Senna-Induced Hepatitis in a Poor Metabolizer
Authors: Ulrich Seybold, Nikola Landauer, Susanne Hillebrand, Frank-Detlef Goebel
Journal: Annals of Internal Medicine (2004)

Letters19 October 2004Senna-Induced Hepatitis in a Poor MetabolizerUlrich Seybold, MD, Nikola Landauer, MD, Susanne Hillebrand, MS, and Frank-Detlef Goebel, MDUlrich Seybold, MDFrom Klinikum der Ludwig-Maximilians-Universität, D-80336 Munich, Germany., Nikola Landauer, MDFrom Klinikum der Ludwig-Maximilians-Universität, D-80336 Munich, Germany., Susanne Hillebrand, MSFrom Klinikum der Ludwig-Maximilians-Universität, D-80336 Munich, Germany., and Frank-Detlef Goebel, MDFrom Klinikum der Ludwig-Maximilians-Universität, D-80336 Munich, Germany.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-8-200410190-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: Preparations of senna leaves and fruits are widely used to treat constipation. Most reports of toxicity have involved only large doses.Objective: To show the increased potential for toxic effects of senna in the context of a variant of cytochrome P450 2D6 (CYP2D6).Case Report: A 28-year-old woman presented with a 2-week history of fatigue, myalgias, epigastric pain, pyrosis, and nausea. For 2 days, she had noted yellowish eyes and dark urine. Recently, she had been consuming 3 to 4 L of beer per week. She had previously received hepatitis A virus and hepatitis B virus ...References1. Kobashi K, Nishimura T, Kusaka M, Hattori M, Namba T. Metabolism of sennosides by human intestinal bacteria. Planta Med. 1980;40:225-36. [PMID: 7443842] CrossrefMedlineGoogle Scholar2. de Witte P, Lemli L. The metabolism of anthranoid laxatives. Hepatogastroenterology. 1990;37:601-5. [PMID: 2289777] MedlineGoogle Scholar3. Beuers U, Spengler U, Pape GR. Hepatitis after chronic abuse of senna [Letter]. Lancet. 1991;337:372-3. [PMID: 1671276] CrossrefMedlineGoogle Scholar4. Krumbiegel G, Schulz HU. Rhein and aloe-emodin kinetics from senna laxatives in man. Pharmacology. 1993;47 Suppl 1 120-4. [PMID: 8234418] CrossrefMedlineGoogle Scholar5. Sachse C, Brockmoller J, Bauer S, Roots I. Cytochrome P450 2D6 variants in a Caucasian population: allele frequencies and phenotypic consequences. Am J Hum Genet. 1997;60:284-95. [PMID: 9012401] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Ulrich Seybold, MD; Nikola Landauer, MD; Susanne Hillebrand, MS; Frank-Detlef Goebel, MDAffiliations: From Klinikum der Ludwig-Maximilians-Universität, D-80336 Munich, Germany. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Underling Mechanisms Exploration of Rubia cordifolia L. Extract Against Rheumatoid Arthritis by Integrating Network Pharmacology and MetabolomicsAcute Hepatitis and Pancytopenia in a Child With Chronic Abuse of SennaComprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbsUrine Metabolomics Study on Potential Hepatoxic Biomarkers Identification in Rats Induced by Aurantio-ObtusinLiver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 seriesAnthraquinones As Pharmacological Tools and DrugsHerbal Hepatotoxicity: Clinical Characteristics and Listing CompilationFabaceaeEffects of long-term administration of Senna occidentalis seeds on the hematopoietic tissue of ratsToxicology and Carcinogenesis Study of Senna in C3B6.129F1- Trp53tm1Brd N12 Haploinsufficient MiceDrug-Induced Liver Injury: The Role of Drug Metabolism and TransportFabaceae Lindl.Herbal hepatotoxicity: a tabular compilation of reported casesSurveillance of suspected adverse reactions to herbal products used as laxativesDiuretics, Ipecac, and LaxativesAn Evidence-Based Systematic Review of Senna ( Cassia senna ) by the Natural Standard Research CollaborationReview of liver injury associated with dietary supplementsAdministration Senna occidentalis Seeds to Adult and Juvenile Rats: Effects on Thymus, Spleen and in Hematological ParametersDrug-induced liver injury: insights from genetic studiesHerbal Medicines – Acanthaceae – ZygophyllaceaeHydroxycut hepatotoxicity: A case series and review of liver toxicity from herbal weight loss supplementsHerbal HepatotoxicityFabaceaeAcute Liver Failure with Renal Impairment Related to the Abuse of Senna Anthraquinone GlycosidesDrug-induced liver disease 2004 19 October 2004Volume 141, Issue 8Page: 650-651KeywordsAlcoholsHalf lifeHepatitis AIngestionLiverMyalgiaPharmacokineticsResearch laboratoriesTeaUrine ePublished: 19 October 2004 Issue Published: 19 October 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...