Supplement-induced liver injury (DILI)

Acute or subacute liver injury caused by dietary supplements or herbal products. Presents with raised ALT and AST, jaundice, dark urine, right upper quadrant pain. In the United States LiverTox and DILIN have catalogued cases for garcinia, ashwagandha, concentrated green tea extracts and kava. Severe forms require hospitalisation; fulminant liver failure and transplantation have been reported.

ICD-10 K71.91 drug

Also known as: Herbal and dietary supplement-induced liver injury, HILI, Supplement-induced DILI

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

FGarcinia cambogia (hydroxycitric acid, HCA)Not recommended · Plant extract of Garcinia gummi-gutta (cambogia) fruits; weight-loss supplement; not registered as a medicine by AEMPS; FDA Safety Communications 2009 and 2017 on hepatotoxicityGarcinia ranks among the top LiverTox entries for supplement-induced liver injury. Reported patterns include acute hepatocellular hepatitis 1–3 months after starting the supplement, cholestatic hepatitis, fulminant liver failure with transplantation and isolated fatalities. Women aged 30–50 are most often affected. Concomitant paracetamol, statins or alcohol increase risk. FDA pulled Hydroxycut in 2009 and updated the garcinia warning in multi-ingredient formulas in 2017. If you take garcinia and develop jaundice, dark urine, pale stools, right upper quadrant pain or marked weakness, stop the supplement immediately and seek medical help. This is not a «detox effect», this is acute hepatitis.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit