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Chaparral-associated hepatotoxicity
N M Sheikh1, R M Philen, L A Love
1Center for Food Safety and Applied Nutrition, Food and Drug Administration, Washington, DC, USA.
Archives of Internal Medicine
|April 28, 1997
Summary
Chaparral, a botanical dietary supplement, may cause severe liver damage, including irreversible injury and liver failure. Healthcare providers should monitor for adverse effects and report them.
Area of Science:
- Hepatology
- Toxicology
- Integrative Medicine
Background:
- Dietary supplements, including botanicals like chaparral (Larrea tridentata), are widely used for health purposes.
- Chaparral is recognized for its antioxidant properties but has been linked to liver injury since 1990.
- The full clinical spectrum of chaparral-associated hepatitis remains incompletely understood.
Purpose of the Study:
- To investigate the clinical presentation and outcomes of adverse events linked to chaparral ingestion.
- To assess the potential for chaparral to cause significant liver damage.
Main Methods:
- A review of 18 case reports submitted to the Food and Drug Administration (FDA) between 1992 and 1994.
- Data sources included reports from healthcare professionals, state health departments, and consumers.
Main Results:
- Hepatotoxicity was evident in 13 of the 18 reported cases.
- Liver injury manifested as jaundice and elevated liver enzymes 3–52 weeks post-ingestion, resolving after cessation.
- The pattern was predominantly toxic or drug-induced cholestatic hepatitis, with 4 cases progressing to cirrhosis and 2 to acute liver failure requiring transplantation.
Conclusions:
- Chaparral use is associated with potential for acute to chronic, irreversible liver damage, including fulminant hepatic failure.
- This highlights the risk of toxic effects from certain dietary supplement ingredients.
- Healthcare professionals should routinely inquire about supplement use, monitor for adverse effects, and report serious events via FDA's MEDWatch Program.