Representational photo. (Getty)

NEW DELHI: Alternative and herbal medicines may not always be without side-effects.

Doctors say unmonitored use of such medication, as also long-term drugs for ailments such as TB and body-building protein supplements, may lead to liver failure even among patients with no history of liver disease.

Take the case of Rashmi Khare (name changed). The 27-year-old Delhi girl was admitted to Institute of Liver and Biliary Sciences (ILBS) with acute liver failure resulting in internal bleeding and fatigue. She had been on medication for TB for a long time but the drug’s effect on the liver was not monitored.

“She is being managed well with plasma exchange therapy. But the need for a transplant in future cannot be ruled out,” said Dr S K Sarin, director, ILBS.

Dr Sarin added that he gets one to two cases of drug-induced liver failure every week. “Alternative medicines or herbal drugs are the most common culprits followed by anti-tubercular medications, body-building protein supplements, painkillers and antibiotics,” he said.

Dr A S Soin who heads the liver transplant unit at Medanta Medicity in Gurgaon and Dr Subhash Gupta of Apollo hospital also confirmed the trend.

In a recent study, conducted by ILBS in collaboration with experts from 29 countries, doctors found one out of every 10 patients suffering from chronic liver disease developed acute failure of the organ due to drug toxicity.

“Complementary and alternative medications (72%) were the commonest cause, followed by combination anti-tuberculosis therapy drugs (27%) and other medications (1%),” states the study published in latest issue of the American Journal of Gastroenterology.

The doctors advised people to be careful with medications that have to be taken for longer duration. “Liver is responsible for concentrating and metabolising a majority of medications. That’s why it is the prime target for medication-induced damage,” say doctors, adding that patients who are put on drugs with known toxicity should be routinely checked for any damage to the liver for timely action.

Those with fatty liver, alcohol-induced liver disease or chronic illnesses caused by viruses Hepatitis B and Hepatitis C need to be even more careful. For, research shows, drug toxicity can precipitate liver damage faster in them.

Precipitation of underlying liver disease can also be caused by alcohol and viruses such as Hepatitis A , B or E. But, the researchers found overall mortality from drug-induced acute chronic liver failure was 46.5%, which was significantly higher than 39% from non-drug causes. The ILBS director said use of complementary and alternative medicines including herbal and dietary substances is ubiquitous and growing, and many of these compounds often contain multiple ingredients that are detrimental to the liver.

“If the drug-induced injury is mild, liver functions can recover by themselves by eliminating the offending drug. But if the injury is severe, that is progressive jaundice, bleeding disorder or swelling over feet or abdomen, it is serious. Such patients may require specialised care and in some cases liver transplant,” Dr Sarin said.

He added that at ILBS they are also experimenting with plasma exchange therapy for drug-induced liver failure in which plasma from the patient’s blood is taken away and replenished with fresh healthy plasma taken donor plasma.

“We have tried this therapy in about 50 patients with promising results,” the ILBS director said. He added patients who start with a new type of drug and get itching or loss of appetite or change in colour of urine should get a liver function test done for early detection of drug-induced liver damage.

