Hepatotoxicity echinacea

The hepatotoxicity of paracetamol may be increased when it is concomitantly used with hepatotoxic herbs (echinacea, kava, herbs containing salicylates such as willow and meadowsweet). 

Echinacea 1. Hepatotoxic drugs, e.g. anabolic steroids 2. amiodarone 3. Methotrexate 4. Ketoconazole Risk of additive hepatotoxicity Use of echinacea for over 8 weeks can cause hepatotoxicity Be aware and use drugs with a potential to cause hypertonicity cautiously, monitoring clinically and biochemically for any early signs of hepatic dysfunction... 

Although the horse appears to be refractory to the hepatic effects of most NSAIDs, their hepato-toxic potential should be considered, especially when they are concomitantly administered with other potentially hepatotoxic agents, such as fluoroquinolones, potentiated sulfonamides or anabolic steroids. In addition, many herbal preparations are potential hepatotoxic agents and clients may administer these compounds concurrently with prescribed NSAIDs without consulting their veterinarian. Echinacea and kava kava products, for example, are reported to be potential hepatotoxins and both are used in herbal remedy products that claim to produce calming or sedating effects in horses (Abebe 2002). 

Unfortunately, persistent misconceptions about botanical safety become part of the conventional wisdom about herbs, as the original case reports are repeatedly cited without any acknowledgement of the explicatory letters that follow in subsequent volumes of the journals in which the original reports or letters appeared. In addition to this unfortunate situation, adverse effects of particular herbs have been predicted, in the absence of case reports or even in vitro studies, on the basis of the chemical composition of the herb in question. For instance, Miller (1998) warned about the expected hepatotoxicity of Echinacea spp. based on the occurrence of the pyrrolizidine alkaloids tussilagine and isotussilagine. These compounds are indeed present (at 0.006%) in Echinacea root, but they are nontoxic because they lack the structural features (1,2 unsaturation in the pyrrolizidine ring) mentioned above necessary for hepatic activation into reactive pyrroles. 

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