Hepatotoxicity of herbal remedies

Abstract

H ERBAL remedies are enjoying a growing popularity in Western countries. This trend has been promoted by several factors (1-4): a) the return to natural products occurring along with the ecologic movement in industrialized countries; b) the naive view that what is natural can only be good; c) the belief that herbal medicines are completely innocuous in contrast to traditional drugs; d) the development of new diseases with severe complications for which there is still no satisfying treatment, for instance the human immunodeficiency virus infection. Problems of toxicity have recently surfaced with several commercially available herbs, challenging the safety reputation of this type of therapy (5-7). The potential hepatotoxicity of herbal remedies is not completely new. Indeed, in Africa, Asia and the West Indies, where herbal remedies are commonly used, it is well known that some plants, particularly the species containing pyrrolizidine derivatives, may be hepatotoxic (8). The hepatotoxicity of herbal remedies is particularly difficult to demonstrate. Automedication is frequent and the patient usually forgets to inform his general practitioner that he takes herbal remedies (9). Furthermore, particular risks of toxicity are associated with the use of herbal products, in addition to those observed with traditional drugs. From the collection of plants to their consumption as pharmaceutical or artisanal products, many errors can occur (see Table 1) (4,10). The risks are particularly high when the therapeutic preparation contains numerous plants. A control of herbal medicine utilization is appearing in many countries. Marketing authorization is given for plants considered efficient and innocuous. In most cases, the efficiency and safety are based more on reputation acquired over centuries than on controlled trials and toxicity studies (10). The major aspects, of herbal medicine hepatotoxicity