[Hepatotoxicity associated with the use of Herbalife]. / Lifrarskadi tengdur notkun á Herbalife.

OBJECTIVE: Many herbal products are known to be hepatotoxic. In a recent survey in Iceland 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 micromol/L (range: 26-311; ref. < 20 micromol/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.

[Herbal medicine - Adverse effects and drug-interaction.].

OBJECTIVE: The aim of the study was to estimate the frequency of adverse effects and drug-interactions attributable to the use of herbal medicine and dietary supplements in Iceland. A further objective was to assess the perception and attitudes of Icelandic physicians towards these products. MATERIAL AND METHODS: A questionnaire was sent to all physicians registered in Iceland, a total of 1083. Physicians were questioned as to whether they had become aware of adverse effects or drug interactions that could be related to the use of herbal medicines or dietary supplements. Several questions concerned education and attitudes towards these products. A search was made using the computer system of the University Hospital in order to find cases of hospitalization resulting from consumption of herbal medicine. Details on admissions to the Emergency Department of the hospital were studied daily for one month. Enquiries made to the Icelandic Poison Center from 1997-2000 and formal reports submitted to the Icelandic Medicines Control Agency and the Surgeon General were examined. RESULTS: Of the 410 physicians that responded, 134 had become aware of adverse effects and 25 had become aware of herbal/drug interactions. Details on 253 adverse effects and 13 interactions were presented. Hospitalization was estimated to have been the consequence of 38 cases, 14 of which had been considered life-threatening. Of those who responded, 17% reported asking their patients always/frequently if they used herbal medicines or dietary supplements, whilst 62% reported asking occasionally/ seldom and 19% never asking. Approximately 55% of the respondents regard it as being very important/important that patients consult a physician before using herbal products or dietary supplements. CONCLUSIONS: Adverse effects and interactions between herbal medicines/dietary supplements and prescribed drugs appear to be under-reported in Iceland. It is important to increase awareness and education in this field amongst physicians and other health-care professionals in Iceland.