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APPENDIX VII
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The following
information is based on an appendix found in The Hepatitis C Help Book
There is a great deal of research still to be done to identify those prescription medications, over-the-counter drugs, herbs and chemicals that are liver toxic. Some substances affect everyone negatively, some are dangerous for people who have liver disease. Others are hazardous when taken in too large a quantity, in combination with other substances or by people who have unusual immune responses. The following list of suspected or confirmed liver-toxic medications and herbs should help guide anyone with hepatitis. It is not comprehensive, however, and any time a person with liver disease contemplates taking a drug or herb, even when prescribed by a health care practitioner, he or she should be on the lookout for negative reactions. Combining herbs with interferon and/or ribavirin demands particular care. Anyone with HCV should discuss potential reactions and drug interactions with both western and Chinese medicine practitioners before taking any medication or herbal remedy. Although liver-toxic substances are identifiable in the laboratory, liver hypersensitivity problems are not predictable. In some cases, hypersensitivity may result in organ failure. Although hypersensitivity is hard to anticipate, some indicators offer clues as to who may be vulnerable. Indicators of possible negative reactions to medical substances include:
Important! You should discontinue taking any drug or herb if you experience a skin rash, substantial nausea, bloating, fatigue and/or aching in the area of the liver, yellowing of the skin, or pale feces. Dr. Gish has contributed information on liver-toxic drugs. David L. Diehl, MD, FACP, an associate clinical professor of medicine at UCLA School of Medicine, focuses on herbal toxicity. He, Ken Flora, MD, formerly of the University of Oregon Health Sciences Center, and Misha Cohen are currently undertaking an extensive survey of the literature concerning the liver toxicity of herbal medicines. Prescription and Over-The-Counter Drugs Patients who take the following medications regularly should undergo monthly laboratory testing for the first three months and then every three to six months to check on changes in liver function. Sample brand names are listed after the pharmaceutical name. Other products in addition to those mentioned may contain these drugs. Talk with your doctor and read all package inserts carefully.
According to an article published in the
April 1996 New England Journal of Medicine, the most common cause
of acute liver failure in the United States is the negative interaction
between acetaminophen (Tylenol) and alcohol. In addition, there are
interactions that are less common but equally as serious. Research
suggests individual genetic variations in liver
enzymes may be the cause. Chinese Herbal Preparations Herbal patent medicines, tonics, elixirs and prepackaged solutions are particularly risky for anyone, whether they have liver disease or not. Ingredient labels may be incomplete or mistranslated. Herbs may be mistakenly used in the concoctions that are dangerous or inappropriate in combination with other herbs. Toxic herbs may be substituted for beneficial ones. The best bet is to avoid self-prescribed premixed preparations. Rely on the best-trained and most experienced herbalist available to individualize your herbal therapy and monitor your reactions. Some reportedly hazardous herbs and herb formulas:
In addition, some Chinese patent
medicines may contain heavy metals, poisons, and other potentially
liver-toxic substances. In other cases, patent medicines contain western
pharmaceutical agents that are not listed on the label. Common Toxic Ingredients Found in Asian Patent Medicines: Be on guard for these ingredients.
Toxic Individual Herbs Dr. Diehl writes: “Herbal medicine is generally safe – safer than western pharmaceuticals. There are certain plants that are highly toxic. The most common examples are those that contain pyrolizidine alkaloids.” Those that contain alkaloids or that reportedly have triggered toxic reactions include the following.
Special Cases Licorice: a mainstay of Chinese formulas, licorice is used in very small quantities to balance herbal action and often appears as glycyrrhizin (licorice root). However, licorice produces well-documented side effects such as hyperaldosteronism (an increase in levels of the adrenal hormone aldosterone, triggering imbalance of electrolytes) when taken in doses of more than 50 grams a day or for six weeks or longer. However, no side effects have been seen in smaller doses over thirty days or in higher doses for a very short period of time. Skullcap: also called scutelleria or scute, this herb is used in many formulas to good effect. However, it appears that the toxic substance germander often is substituted for skullcap in formulas without being properly identified. As a result skullcap looks like the offending substance. Dr. Diehl found several mentions of skullcap toxicity in the literature, but those mentions may in fact refer to unidentified substitutions of germander. Further research is needed to clarify this. Until then, whenever skullcap appears in a formula, make sure that it, not germander, is in fact being used. If you cannot be sure, do not take the formula or herb. Dr. Diehl has found one mention of toxicity in the literature for the following herbs. Further documentation of toxicity is needed.
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having multiple allergies and having had
previous adverse reactions to drugs or herbs