slowly metabolized chemicals: >15 days) | - | - | - | PS | - | Venlafaxine | - |
| Course of ALT after cessation of the drug/herb (percentage difference between ALT peak and N) | - | - | - | - | - | - | - |
| Decrease ≥50% within 8 days | - | - | All | - | All | - | - |
| Decrease ≥50% within 30 days | - | All | - | - | - | All | All |
| No information | All | - | - | PS | - | - | - |
| Decrease ≥50% after the 30th day | |||||||
| Decrease <50% after the 30th day or recurrent increase | - | - | - | - | - | - | - |
| ALT normalization after cessation of drug/herb | Not known | Not known | Not known | Not known | Yes (30 days) | Yes (10 days) | Not known |
1 The pattern of liver injury could not be assessed as no ALP values were available and no liver biopsy was conducted; 2 Based on the updated CIOMS score as proposed by Teschke et al. [4]; 3 Tea containing liquorice, ginger, cardamom, and cinnamon. Herbs are written in bold. Numbers in brackets depict the points in CIOMS score for each compound. ASA = acetyl salicylic acid; PS = Pelargonium sidoides; ALT = alanine aminotransferase; N = enzyme value at a certain time point; CIOMS = Council for International Organizations of Medical Sciences.