Literature review of liver injury induced by Tinospora crispa associated with two cases of acute fulminant hepatitis.

INTRODUCTION: Species of Tinospora are used as herbal remedies for the treatment of various diseases with very few toxic effects having been reported. Tinospora cordifolia (TCF) has been reported to effectively prevent hepatotoxicity. However, there are an increasing number of cases revealing that Tinospora crispa (TCP) might have the negative effect of inducing hepatotoxicity. Because of the similar leaves, people may mistake TCP for TCF, and consume it with the purpose of protecting liver function. OBJECTIVE: Find out the misusing level of TCP and TCF and which chemical compound in TCP might induce hepatotoxicity. METHODS: We report two cases of acute fulminant hepatitis associated with chronic use of TCP. Given that the two herbs were misidentified in these two reports, we investigated the frequency of erroneous identification by using three keywords ("Guduchi", "Tinospora cordifolia", "Tinospora crispa") to search images from the Google Images database. To further clarify the influence of liver function between TCP and TCF, we searched PubMed (up to 29 July 2018) for relevant publications on clinical trials or case reports. RESULTS: Based on web review, over 35 percent of websites failed to accurately identify these two herbs. The different effects on liver function between TCP and TCF were compared through literature review. It indicated that TCF exerted liver protection, TCP had a contrary effect, suggesting its cis-Clerodane-type furano-diterpenoids might be an important factor of inducing hepatotoxicity. CONCLUSIONS: We concluded that people might cause hepatic injury or even death without correctly identifying these two Tinospora species.

Reducing drug-herb interaction risk with a computerized reminder system.

BACKGROUND: Traditional Chinese medicine (TCM) and Western medicine are both popular in Taiwan. Approximately 14.1% of Taiwanese residents use Western drugs and Chinese herbs concurrently; therefore, drug-herb interaction is critical to patient safety. This paper presents a new procedure for reducing the risk of drug interactions. METHODS: Hospital computer systems are modified to ensure that drug-herb interactions are automatically detected when a TCM practitioner is writing a prescription. A pop-up reminder appears, warning of interactions, and the practitioner may adjust doses, delete herbs, or leave the prescription unchanged. A pharmacist will receive interaction information through the system and provide health education to the patient. RESULTS: During the 2011-2013 study period, 256 patients received 891 herbal prescriptions with potential drug-herb interactions. Three of the 50 patients who concurrently used ginseng and antidiabetic drugs manifested hypoglycemia (fasting blood sugar level ≤70 mg/dL). CONCLUSION: Drug-herb interactions can cause adverse reactions. A computerized reminder system can enable TCM practitioners to reduce the risk of drug-herb interactions. In addition, health education for patients is crucial in avoiding adverse reaction by the interactions.