Herbal hepatotoxicity: Challenges and pitfalls of causality assessment methods

摘要: The diagnosis of herbal hepatotoxicity or herb induced liver injury (HILI) represents a particular clinical and regulatory challenge with major pitfalls for the causality evaluation. At day HILI is suspected in patient, physicians should start assessing quality used product, optimizing data completeness, applying Council International Organizations Medical Sciences (CIOMS) scale initial assessment. This structured, quantitative, specific, validated cases. Its items provide individual scores, which together yield levels highly probable, possible, unlikely, excluded. After completion by additional information including raw data, this all be reported to agencies manufacturers further CIOMS preferred as tool cases, compared numerous other assessment methods, are inferior on various grounds. Among these disputed methods Maria Victorino scale, an insufficiently qualified, shortened version well unspecific such ad hoc approach, Naranjo World Health Organization (WHO) method, Karch Lasagna method. An expert panel required Drug Induced Liver Injury Network WHO approaches based opinion, retrospective analyses long delay thereby prevent timely illness question physician. In conclusion, challenging best achieved specific avoiding commonly observed approaches.