Acute liver injury due to flavocoxid (Limbrel), A medical food for osteoarthritis: A case series

Naga Chalasani, Raj Vuppalanchi, Victor Navarro, Robert Fontana, Herbert Bonkovsky, Huiman Barnhart, David E. Kleiner, Jay H. Hoofnagle

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Flavocoxid is a prescription medical food that is used to treat osteoarthritis. It is a proprietary blend of 2 flavonoids, baicalin and catechins, which are derived from the botanicals Scutellaria baicalensis and Acacia catechu, respectively. Objective: To describe characteristics of patients with acute liver injury suspected of being caused by flavocoxid. Design: Case series. Setting: Drug-Induced Liver Injury Network Prospective Study ongoing at multiple academic medical centers since 2004. Patients: Four adults with liver injury. Measurements: Clinical characteristics, liver biochemistry values, and outcomes. Results: Among 877 patients enrolled in the prospective study, 4 had liver injury suspected to have been caused by flavocoxid. All were women; ages ranged from 57 to 68 years. All developed symptoms and signs of liver injury within 1 to 3 months after initiating flavocoxid. Liver injury was characterized by marked elevations in levels of alanine aminotransferase (mean peak, 1268 U/L; range, 741 to 1540 U/L), alkaline phosphatase (mean peak, 510 U/L; range, 286 to 770 U/L), and serum bilirubin (mean peak, 160.7 μmol/L [9.4 mg/dL]; range, 34.2 to 356 μmol/L [2.0 to 20.8 mg/dL]). Liver biochemistry values decreased to the normal range within 3 to 12 weeks after flavocoxid was stopped, and all patients recovered without experiencing acute liver failure or chronic liver injury. Causality was adjudicated as highly likely in 3 patients and as possible in 1 patient. Limitation: The frequency and mechanism of liver injury could not be assessed. Conclusion: Flavocoxid can cause clinically significant liver injury, which seems to resolve within weeks after cessation. Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases.

Original languageEnglish
Pages (from-to)857-860
Number of pages4
JournalAnnals of Internal Medicine
Volume156
Issue number12
StatePublished - Jun 19 2012

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Osteoarthritis
Food
Liver
Wounds and Injuries
Biochemistry
National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
Scutellaria baicalensis
flavocoxid
Prospective Studies
Acacia
Chemical and Drug Induced Liver Injury
Acute Liver Failure
Catechin
Alanine Transaminase
Bilirubin
Flavonoids
Causality
Signs and Symptoms
Prescriptions
Alkaline Phosphatase

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Chalasani, N., Vuppalanchi, R., Navarro, V., Fontana, R., Bonkovsky, H., Barnhart, H., ... Hoofnagle, J. H. (2012). Acute liver injury due to flavocoxid (Limbrel), A medical food for osteoarthritis: A case series. Annals of Internal Medicine, 156(12), 857-860.

Acute liver injury due to flavocoxid (Limbrel), A medical food for osteoarthritis : A case series. / Chalasani, Naga; Vuppalanchi, Raj; Navarro, Victor; Fontana, Robert; Bonkovsky, Herbert; Barnhart, Huiman; Kleiner, David E.; Hoofnagle, Jay H.

In: Annals of Internal Medicine, Vol. 156, No. 12, 19.06.2012, p. 857-860.

Research output: Contribution to journalArticle

Chalasani, N, Vuppalanchi, R, Navarro, V, Fontana, R, Bonkovsky, H, Barnhart, H, Kleiner, DE & Hoofnagle, JH 2012, 'Acute liver injury due to flavocoxid (Limbrel), A medical food for osteoarthritis: A case series', Annals of Internal Medicine, vol. 156, no. 12, pp. 857-860.
Chalasani, Naga ; Vuppalanchi, Raj ; Navarro, Victor ; Fontana, Robert ; Bonkovsky, Herbert ; Barnhart, Huiman ; Kleiner, David E. ; Hoofnagle, Jay H. / Acute liver injury due to flavocoxid (Limbrel), A medical food for osteoarthritis : A case series. In: Annals of Internal Medicine. 2012 ; Vol. 156, No. 12. pp. 857-860.
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