Chaparral-induced hepatotoxicity

Background: Chaparral leaf (Larrea tridentata) has been used for centuries to treat a variety of ailments. Laboratory investigations have demonstrated the presence of at least one pharmacologically active lignan, but no controlled studies have demonstrated efficacy and safety in vivo. Recent reports suggest chaparral may cause toxic hepatitis in some chronic users. Case Report: A 27-year-old Hispanic male developed hepatitis approximately 12 months after beginning therapy with chaparral capsules. Liver biopsy showed hepatocellular injury with necrosis and periportal inflammation. Liver function stabilized 6 weeks after hepatitis was first recognized. Conclusions: Although Chaparral has been associated with cholangitis, impaired synthetic function and fulminant hepatic failure, because the pattern of chaparral use is unknown, the incidence of hepatotoxicity is also unknown. Severe liver damage may be more common in patients taking higher doses for longer periods of time. Prolonged courses of chaparral should not be recommended routinely. Patients desiring to use chaparral for periods greater than two weeks should be warned of the potential for hepatotoxicity and monitored closely.