

Лекарственное повреждение печени, вызванное приемом «биологически активной добавки» Ашваганды: систематический обзор отчетов о случаях
https://doi.org/10.33667/2078-5631-2024-16-83-87
Аннотация
Биологически активная добавка «Ашваганды» стала популярна среди россиян. Информация о побочных эффектах, связанных с приемом Ашваганды, присутствует в отчетах о случаях и сериях случаев, хотя она может быть недоступна.
Цель. Проведение систематического обзора клинических случаев и серий случаев о предполагаемом повреждении печени, вызванным Ашвагандой.
Методы. Исследование было проведено в соответствии с заявлением о предпочтительных отчетных показателях для систематических обзоров и метаанализов. В данном обзоре рассматривались статьи, опубликованные с декабря 2018 г. по декабрь 2023 г. Для проведения систематического поиска было использовано несколько научных баз: PubMed, Science Direct и Google Scholar. Уровень доказательности включенных исследований был классифицирован с использованием уровня доказательности Оксфордского центра доказательной медицины.
Результаты. Всего в базах данных было выявлено 76 упоминаний, в ходе процедуры скрининга в обзор было включено 11 исследований.
Выводы. Таким образом, мы представляем 23 случая лекарственного поражения печени, вызванных Ашвагандой, с аналогичными паттернами поражения печени и исходами.
Ключевые слова
Об авторах
А. Б. МирошниковРоссия
Мирошников Александр Борисович, д. б. н., доцент, проф. кафедры спортивной медицины, декан факультета адаптивной физической культуры, рекреации и туризма
Москва
П. Д. Рыбакова
Россия
Рыбакова Полина Денисовна, аналитик отдела спортивной нутрициологии
Москва
А. Г. Антонов
Россия
Антонов Алексей Геннадьевич, аналитик отдела спортивной нутрициологии
Москва
Список литературы
1. Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern Med Rev. 2000; 5 (4): 334–46.
2. Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014; 20 (12): 901–8. DOI: 10.1089/acm.2014.0177
3. Durg S, Shivaram SB, Bavage S. Withania somnifera (Indian ginseng) in male infertility: An evidence-based systematic review and meta-analysis. Phytomedicine. 2018; 50: 247–256. DOI: 10.1016/j.phymed.2017.11.011
4. Smith SJ, Lopresti AL, Teo SYM, Fairchild TJ. Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review. Adv Nutr. 2021; 12 (3): 744–765. DOI: 10.1093/advances/nmaa134
5. Morgado A, Tsampoukas G, Sokolakis I, Schoentgen N, Urkmez A, Sarikaya S. Do «testosterone boosters» really increase serum total testosterone? A systematic review. Int J. Impot. Res. 2023. DOI: 10.1038/s41443–023–00763–9
6. Nasimi Doost Azgomi R, Zomorrodi A, Nazemyieh H, Fazljou SMB, Sadeghi Bazargani H, Nejatbakhsh F, Moini Jazani A, Ahmadi AsrBadr Y. Effects of Withania somnifera on Reproductive System: A Systematic Review of the Available Evidence. Biomed. Res. Int. 2018; 2018: 4076430. DOI: 10.1155/2018/4076430
7. Durg S, Bavage S, Shivaram SB. Withania somnifera (Indian ginseng) in diabetes mellitus: A systematic review and meta-analysis of scientific evidence from experimental research to clinical application. Phytother. Res. 2020; 34 (5): 1041–1059. DOI: 10.1002/ptr.6589
8. Ng QX, Loke W, Foo NX, Tan WJ, Chan HW, Lim DY, Yeo WS. A systematic review of the clinical use of Withania somnifera (Ashwagandha) to ameliorate cognitive dysfunction. Phytother. Res. 2020; 34 (3): 583–590. DOI: 10.1002/ptr.6552
9. Della Porta M, Maier JA, Cazzola R. Effects of Withania somnifera on Cortisol Levels in Stressed Human Subjects: A Systematic Review. Nutrients. 2023; 15 (24): 5015. DOI: 10.3390/nu15245015
