Drug-induced toxicity is the leading cause of acute liver failure and acute hepatitis in the United States. Prescription drugs such as amoxicillin-clavulanic acid, troglitazone, antiretrovirals, angiotensin receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-I), anti-diabetic agents (acarbose, gliclazide, metfomin, and insulin), anticonvulsants, antiepileptics, and other psychotropics (e.g. selective-serotonin reuptake inhibitors [SSRIs]) have all been implicated in liver damage. Most prescription anti-inflammatory drugs (COX-2 inhibitors) have been completely pulled off the market, and even the most common over-the-counter (OTC) drugs – non-steroidal, anti-inflammatory drugs (NSAIDs) – are being linked with increasing prevalence to hepatotoxicity. The effects of overusing aspirin, ibuprofen, naproxen, etc… are increasingly being linked with organ distress. Even renal (kidney) damage is being linked to toxic levels of NSAID use. Some scientists speculate that this is one of the underlying factors related to kidney and liver problems in professional athletes. This subset of the population is notorious for abusing NSAIDs due to the daily strains of athletic performance. According to the National Kidney Foundation 10% of kidney failures are associated with substantial overuse of NSAIDS. Professional athletes including Alonzo Morning, Sean Elliot, and Kenny Ezeasley all attribute their kidney problems to NSAID abuse.

In an effort to shy away from the negative effects of prescription drugs and OTC drugs, many individuals have turned to herbal supplements and other “natural” remedies for ailments and disease prevention. For example, the Women’s Health Initiative indicated that estrogen and progesterone hormone replacement increased the risk of cardiovascular events. In response, a plethora of post-menopausal women have looked for alternative treatment for symptoms. Black cohosh for example, is one common herb used to treat the symptoms specific to post-menopause and has been linked to several case reports associated with hepatitis and culminant hepatic failure. Lynch et al. reported a case study of one woman who required a liver transplant following acute hepatic failure that was directly attributed to her use of the herbal supplement.

Most individuals are uninformed to the fact that the herbal and supplement industry is unregulated, and many who understand that it is unregulated do not comprehend what this means. Even though dietary and herbal supplements are governed under the DSHEA act of 1994, they are not regulated by the Food and Drug Administration (FDA) and their safety profiles are not documented. These products are not standardized with regard to their contents, checked for purity or content, and unlike OTC medications are not required to be proven safe before being sold. Consistent reports suggest that there is a very large variability of ingredients from one bottle to another, and this is even true of the same product from the same company. This especially occurs with crude herbals that are commonly formulated as a mixture or “proprietary blend” resulting in an ambiguous list of ingredients and even potentially harmful contaminants. The surge in the sale and usage of herbal remedies has been catalyzed by the notion that all herbal products are safe and effective; the fact that consumers are more prone to self-treatment; and the high availability of these products due to a lack of regulation. As a result, reports of hepatotoxicity due to herbal use are on the rise.