Hepatotoxic herbs: will injury mechanisms guide treatment strategies?

Harmful and fatal outcomes related to specific herbal therapies are reported with increasing regularity. However, US physicians remain inadequately informed about potential toxicities. The purpose of this focused review is to highlight past and more recently recognized herbal therapies or complementary and alternative medicine (CAM) that are shown to cause hepatotoxicity. Where available, the proposed mechanisms for toxicity are discussed. An aggressive approach for more stringent regulation of CAM is needed, in addition to a systematic and scientific study of causality and underlying toxic mechanisms, to provide reliable information about the safety of CAM and enable practitioners to deliver effective remedies when toxicities occur.