Herb-induced liver injury (HILI) has recently attracted attention due to
increasing reports of hepatotoxicity associated with use of phytotherapeutics.
Here, we present data on HILI from the Berlin Case-Control Surveillance Study.
The study was initiated in 2000 to investigate the serious toxicity of drugs
including herbal medicines. Potential cases of liver injury were ascertained
in more than 180 Departments of all 51 Berlin hospitals from October 2002 to
December 2011. Drug or herb intake was assessed through a standardized face-
to-face interview. Drug or herbal aetiology was assessed based on the updated
Council for International Organizations of Medical Sciences scale. In ten of
all 198 cases of hepatotoxicity included in the study, herbal aetiology was
assessed as probable (once ayurvedic herb) or possible (Valeriana five times,
Mentha piperita once, Pelargonium sidoides once, Hypericum perforatum once,
Eucalyptus globulus once). Mean age was 56.4 ± 9.7 years, and the predominant
pattern of liver injury was hepatocellular. No cases of acute liver failure or
death were observed. This case series corroborates known risks for ayurvedic
herbs, supports the suspected association between Valeriana use and liver
injury, and indicates a hepatotoxic potential for herbs such as Pelargonium
sidoides, Hypericum perforatum or Mentha piperita that were rarely associated
with liver injury before. However, given that possible causality does not
prove clinical significance, further studies in this field are needed