Hepatotoxicity of herbal remedies: an emerging dilemma.

The surge in consumption of herbal remedies has been stimulated by several factors, including the notion that all herbal products are safe and effective, consumers becoming more proactive in self-treating, and lack of regulation by the Food and Drug Administration. Although herbal remedies are generally perceived as harmless, reports of hepatotoxicity associated with herbal use are accumulating, suggesting they are not completely innocuous. On the basis of various case reports, the liver injury from herbal remedies has ranged from mild elevations of liver enzymes to fulminant liver failure requiring liver transplantation. Although regulation by the Food and Drug Administration may be part of the solution, increasing public awareness and educating healthcare professionals about the potential dangers of herbal preparations will need to be implemented. This article reviews the hepatotoxicity of herbal remedies as reported in the literature and discusses issues related to regulation of herbal preparations.