Hepatotoxicity

Hepatotoxicity refers to liver damage caused by exposure to chemicals, drugs, or natural products. In the supplement context, hepatotoxicity is a critical safety concern for certain botanicals. The most well-documented case is kava (Piper methysticum), which has been associated with rare but serious liver injury, including cases requiring liver transplant. Other supplements with hepatotoxicity reports include green tea extract (high-dose EGCG), black cohosh, and pyrrolizidine alkaloid-containing herbs (comfrey, butterbur). Risk factors include genetic differences in liver enzyme (CYP450) activity, pre-existing liver disease, alcohol use, and concurrent hepatotoxic medications. Monitoring liver function (ALT, AST) is recommended when using supplements with known hepatotoxicity risk.