Hepatotoxicity associated with Garcinia cambogia: A case report

Table 3 The Council of International Organizations of Medical Sciences and Roussel Uclaf Causality Assessment Method Scale

Criteria	Score
Time from drug intake until reaction onset
5-90 d	+2
< 5 or > 90 d	+1
Time from drug withdrawal until reaction onset
< 15 d	+1
> 15 d	0
Alcohol risk
Present	+1
Absent	0
Age
> 55 yr	+1
< 55 yr	0
Course of reaction
> 50% improvement within 8 d	+3
> 50% improvement within 30 d	+2
Worsening or < 50% improvement in 30 d	-1
Concomitant therapy
Time to onset incompatible	0
Time to onset compatible but with unknown reaction	-1
Time to onset compatible but known reaction Role proved in the case	-2 -3
None or information not available	0
Exclusion of non-drug related causes
Ruled out	+2
Possible or not investigated	0
Probable	-3
Previous information on hepatotoxicity
Reaction unknown	0
Reaction published but unlabeled	+1
Reaction labeled in the product’s characteristics	+2
Response to re-administration
Positive	+3
Compatible	+2
Negative	-2
Not available or not interpretable	0
Plasma concentration of drug known as toxic	+3
Validated laboratory test with high specificity, sensitivity, and predictive values positive	+3
Validated laboratory test with high specificity, sensitivity, and predictive values negative	-3
Interpretation of score for drug induced liver injury:
> 8 definite drug induced liver injury
6-8 probable drug induced liver injury
3-5 Possible drug induced liver injury
1-2 Unlikely drug induced liver injury
< 0 drug induced liver injury excluded