Liver Injury due to Ashwagandha. A Case Series from Iceland and the U.S. Drug-Induced Liver Injury Network
dc.contributor.author | Björnsson, Helgi K. | |
dc.contributor.author | Björnsson, Einar S. | |
dc.contributor.author | Avula, Bharathi | |
dc.contributor.author | Khan, Ikhlas A. | |
dc.contributor.author | Jonasson, Jon G. | |
dc.contributor.author | Ghabril, Marwan | |
dc.contributor.author | Hayashi, Paul H. | |
dc.contributor.author | Navarro, Victor | |
dc.contributor.department | Medicine, School of Medicine | en_US |
dc.date.accessioned | 2022-08-24T12:30:47Z | |
dc.date.available | 2022-08-24T12:30:47Z | |
dc.date.issued | 2020-04 | |
dc.description.abstract | Background & aims: Ashwagandha (Withania somnifera) is widely used in Indian Ayurvedic medicine. Several dietary supplements containing ashwagandha are marketed in the US and Europe, but only one case of drug-induced liver injury (DILI) due to ashwagandha has been published. The aim of this case series was to describe the clinical phenotype of suspected ashwagandha-induced liver injury. Methods: Five cases of liver injury attributed to ashwagandha-containing supplements were identified; three were collected in Iceland during 2017-2018 and two from the Drug-Induced Liver Injury Network (DILIN) in 2016. Other causes for liver injury were excluded. Causality was assessed using the DILIN structured expert opinion causality approach. Results: Among the five patients, three were males; mean age was 43 years (range 21-62). All patients developed jaundice and symptoms such as nausea, lethargy, pruritus and abdominal discomfort after a latency of 2-12 weeks. Liver injury was cholestatic or mixed (R ratios 1.4-3.3). Pruritus and hyperbilirubinaemia were prolonged (5-20 weeks). No patient developed hepatic failure. Liver tests normalized within 1-5 months in four patients. One patient was lost to follow-up. One biopsy was performed, showing acute cholestatic hepatitis. Chemical analysis confirmed ashwagandha in available supplements; no other toxic compounds were identified. No patient was taking potentially hepatotoxic prescription medications, although four were consuming additional supplements, and in one case, rhodiola was a possible causative agent along with ashwagandha. Conclusions: These cases illustrate the hepatotoxic potential of ashwagandha. Liver injury is typically cholestatic or mixed with severe jaundice and pruritus, but self-limited with liver tests normalizing in 1-5 months. | en_US |
dc.eprint.version | Author's manuscript | en_US |
dc.identifier.citation | Björnsson HK, Björnsson ES, Avula B, et al. Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int. 2020;40(4):825-829. doi:10.1111/liv.14393 | en_US |
dc.identifier.uri | https://hdl.handle.net/1805/29858 | |
dc.language.iso | en_US | en_US |
dc.publisher | Wiley | en_US |
dc.relation.isversionof | 10.1111/liv.14393 | en_US |
dc.relation.journal | Liver International | en_US |
dc.rights | Publisher Policy | en_US |
dc.source | PMC | en_US |
dc.subject | Liver | en_US |
dc.subject | Drug-Induced Liver Injury | en_US |
dc.subject | Dietary Supplements | en_US |
dc.title | Liver Injury due to Ashwagandha. A Case Series from Iceland and the U.S. Drug-Induced Liver Injury Network | en_US |
dc.type | Article | en_US |