Nausea chaparral

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. 

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... 

In a similar case also included in the Sheikh et al. review, a 45-yr-old woman presented with painless jaundice, anorexia, fatigue, nausea, vomiting, and pruritus after consuming 160 mg/d of chaparral for 10 wk (Alderman et al., 1994 Sheikh et al., 1997). Past medical history included alcohol abuse for 4 yr. 

In one of the cases reviewed by Sheikh and colleagues, a patient developed a generalized urticarial rash, nausea, and abdominal pain after ingestion of chaparral, but had been taking chaparral for 1 yr, had a history of allergies, and was also taking naproxen and ketorolac. Miscellaneous adverse effects associated with chaparral use include sudden unilateral loss of vision, tachycardia, electrolyte abnormalities with cardiac arrest, and syncopal episodes (Sheikh et al., 1997). 

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). 

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). 

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