Drug and herbal/dietary supplements-induced liver injury: A tertiary care center experience

Table 3 Histopathological patterns, R ratios and Drugs/HDS in our study

Histopathological pattern	R ratio	Total, n = 38 (%)	Drugs/HDS (n)
Hepatitis	12 ± 0.4	18 (47.4)
Acute	16 ± 0.1	5 (13.2)	Nitrofurantoin (1)
			Black cohosh1 (1)
			Sertraline (1)
			Lamotrigine (1)
			Green tea extract (1)
Acute with extensive necrosis	11 ± 3.3	8 (21.1)	Diclofenac (1)
			Acetaminophen (6)
			Black cohosh1 (1)
Autoimmune-like	6.2 ± 0.1	3 (7.9)	Infliximab (2)
			Isoniazid (1)
Chronic	8.8	1 (2.6)	Nitrofurantoin (1)
Non-necrotizing granulomatous hepatitis	14	1 (2.6)	BCG (1)
Cholestasis	0.5 ± 0.1	5 (13.2)
Acute	0.4 ± 0.5	4 (10.5)	Ceftriaxone (1)
			Methimazole (1)
			Total parenteral nutrition (1)
			Rivaroxaban (1)
Chronic	0.8	1 (2.6)	Triazolam and statin (1)
Cholestatic hepatitis	9.0 ± 5.6	8 (21.1)	Ezetimibe (1)
			Cefazolin (1)
			Hydroxycut2 (1)
			Rizatriptan5 (1)
			Methyldrostanolone (1)
			Trimethobenzamide Hydrochloride5 (1)
			Mesalamine (1)
			C4 extreme3 (1)
Macrovesicular steatohepatitis	1.4 ± 1.2	5 (13.2)	Trimethoprim-sulfamethoxazole6 (1)
			L-asparaginase (1)
			Valproic acid (1)
			Haart4 (1)
			Amiodarone (1)
Mixed cholestatic hepatitis with steatosis and bile duct injury	1.1 ± 0.8	2 (5.3)	Dronedarone6 (1)
			Hydroxycut26 (1)

¹Actaea racemosa or cimicifuga racemose.

²Contains caffeine, lady's mantle extract (Alchemilla vulgaris), wild olive extract (Olea europaea), cumin extract (Cuminum cyminum), wild mint extract (Mentha longifolia), and, in some products, green coffee bean extract (Coffea canephora).

³CarnoSyn Beta Alanine to support muscular endurance, TeaCrine to prolong tolerance buildup, Rauwolfia, and Toothed Clubmoss.

⁴Highly active antiretroviral therapy.

⁵Not previously reported.

⁶Unusual patterns for this drug/HDS. HDS: Herbal/Dietary supplements; BCG: Bacillus Calmette Guerin.