Læknablaðið - 15.03.2010, Page 24

FRÆÐIGREINAR
SJÚKRATILFELLI
O G Y F I R L I T
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Hepatotoxicity associated with the use of Herbalife
Objective: Many herbal products are known to be
hepatotoxic. In a recent survey in lceland concerning
adverse reactions related to herbal medicines, Herbalife
products were implicated in the majority of the reported
cases of hepatotoxicity.
Methods: The clinical presentations of five cases of
Herbalife related liver injury during the period of 1999-2008
are analysed. Causality was assessed by using the WHO-
UMC system for causality assessment and the RUCAM
method.
Results: Of the five cases there were four females and one
male; median age was 46 years (range 29-78). Herbalife
had been used for 1 to 7 months prior to presentation.
Four patients presented with a hepatocellular and one
with a cholestatic reaction. Median values were for
bilirubin 190 pmol/L (range: 26-311; ref. < 20 pmol/L),
ALP 407 U/L (range: 149-712; ref. 35-105 U/L) and ALT
24 87 U/L (range: 456-2637; ref. 70 and 45 U/L for males
and females, respectively). Liver biopsy was performed
in 2 patients and was consistent with toxic hepatitis in
both cases. Other causes of hepatitis were excluded by
appropriate serological testing and ultrasound. Causality
assessment according to RUCAM was probable in three
cases and possible in two. Using the WHO-UMC criteria
causality was certain in one case, probable in two and
possible in two cases.
Conclusions: Hepatotoxicity is probably associated with
the use of Herbalife products. Hepatotoxicity due to herbal
remedies is an important differential diagnosis in the
diagnostic work-up of liver injury.
Johannsson M, Ormarsdottir S, Olafsson S
Hepatotoxicity associated with the use of Herbalife. Icel Med J 2010; 96: 177-82
Key words: toxic hepatitis, herbai remedies, Herbalife.
Correspondence: Magnús Jóhannsson, magjoh<Shi.is
Barst: 9. desember 2009, - samþykkt til birtingar: 17. janúar 2010
Hagsmunatengsl höfunda: Engin
172 LÆKNAblaðið 2010/96