Imatinib and Panax Ginseng: A Potential Interaction Resulting in Liver Toxicity

• DOI: 10.1345/aph.1m715
• Publication Date: 2010-03-24T02:14:56Z
• Authors: Naveen Bilgi; Kim Bell; Ashwin N Ananthak...; Ehab Atallah
• Keywords: Liver toxicity; Araliaceae

OBJECTIVE: To report a case of imatinib-induced hepatotoxicity after concurrent ginseng ingestion in patient with chronic myelogenous leukemia (CML). CASE SUMMARY: A 26-year-old man CML who had taken imatinib 400 mg daily for 7 years no complications presented right upper quadrant pain. Laboratory test results included alanine aminotransferase 1069 U/L, aspartate 481 alkaline phosphatase 124 IU/L, total bilirubin 1.4 mg/dL, albumin 4.0 g/dL, and international normalized ratio 1.08. Liver biopsy showed acute lobular hepatitis favoring drug-induced etiology, diagnosis was made. The patient's only lifestyle modification prior to the Panax via energy drinks past 3 months. Both were discontinued, treated short course corticosteroids. Imatinib later restarted at same dose recurrent elevations his liver enzyme levels. DISCUSSION: Imatinib-associated usually presents within 1-2 therapy initiation, median time being 100 days. Ginseng is an herb that not known be hepatotoxic. In vivo, inhibit CYP3A4, primary involved metabolism imatinib. We propose our late-onset imatinib-associated due interaction between through CYP3A4. Based on Naranjo probability scale, it probable caused this hepatotoxicity, Horn drug scale also indicates ginseng. CONCLUSIONS: This emphasizes importance continuous monitoring function tests even several advising patients avoid any other over-the-counter herbal supplements may interact