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Review

Tinospora

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In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
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Review

Tinospora

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Excerpt

Tinospora cordifolia is an herbaceous climbing shrub native to India and South Asia, extracts of leaves, roots and bark of which have been used extensively in traditional Indian (Ayurveda) medicine for a multitude of conditions including diabetes, arthritis, liver diseases, malaria, pain, urinary tract infection, and recently prevention or amelioration of COVID-19 infection. Several recent reports have documented the occurrence of clinically apparent liver injury with its long term use.

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References

CITED REFERENCE

    1. Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, Reddy KR, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology 2014; 60: 1399-408. - PMC - PubMed

References

    1. Zimmerman HJ. Unconventional drugs. Miscellaneous drugs and diagnostic chemicals. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott,1999: pp. 731-4.(Expert review of hepatotoxicity published in 1999; several herbal medications are discussed, but not Tinospora).
    1. Liu LU, Schiano TD. Hepatotoxicity of herbal medicines, vitamins and natural hepatotoxins. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 2nd ed. New York: Informa Healthcare USA, 2007, pp. 733-54.(Review of hepatotoxicity of herbal and dietary supplements [HDS] published in 2007; no mention of Tinospora).
    1. Tinospora. In, PDR for Herbal Medicines. 4th ed. Montvale, New Jersey: Thomson Healthcare Inc. 2007: pp. 935-7.(Compilation of short monographs on herbal medications and dietary supplements).
    1. Sangsuwan C, Udompanthurak S, Vannasaeng S, Thamlikitkul V. Randomized controlled trial of Tinospora crispa for additional therapy in patients with type 2 diabetes mellitus. J Med Assoc Thai. 2004;87:543-6.(Among 40 patients from Thailand with type 2 diabetes with inadequate responses to oral hypoglycemic agents and refusal to start insulin who were treated with Tinospora crispa [1 gm] or placebo 3 times daily for 6 months, fasting glucose, HgbA1c, and insulin levels did not change, while patients on the herbal therapy lost weight, had increases in serum cholesterol, and two [10%] had marked increases in serum ALT or AST [above 200 U/L] without symptoms or jaundice that resolved rapidly with stopping treatment [to less than 30 U/L]). - PubMed
    1. Denis G, Gérard Y, Sahpaz S, Laporte R, Viget N, Ajana F, Riff B, et al. Prophylaxie antipaludéenne par plantes médicinales: hépatite toxique à Tinospora crispa [Malarial prophylaxis with medicinal plants: toxic hepatitis due to Tinospora crispa]. Therapie. 2007;62:271-2. French.(37 year old man developed indigestion and fatigue 7 weeks after starting an herbal preparation of Tinospora crispa as prophylaxis against malaria while visiting in Indonesia [ALT 18 times ULN, GGT 4 times ULN, bilirubin levels not given], which resolved within a few weeks of stopping, chemical analysis demonstrating typical profile of T. crispa and the apparent dose being 3.2 gm daily). - PubMed

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