10. Gómez Afonso A, Fernandez-Lazaro D, Adams DP, Monserdà-Vilaró A, Fernandez-Lazaro CI. Effects of Withania somnifera (Ashwagandha) on Hematological and Biochemical Markers, Hormonal Behavior, and Oxidant Response in Healthy Adults: A Systematic Review. Curr. Nutr. Rep. 2023; 12 (3): 465–477. DOI: 10.1007/s13668–023–00481–0
11. Pérez-Gómez J, Villafaina S, Adsuar JC, Merellano-Navarro E, Collado-Mateo D. Effects of Ashwagandha (Withania somnifera) on VO2max: A Systematic Review and Meta-Analysis. Nutrients. 2020; 12 (4): 1119. DOI: 10.3390/nu12041119
12. Bonilla DA, Moreno Y, Gho C, Petro JL, Odriozola-Martínez A, Kreider RB. Effects of Ashwagandha (Withania somnifera) on Physical Performance: Systematic Review and Bayesian Meta-Analysis. J Funct Morphol Kinesiol. 2021; 6 (1): 20. DOI: 10.3390/jfmk6010020
13. Rukstela A, Lafontant K, Helms E, Escalante G, Phillips K, Campbell BI. Bodybuilding Coaching Strategies Meet Evidence-Based Recommendations: A Qualitative Approach. J. Funct. Morphol. Kinesiol. 2023; 8 (2): 84. DOI: 10.3390/jfmk8020084
14. Technical Regulation of the Customs Union TR TS (Russia) 021/2011O food safety [Electronic resource] Access modehttps://docs.cntd.ru/document/902320560
15. Dickson K, Yeung CA. PRISMA 2020 updated guideline. Br. Dent. J. 2022; 232 (11): 760–761. DOI: 10.1038/s41415–022–4359–7
16. McHugh ML. Interrater reliability: the kappa statistic. Biochem. Med. (Zagreb). 2012; 22 (3): 276–82.
17. Howick J, Chalmers I, Glasziou P et al. Background document: explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence. University of Oxford, Centre for Evidence-Based Medicine, Oxford, UK. 2011.
18. Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid-Based Med. 2018; 23: 60–63. DOI: 10.1136/ bmjebm‑2017–110853
19. Suryawanshi G, Abdallah M, Thomson M, Desai N, Chauhan A, Lim N. Ashwagandha-Associated Acute Liver Failure Requiring Liver Transplantation. Am. J. Ther. 2023; 30 (1): e80–e83. DOI: 10.1097/MJT.0000000000001466
20. Weber S, Gerbes AL. Ashwagandha-Induced Liver Injury: Self-Reports on Commercial Websites as Useful Adjunct Tools for Causality Assessment. Am. J. Gastroenterol. 2021; 116 (10): 2151–2152. DOI: 10.14309/ajg.0000000000001369
21. Inagaki K, Mori N, Honda Y, Takaki S, Tsuji K, Chayama K. A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by ashwagandha. Kanzo. 2017; 58 (8). DOI: 10.2957/kanzo.58.448
22. Rattu Mohammad, Maddock Eric, Espinosa James, Lucerna Alan, Bhatnagar Neeharika. An Herbal Liver Effect: Ashwagandha-Induced Hepatotoxicity. Stratford Campus Research Day. 2022; 14.
23. Vazirani S. Supplements Are Not a Synonym for Safe: Suspected Liver Injury From Ashwagandha. Federal Practitioner. 2023; 40 (9). DOI: 10.12788/fp.0409
24. Wayman C, Halterman T. S 3229 A Case of Cholestatic Drug-Induced Liver Injury After Ashwagandha Root Supplementation. The American Journal of Gastroenterology. 2022; 117 (10S): e2062. DOI: 10.14309/01.ajg.0000869556.43701.6b
25. Tóth M, Benedek AE, Longerich T, Seitz HK. Ashwagandha-induced acute liver injury: A case report. Clin. Case. Rep. 2023; 11 (3): e7078. DOI: 10.1002/ccr3.7078
26. Lubarska M, Hałasiński P, Hryhorowicz S, Mahadea DS, Łykowska-Szuber L, Eder P, Dobrowolska A, Krela-Kaźmierczak I. Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury. Int J. Environ Res. Public. Health. 2023; 20 (5): 3921. DOI: 10.3390/ijerph20053921
27. Ireland PJ, Hardy T, Burt AD, Donnelly MC. Drug-induced hepatocellular injury due to herbal supplement ashwagandha. J. R. Coll. Physicians Edinb. 2021; 51 (4): 363–365. DOI: 10.4997/JRCPE.2021.409
28. Philips CA, Valsan A, Theruvath AH, Ravindran R, Oommen TT, Rajesh S, Bishnu S, Augustine P. Liver Research Club India. Ashwagandha-induced liver injury-A case series from India and literature review. Hepatol. Commun. 2023; 7 (10): e0270. DOI: 10.1097/HC 9.0000000000000270
