The efficacy of Jujube syrup on the prevention of drug-induced hepatotoxicity in pulmonary tuberculosis patients: A pilot randomized double-blind placebo-controlled clinical trial.

The short version

This pilot, double-blind, placebo-controlled trial with 34 newly diagnosed pulmonary tuberculosis patients explored whether Jujube (Ziziphus jujuba), a fruit long used in traditional Persian medicine for liver complaints, could guard the liver during the first weeks of standard four-drug anti-tuberculosis treatment. Anti-TB drugs commonly injure the liver, a complication called drug-induced hepatotoxicity (governing whether treatment can continue on schedule), reported in up to 28% of patients. Jujube's traditional reputation rests partly on compounds called phenols, which govern antioxidant activity by neutralizing the free radicals that anti-TB drugs generate in liver cells. Over four weeks across five Iranian health centers, participants aged 18 to 68 took either 10 cc of jujube syrup or an identical-tasting placebo syrup daily alongside their standard tuberculosis medications. Researchers measured liver enzymes by blood test at the start, two weeks, and four weeks in, and tracked cough, appetite loss, nausea, and overall quality of life using standardized questionnaires. Seventeen of the 34 enrolled participants, eight jujube and nine placebo, completed all four weeks, with a COVID-19 outbreak driving most of the dropout. By the two-week mark, more than a quarter of placebo-group patients (27.3%) had developed liver injury, compared to none in the jujube group, a statistically meaningful difference (p=.037, meaning this gap is unlikely to be chance). AST liver-enzyme levels were also significantly lower with jujube at two weeks (p=.039, a large effect), though the companion ALT measurement did not reach statistical significance (p=.114). Cough severity dropped significantly more with jujube at both two weeks (p=.046) and four weeks (p=.024), and overall quality of life improved significantly more by four weeks (p=.032), especially in physical well-being. Gastrointestinal symptoms like nausea and appetite loss improved similarly in both groups. No one in the jujube group stopped taking it because of side effects. These early results suggest jujube syrup could be a simple, low-cost addition to standard tuberculosis care that protects the liver during its highest-risk window while easing cough and improving daily life. The catch: only 17 patients completed the study, and a pandemic-driven dropout forced the trial to end as a small pilot rather than its originally planned larger version, so these findings point toward a promising direction rather than settled proof. Confirmation in a full-scale trial is the clear next step before jujube syrup could be recommended in tuberculosis treatment.

Key findings

• In this small pilot trial, none of the 8 patients who took jujube (Ziziphus jujuba) syrup developed liver damage from their tuberculosis medications, compared to 27.3% of the 9 patients who received a placebo syrup (p=.037).
• Jujube syrup also significantly reduced cough severity at two and four weeks and improved overall quality of life, especially physical well-being, compared to placebo.
• Researchers believe jujube's benefit comes from its phenolic compounds, which act as antioxidants (substances that neutralize the cell-damaging molecules called free radicals) and may protect the liver from the toxic effects of anti-tuberculosis drugs.
• No significant side effects from the jujube syrup itself were reported, and no participant stopped taking it because of side effects.
• Because only 17 of the 34 enrolled patients completed the four-week study, partly due to a COVID-19 outbreak that disrupted recruitment, these findings are considered preliminary and need confirmation in a larger clinical trial before jujube syrup can be recommended in tuberculosis care.

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