Ginseng is a popular herbal medication and extract derived from the roots of a perennial plant (Panax ginseng) found mostly in China, Korea and Siberia. Ginseng is used is to promote health and improve wellness, as well as to treat stress and as a mild stimulant. Ginseng has not been implicated in causing liver injury although it may have the potential of causing significant herb-drug interactions that can lead to liver injury.
Ginseng (jin' seng) is a widely used herbal derived from the roots of eleven distinct species of plants belonging to the genus Panax and family Araliaceae. Ginseng grows in the Northern Hemisphere in eastern Asia, mostly China, Korea and Siberia. The form of ginseng most commonly used is Asian (or Chinese) ginseng made from the dried roots of Panax ginseng. American ginseng (Panax quinquefolius) has similar properties. The word ginseng derives from the Chinese character “rénshen” meaning “man root”, which refers to the ginseng root’s characteristic forked shape. The botanical name Panax is derived from the Greek word meaning “all-heal” as in the term panacea. Ginseng is taken promote health and healing, as an adaptogen (to treat stress and enhance recovery from illness), aphrodisiac (to aid in sexual desire and performance) and a stimulant (wakefulness and mental acuity). Ginseng is also claimed to lower blood glucose levels and to be beneficial in diabetes. Ginseng is found in energy drinks as well as in many cosmetic preparations. The scientific bases for the purported effects of ginseng are not well established. Ginseng contains 30 different triterpene saponins, referred to as ginsenosides and panaxosides, which are considered the active compounds and which have antioxidant and stimulatory activities. Commercial preparations of ginseng vary widely in ginsenoside content (some have none at all), which may cause variation in their biologic effects. The recommended daily dose varies widely (100 to >1,000 mg daily), depending on the preparation used (capsules, tablets, liquid, root extract, tea) and indications. Side effects of ginseng are uncommon and mild, and include inability to sleep, nausea, morning diarrhea, headaches and nose bleeds.
Despite wide spread use, ginseng by itself has not been linked to liver injury, either in the form of transient serum enzyme elevations or clinically apparent acute liver injury. Indeed, ginseng is sometimes used to treat acute or chronic liver injury, although its efficacy and safety in this situation have not been proven. Nevertheless, ginseng has been reported to affect cytochrome P450 activity and cause significant herb-drug interactions that can lead to adverse events including liver injury. In vitro studies have found that different gensinosides have different effects on cytochrome P450 activity, and some may inhibit CYP 3A4 sufficiently to affect the metabolism of other drugs, increasing or decreasing their activity. Thus, different ginseng preparations may exhibit varying degrees of herb-drug interaction. Liver injury has been reported to develop 1 to 3 months after starting ginseng in patients who previously tolerated the potentially toxic agent (imatinib, raltegravir) without liver injury and who later tolerated restarting the medication without concurrent ginseng use.
Likelihood score: E (by itself, unlikely cause of clinically apparent liver injury).
REPRESENTATIVE TRADE NAMES
Ginseng – Generic
Herbal and Dietary Supplements
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References updated: 14 March 2018
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potential interaction resulting in liver toxicity. Ann Pharmacother 2010; 44: 926-8. PubMed Citation (26 year old man with CML on imatinib for 7 years developed symptomatic liver injury 3 months after starting daily use of an energy drink with Panax ginseng [bilirubin 1.4 mg/dL, ALT 1069 U/L, Alk P 124 U/L] which resolved with stopping both medications, but he was able to restart imatinib without recurrence of liver injury after recovery and while remaining off of ginseng).
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Pharmacotherapy 2015; 35: e9-e12. PubMed Citation (44 year old man developed rash and eosinophilia 35 days after starting lamotrigine for seizures and while taking ginseng daily for general health [bilirubin 1.4 mg/dL, ALT 473 U/L, Alk P 465 U/L, eosinophils 3040/µL], resolving within 3 weeks of stopping lamotrigine).
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PubMed Citation (Among
2048 adult liver transplants recipients enrolled in the Scientific Registry of
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nutrition supplements [MINS]).
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multiingredient products, none specifically mentioning ginseng).
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