29. Kumari S, Pal B, Sahu SK, Prabhakar PK, Tewari D. Adverse events of clenbuterol among athletes: a systematic review of case reports and case series. Int J. Legal. Med. 2023; 137 (4): 1023–1037. DOI: 10.1007/s00414–023–02996–1
30. Ali Sajjadh M J, Suresh M, Sanchez-Cruz J, Anand C. S 2976 Cry Me a Liver: Ashwagandha Induced Liver Toxicity. The American Journal of Gastroenterology. 2022; 117 (10S): p e1931. DOI: 10.14309/01.ajg.0000868544.04043.fe
31. Bokan G, Glamočanin T, Mavija Z, Vidović B, Stojanović A, Björnsson ES, Vučić V. Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause. Pharmaceuticals (Basel). 2023; 16 (8): 1129. DOI: 10.3390/ph16081129
32. Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro V. Ashwagandha- induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int. 2020; 40 (4): 825–829. DOI: 10.1111/liv.14393
33. Gnecco J, Baher H, Briones BM, Poordad F. S 2939 Ashwagandha Toxicity: A Rare Case of Drug Induced Liver Injury (DILI). Official journal of the American College of Gastroenterology| ACG. 2022; 117 (10S): e1910–1. DOI: 10.14309/01.ajg.0000868396.87202.fb
34. Woo SM, Davis WD, Aggarwal S, Clinton JW, Kiparizoska S, Lewis JH. Herbal and dietary supplement induced liver injury: Highlights from the recent literature. World J. Hepatol. 2021; 13 (9): 1019–1041. DOI: 10.4254/wjh.v13.i9.1019
35. Ballotin VR, Bigarella LG, Brandão ABM, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: Systematic review and meta-analysis. World J. Clin. Cases. 2021; 9 (20): 5490–5513. DOI: 10.12998/wjcc.v9.i20.5490
36. Başaran N, Paslı D, Başaran AA. Unpredictable adverse effects of herbal products. Food Chem Toxicol. 2022; 159: 112762. DOI: 10.1016/j.fct.2021.112762
37. Karousatos CM, Lee JK, Braxton DR, Fong TL. Case series and review of Ayurvedic medication induced liver injury. BMC Complement Med Ther. 2021; 21 (1): 91. DOI: 10.1186/s12906–021–03251-z
38. Devarbhavi H, Aithal G, Treeprasertsuk S, Takikawa H, Mao Y, Shasthry SM, Hamid S, Tan SS, Philips CA, George J, Jafri W, Sarin SK; Asia Pacific Association of Study of Liver. Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines. Hepatol. Int. 2021; 15 (2): 258–282. DOI: 10.1007/s12072–021–10144–3
39. Smith SJ, Lopresti AL, Fairchild TJ. Exploring the efficacy and safety of a novel standardized ashwagandha (Withania somnifera) root extract (Witholytin®) in adults experiencing high stress and fatigue in a randomized, double-blind, placebo-controlled trial. J. Psychopharmacol. 2023; 37 (11): 1091–1104. DOI: 10.1177/02698811231200023
40. Lammert C, Einarsson S, Saha C, Niklasson A, Bjornsson E, Chalasani N. Relationship between daily dose of oral medications and idiosyncratic drug-induced liver injury: search for signals. Hepatology. 2008; 47 (6): 2003–9. DOI: 10.1002/hep.22272
41. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; CARE Group*. The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob. Adv. Health Med. 2013; 2 (5): 38–43. DOI: 10.7453/gahmj.2013.008
Рецензия
Для цитирования:
Мирошников А.Б., Рыбакова П.Д., Антонов А.Г. Лекарственное повреждение печени, вызванное приемом «биологически активной добавки» Ашваганды: систематический обзор отчетов о случаях. Медицинский алфавит. 2024;(16):83-87. https://doi.org/10.33667/2078-5631-2024-16-83-87
For citation:
Miroshnikov A.B., Rybakova P.D., Antonov A.G. Drug-induced liver injury caused by Ashwagandha “supplementation”: a systematic review of case reports. Medical alphabet. 2024;(16):83-87. (In Russ.) https://doi.org/10.33667/2078-5631-2024-16-83-87