Hepatotoxizität von Arzneimitteln pflanzlichen Ursprungs

Pflanzliche Medikamente sind weit verbreitet und enthalten häufig pharmakologisch hoch aktive Substanzen. In letzter Zeit häufen sich Berichte über eine Hepatotoxizität pflanzlicher Medikamente mit leichten Leberwertveränderungen bis zu schwersten chronischen Lebererkrankungen und Leberversagen.

Eine Hepatotoxizität chinesischer Kräutertees wurde unter anderem im Zusammenhang mit der Behandlung von Hautekzemen beobachtet, die verantwortlichen Substanzen sind bisher allerdings unbekannt. Die akute Lebervenen-Verschlusskrankheit wird von in vielen Pflanzen enthaltenen Pyrrolizidinalkaloiden hervorgerufen. Teucrium chamaedrys, auch Edelgamander genannt, kann zu Hepatitis und Leberzirrhose führen. Erhebliche Leberschäden wurden mit Kreosoth in Verbindung gebracht. Vor kurzem konnte auch Schöllkraut, das unter anderem zur Behandlung von Gallenleiden und Dyspepsie eingesetzt wurde, als Auslöser einer cholestatischen Hepatitis identifiziert werden. Hepatotoxische Reaktionen wurden auch nach der Einnahme von Atractylis gummifera, Callilepsis laureola, Senna, Kavapyron und Pulegium beschrieben.

Ziel dieser Übersicht ist es, auf die wesentlichen pflanzlichen, potenziell hepatotoxischen Substanzen hinzuweisen, deren Toxizität - soweit bekannt - zu skizzieren und damit das Bewusstsein für pflanzliche Pharmaka als mögliche Ursache von Leberschäden zu schärfen.

Hepatotoxicity of herbal remedies

Herbal drugs are widely used and often contain highly active pharmacological compounds. Recently, reports have mounted about hepatotoxicity of herbal remedies which ranges from mild liver enzyme alterations to chronic liver disease and liver failure.

Hepatotoxicity of Chinese herbs has been recognized, e. g. during treatment of patients with atopic eczema. However, the toxic compounds remain to be determined. Hepatic veno-occlusive disease may result from pyrrolizidine alkaloids which are contained in numerous plants worldwide. Teucrium chamaedrys, commonly referred to as germander, may cause hepatitis and even liver cirrhosis. Significant hepatotoxicity has also been observed after the ingestion of chaparral. Recently, greater celandine, which is widely used for biliary disorders and dyspepsia, was identified as a cause of cholestatic hepatitis. Hepatotoxic reactions have also been observed after the ingestion of Atractylis gummifera, Callilepsis laureola, Senna, Kavapyrone and Pulegium.

The aim of this review is to summarize potentially hepatotoxic herbal remedies, to further elucidate their mechanisms of toxicity and thereby underline the likelihood of plants to be the cause of liver damage.

Schlüsselwörter

Hepatotoxizität - Pflanzliche Arzneimittel - Chinesische Kräuter - Gamander - Phytopharmaka - Pyrrolizidinalkaloide - Schöllkraut - Senna - Sho-saiko-to - Alternative Medizin

Key words

Hepatotoxicity - Botanicals - Chinese Herbs - Germander - Phytotherapy - Pyrrolizidine Alkaloids - Greater Celandine - Senna - Sho-saiko-to - Alternative Medicine

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