Drug-Induced Hepatotoxicity

Francisca Herrera Vielma et al. (2025) · Pharmaceuticals (Basel, Switzerland)

This narrative review pulled together the existing lab and animal research on dandelion (Taraxacum officinale) — the common yellow-flowered "weed" long used in folk medicine across Europe, China, and North America for liver complaints — to ask what modern science actually shows about its ability to protect the liver. Liver disease, especially fatty liver linked to obesity and metabolic syndrome, is a fast-growing health problem with no approved drug treatment, which is part of what motivated researchers to revisit this traditional remedy scientifically. The review authors compiled dozens of published studies testing dandelion leaf, root, and whole-plant extracts, plus an isolated dandelion compound called taraxasterol, across many animal and cell models of liver injury: damage from drug overdose (acetaminophen), industrial toxins (carbon tetrachloride), alcohol, diabetes, and even liver cancer. No studies in human patients or volunteers were included anywhere in this review — every finding described here comes from lab-bench or animal-model science, not from people, which matters when weighing how confidently these results apply to human liver health. Across nearly every model tested, dandelion extracts and taraxasterol reduced liver damage markers, calmed inflammation, and boosted the body's own antioxidant defenses, with liver enzyme levels (AST, ALT) dropping toward normal after treatment. In one fatty-liver model, a leaf extract normalized blood sugar and insulin while cutting fat buildup in the liver, along with triglycerides and cholesterol. In cancer models, taraxasterol slowed tumor growth and helped cancer cells self-destruct while boosting immune activity against the tumor. The compound appears to work chiefly through two pathways: activating the cell's Nrf2 antioxidant defense system and blocking NF-κB, a master switch for inflammation. Doses used in these animal studies were often well above what a person would take in typical herbal use, so exact human relevance is unclear. These findings make a strong mechanistic case for dandelion's liver-protective potential, but the authors are clear this remains preclinical: no human clinical trials have tested it for liver disease, and animal-to-human translation is uncertain. Dandelion can interact with blood thinners, diuretics, and blood-pressure medication, and the review flags severe liver or kidney disease and pregnancy as situations where its safety has not been established. Real clinical trials are the necessary next step before dandelion can be recommended as a liver treatment.

Chote Luangchosiri et al. (2015) · BMC complementary and alternative medicine

This double-blind, placebo-controlled trial with 55 tuberculosis patients in Bangkok, Thailand explored whether silymarin, an extract of milk thistle (Silybum marianum) seeds long sold as a liver-support supplement, could protect the liver during standard four-drug tuberculosis treatment. Anti-tuberculosis drugs commonly injure the liver, a complication called drug-induced liver injury (governing whether treatment must be paused or adjusted), with past studies reporting it in up to nearly 28% of patients. Silymarin's traditional reputation rests on antioxidant activity, meaning it governs the body's ability to neutralize cell-damaging molecules called free radicals that these drugs generate in liver tissue. Over four weeks, participants took either a 140 mg silymarin tablet or an identical placebo three times daily alongside their standard tuberculosis medications (27 people got silymarin, 28 got placebo). Researchers tracked liver enzymes and antioxidant markers in blood tests at the study's start, two weeks, and four weeks in, and recorded any liver injury meeting a pre-set clinical definition. The trial planned to enroll 70 to 80 patients but stopped at 55 due to slow recruitment during the one-year study window. Liver injury developed in just 3.7% of the silymarin group (1 of 27 patients) compared to 32.1% of the placebo group (9 of 28), a statistically significant difference (p=.012) meaning silymarin lowered the risk by about 28 percentage points; put another way, treating about four patients with silymarin prevented one case of liver injury. Interestingly, the single peak liver-enzyme reading (ALT) at four weeks was not significantly different between groups (p=.455), so silymarin's benefit shows up in how many people develop liver injury, not necessarily in the single highest enzyme reading. An antioxidant enzyme called superoxide dismutase held up better in the silymarin group (p=.027), supporting the idea that silymarin works by boosting the body's own antioxidant defenses. Mild side effects like nausea and dizziness were equally uncommon in both groups, and no one had a serious reaction. These results suggest a low-cost silymarin tablet taken alongside standard tuberculosis treatment can meaningfully cut the chance of drug-induced liver injury, likely by protecting the liver's antioxidant capacity. The main limitation is that the study fell short of its planned enrollment (55 of 70-80 patients) at a single hospital, so despite properly randomized, double-blind design, the finding needs confirmation in larger, multi-center trials before silymarin becomes a routine addition to tuberculosis care.

Seyedeh Zahra Maddahi et al. (2022) · Pharmacology research & perspectives

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.

Janmejaya Samal (2015) · Journal of intercultural ethnopharmacology

This systematic review pooled published research on using Ayurveda, India's traditional medical system, alongside standard drugs for pulmonary tuberculosis (PTB) — a bacterial lung infection that remains one of India's leading causes of death. The review searched PubMed through April 2015 and found six studies worth including: four human trials testing Ayurvedic herbal formulas as add-ons to standard anti-TB drugs (ATDs), and two lab studies testing plant extracts directly against the TB bacterium. In Ayurveda, PTB is traditionally understood as Rajayakshma, a wasting condition tied to depleted bodily tissues (dhatu) and vital reserve (ojas) — explaining why many of the formulas studied are rejuvenative "Rasayana" tonics rather than antibiotics. The four clinical trials enrolled 30 to 133 PTB patients each, all in India, and ran from 28 days to 6-8 months. Participants took Ayurvedic formulas — a nine-herb Rasayana capsule, a liquid tonic called Bhringarajasava, Ashwagandha with Chyawanprash, or a hepatoprotective blend called Liv-600 — alongside their prescribed drug regimen (DOTS). Researchers tracked symptoms like cough and fever, body weight, X-ray changes, drug blood levels, and liver enzymes. The two lab studies tested leaf and plant extracts against TB bacteria in culture, measuring the lowest concentration that stopped bacterial growth. Across the trials, Ayurvedic add-ons consistently eased symptoms and supported weight gain more than standard treatment alone (p<0.001 in the largest trial). One striking finding: Ashwagandha plus Chyawanprash raised blood levels of two key TB drugs, isoniazid and pyrazinamide, by 7-10% (meaning the body absorbed more of the medicine that actually kills the bacteria) — potentially valuable given rising drug resistance. The hepatoprotective blend showed no harmful rise in liver enzymes, suggesting it may guard against the liver damage these drugs can cause. In the lab, extracts from four of five tested legumes completely stopped bacterial growth at a low concentration (50 micrograms per milliliter), and extracts from five other plants inhibited even drug-resistant TB strains by up to 95%. These findings position Ayurvedic formulas as promising supportive care — easing symptoms, protecting the liver, and possibly boosting drug absorption — rather than replacements for standard TB treatment, which no study tested. The evidence base is thin: only six studies total, all small, mostly from India, with just one describing blinding and none pooling results statistically. The authors call for properly designed clinical trials of the lab-active plants, especially against multidrug-resistant TB. The evidence reviewed concerns Ayurvedic preparations as adjuncts to prescribed drug therapy; none of it addresses their use instead of it.