Chaparral capsules

A 27-year-old Hispanic man presented with nausea and vomiting, diarrhea, and upper abdominal pain 12 months after starting to take chaparral capsules. A liver biopsy showed hepatocellular injury with necrosis and periportal inflammation. His liver function stabilized after withdrawal of chaparral. 

A person s use of alternative medicine must be solicited. Many herbal remedies were once wisely abandoned because of their common adverse reactions. Comfrey tea is a common cause of hepatocellular damage. As in the case of the Chinese remedy jin bu huan, or as in the case of the more elegantly presented chaparral capsules containing grease wood leaves, the end of therapy with these types of agents is occasionally severe disability or death from fulminant hepatic failure." Pennyroyal oil, maragosa oil, and clove oil cause a dose-related hepatotoxicity." ... 

There are several on-line sources for chaparral and chaparral-containing products advertising chaparral capsules, cut herb, herb powder, tincture, concentrated liquid for compresses, and various combination products for colds, flu, arthritis, detoxification, immune system enhancement, and adrenal protection. 

Hepatic Effects. Icterus, jaundice, abdominal pain, liver failure, acute toxic hepatitis, and elevated serum liver enzymes were among the effects reported in four individuals who repeatedly ingested chaparral capsules (160-1,500 mg chaparral/day) over a period ranging from 6 weeks to 10 months. 

Liver transplant was required for one of the patients. Elevated liver enzymes returned to normal levels 3-6 weeks after exposure to chaparral was discontinued. Increased liver-to-body weight ratio has been observed in rats and mice orally exposed to beechwood creosote for as little as 3 months. The effect was generally seen at doses >143 mg/kg/day. However, no treatment-related liver histopathological alterations were observed in these animals. These findings are relevant for individuals in the general population who ingest chaparral capsules or chaparral tea. 

Toxic liver damage with fatigue, jaundice, and dark urine was reported in a 25-year-old man who consumed 3830 mg chaparral capsules daily for 2 to 3 weeks, then 5760 mg daily for 10 weeks. After cessation of chaparral, the patient recovered within 2 weeks (Sheikh et al. 1997). 

Jaundice with possible toxic liver damage was reported in a 71-year-old man who had been taking an unspecified amount of chaparral capsules daily for an unspecified amount of time. Symptoms of flu-like illness, ascites, and jaundice abated 2 months after cessation of chaparral. The man had a history of alcohol use (14 oz wine daily). One month after restarting chaparral use, the man developed jaundice, ascites, scleral icterus, and nausea. Liver biopsy indicated diffuse necrosis with inflammation, portal tract expansion, mild cholestasis, and mild fibrous septation. A biopsy 3 months later indicated marked improvement (Batchelor et al. 1995). 

Chaparral can be found in health food stores as capsules and tablets and is used as an antioxidant and anti-cancer herbal product. Leaves, stems and bark in bulk are also available for brewing tea. However, this product can cause severe hepatotoxicity. Several reports of chaparral-associated hepatitis have been reported. A 45-year-old woman who took 160 mg of chaparral per day for 10 weeks presented with jaundice, anorexia, fatigue, nausea and vomiting. Liver enzymes and other liver function tests showed abnormally high values (ALT 1611 U L- AST 957 U L, alkaline phosphatase 265 U L, GOT 993 U L and bilirubin... 

Chaparral can be found in health food stores and on various sites on the World Wide Web. Products available include leaves, stems, and bark in bulk to be used in brewing tea. The tea is made by steeping the dried leaves and stems in hot water. Approximately 7-8 g of leaves are used per quart of water (Smart et ah, 1969). Capsules and tablets have also been formulated in various dosages. Products can be found containing chaparral as the only active ingredient, or in combination with other herbs. Dosages used by patients in a case series detailing chaparral-associated hepatotoxicity and other adverse effects (Sheikh, 1997) included 100-mg, 400-mg, 450-mg, and 480-mg capsules and 64.8-mg and 100-mg tablets. 

Creosote Bush. A report was found in the literature describing a 45-year-old woman who developed painless jaundice, fatigue, anorexia, and pruritus after taking chaparral tablets, 160 mg/day for around 2 months (Alderman et al. 1994). Complete blood count, platelet count, and clotting times were normal. A 60-year-old woman was hospitalized with a 1-week history of upper quadrant abdominal pain, anorexia, and jaundice (Gordon et al. 1995). The patient had been taking 1-2 capsules of chaparral daily for the past 10 months. The patient developed "flulike syndrome" and increased her chaparral intake to 6 capsules a day 3 weeks before admission. The patient s prothrombin time increased from 15.9 to 28 seconds (normal values 10.9-13.7 seconds). 

Creosote Bush. Acute toxic hepatitis has been attributed to ingestion of chaparral, an herbal nutritional supplement product derived from the leaves of the creosote bush (Clark and Reed 1992). A 42-year-old man had icterus and jaundice after consuming three 500 mg capsules of chaparral a day for 6 weeks. Serum chemistry tests showed elevated bilirubin, gamma glutamyltranspeptidase (GGT), AST, and lactate dehydrogenase. His illness was diagnosed as hepatic dysfunction secondary to chaparral ingestion. 

The patient had been taking 1-2 capsules of chaparral daily for the past 10 months. The patient increased her chaparral intake to six capsules/day 3 weeks before admission. Renal failure ensued, which required hemodialysis. The patient underwent cadaveric renal transplantation. The patient slowly recovered and was discharged. 

Incidentally, Essiac tea was named after Nurse Rende Caisse of Canada — her last name spelled backwards — and is said to be derived from the herbal lore of Indian tribes in the Canadian North. (And though Essiac tea tastes pretty good, chaparral tea is anything but good the plant is not called the creosote bush for nothing. So some folks have opted for chaparral pills, tablets, or capsules.)... 

Case reports have indicated a correlation between chaparral consumption and liver damage. Amounts of chaparral taken range from 0.3 to 6 g daily, and the duration of use has been from 20 days to "many years," with chaparral being taken as capsules or tablets in most of the cases. The product taken was analyzed in only one case. Although one patient with toxic liver damage required a liver transplant, other cases resolved on cessation of chaparral (lOM 2001). A review of those case reports and associated toxicity studies noted that the severity of liver damage was not related to the dose or duration of chaparral use (lOM 2001). 

Toxic liver damage with fatigue, jaundice, dark urine, nausea, abdominal pain, and diarrhea was reported in a 44-year-old woman who had taken capsules containing 2400 mg chaparral daily for 10 days and then 800 mg daily for another 10 days (Clark and Reed 1992 Sheikh et al. 1997). 

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