Monitoring of liver enzymes in patients treated with traditional Chinese drugs

Summary Background: Use of traditional Chinese drug treatment is widespread. While cases of hepatotoxic effects have been reported, little is known about the frequency of such effects. Objectives: To investigate the frequency, magnitude and course of liver enzyme elevations in patients treated with traditional Chinese drugs. Design: Retrospective study. Setting: Hospital for traditional Chinese medicine in Germany. Patients: All 1507 patients admitted for inpatient treatment between February1994 and July 1995. Main outcome measure: Number of patients who presented at discharge with a more than 2-fold elevation of alanine amino transferase (ALT) levels (over maximum normal values or elevated admission values). Results: A more than 2-fold elevation of ALT values was observed in 14 patients (0.9%). In 13 cases a causal relationship with Chinese drug therapy seemed possible and, for one patient, likely. However, all patients were also on non-Chinese drug treatment. Follow-up values of ALT within 8 weeks after discharge were normal in 11 patients (six of them had continued to take traditional Chinese drugs) and close to normal in the remaining three. In five patients there were indications for previous liver damage. Conclusions: In the population and setting studied, clinically relevant liver enzyme elevations occurred in about 1/100 patients treated with traditional Chinese drugs.