Increased hospitalization related to acute hepatitis in Chinese herbs users-A population-based case-crossover study in Taiwan

Although the increase in popularity of herbal products in past years, there has been a growing concern about health hazards caused by Chinese herbs. There are few epidemiological studies addressing the relationship between Chinese herbs and hepatic adverse effects worldwide. In Taiwan, Chinese herbal medicines (CHMs) play an important role of health care system and payments of Bureau of National Health Insurance apply to most CHMs in concentrated form. We attempted to determine the relation between the hospitalization related to acute hepatitis and CHMs prescriptions. We designed a case-crossover study by using the database of 200,000 people randomly sampled from the National Health Insurance during 1997-2002.
We found 30 days were the most probable time to event. The significant adjusted odds ratio was the population of other acute hepatitis, 5.53 (95% confidence interval: 2.05 to 14.89) and acute hepatitis B 2.17 (95% confidence interval: 1.01 to 4.68). By the temporal sequence, cumulative dose and challenge assessment of 32 case with hepatoxic CHMs and western medicines in two groups, we found 12 cases having relation with hepatoxic CHMs possibly and eight of them were admitted for more than one week. The hepatoxic CHMs that had been reported, Radix Scutellariae, Radix Bupleuri, Herba Ephedrae, Rhizoma Atracylodis Macrocephalac, Radix Glycyrrhizae, Cortex Moutan, Cortex Dictamni, and Radix Paeoniae was also possibly causal to hospitalization. Further, Corydalis decumbens, Herba Artemisiae Scopariae, Rhizoma Coptidis and Fructus Toosendan less or no reported previously were suspected with causal relation to hospitalization.
Our results can provide some safety information about CHMs users in Chinese society to demonstrate increased hospitalization related to acute hepatitis in Chinese herbs users. People and physicians should take into account this finding and should be aware of possible ingestion of herbal medicines, especially these suspected hepatoxic CHMs. We recommend that it is important to conduct systematic Chinese herbal pharmacovigilance and active surveillance study for these hepatotoxic CHMs in the near future.