Ethnobotanical Leaflets 12: 286-298. 2008.

Will Herbal-Paracetamol Combination Drug Prevent both Liver and Kidney Disease? - Results and Possibilities

Anjali Sharma, Mukesh Makwana and H.S. Rathore*

Cell Biology Unit, School of Studies in Zoology and Biotechnology

Vikram University, Ujjain 456010. India

*Contact: hrvuz2000@yahoo.co.in

Issued 24 May 2008

ABSTRACT

An attempt has been made to briefly review the existing information on herbal compounds which could combat acetaminophen (paracetamol) toxicity. A careful perusal of literature revealed that acetaminophen overdose not only damages liver but also the kidney. Nevertheless, the kidney was badly ignored in studies aimed at preventing paracetamol toxicity with herbal drugs. On account of such major neglect, so far no herbal-paracetamol combination could be made. Milk thistly is only well researched drug which appears as a suitable future candidate, but its action towards the kidney must be studied. The importance of such studies in the future is discussed.

Key words: Acetaminophen/paracetamol, hepatoxicity, Nephrotoxicity, Herbal Drugs/combination.

INTRODUCTION

Acetaminophen (Paracetamol: N-acetyl-p-aminophen) is an effective analgesic - antipyretic drug which is often used to treat pain and fever. Acetaminophen is available without prescription in many parts of the world (Goodman and Gilman 1996).

The most serious adverse effect of acute overdose of acetaminophen is dose-dependent, potentially fatal hepatic necrosis (Thomas 1993) which may be associated with renal tubular necrosis (Goodman and Gilman 1996). The number of self poisoning suicides with acetaminophen has grown alarming in recent years (Goodman and Gilman 1996; Gyamlani and Parikh 2002). According to a study in USA paracetamol was found to be associated with more than 10, 00, 00 cases of poisoning, 56000 visits to emergency departments, 26000 hospitalization and 450 deaths a year (BMJ 2002). Also acetaminophen was the drug most commonly taken in United Kingdom (Howton et al 1997) causing substantial number of deaths (Bray 1993). Cases of overdoses of acetaminophen in India are also not uncommon (Sharka et al. 1999).

The principal antidotal treatment is the administration of sulphydryl compound like N-acetyl-cysteine which act by replenishing hepatic stores of glutathione. This drug is effective only if given orally or intravenously within less than 10 hours after ingestion (Smilkstein et al 1988).

BRIEF REVIEW OF EXISTING REPORTS

In the past, several herbal compounds have also been screened to test their ability to reduce and / or nullify acetaminophen induced hepatotoxicity. These reports are given subsequently. It is of interest to mention here that only in two studies both liver and kidney were taken into consideration (Lee et al. 2002 and Bagchi et al. 2002) otherwise the kidney is badly ignored. However, quite earlier it was suggested that special caution should be taken in patients with liver and kidney disease while using paracetamol (Brzeznicka and Piotrowsi 1989).

BRIEF REVIEW OF EXISTING REPORTS

S. No.	Worker	Year	Model	Name of the herbal Compound	Hepato protective property	Nephro protective property	Parameters
							Lethali ty test	Histo - pathology	Biochemical / clinical /other parameters
1	Akintonwa et al.	1990	Rat	Garcinia Kola	Yes	No	Yes	Yes	Glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT)
2	Handa et al.	1990	Rat	Andrographis paniculata (andrographolide)	Yes	No	No	Yes	GOT, GPT, ALP, bilirubin, triglycerides
3	Donatus et al.	1990	Rat hepatocytes	Curcuma longa (Curcumin)	Yes (cytopro tectivity)	No	No	No	lipid peroxidation, LDH - leakage, GSH - depletion
4	Ansari et al.	1991	Rat	Picrorhiza kurrooa (Picrolive)	Yes	No	No	Yes	Various biochemical parameters
5	Chattopadhyay et al.	1992	Rat	Azadirachta indica	Yes	No	No	Yes	GOT, GPT, acid phosphatase, alkaline phosphatase
6	Muriel et al.	1992	Rat	Silymarin	Yes	No	No	No	Liver glutathione,lipid peroxidation, glycogen & serum alkaline phasphotase(AP)gamma- glutamyltranspeptidase,(GGT P) glutamic pyruvic transaminase (GPT)
7	Yamada et al.	1993	Rat	Scizandra fruits(gomisin A)	Yes	No	No	Yes (degeneration and necrosis of hepatocytes)	Serum amino transferase activity and hepatic lipoperoxides content, glutathione
8	Gilani et al.	1993	Mice & Rat	Artemisia scoparia	Yes	No	Yes	No	GOT, GPT
9	Cheng et al.	1994	Mice & Rat	Hippophae rhammoides	Yes	No	No	Yes	MDA), GPT, GOT, GSH
10	Lin et al.	1994	Mice	Wedelia chinensis	Yes	No	No	Yes	GOT, GPT
11	Lin et al.	1995	Rat	'teng-khia-u' Taiwan folk medicine (Elephantopus scaber L. E.mollis H.B.K. and Pseudoelephantopus spicatus(Juss.)Rohr.)	Yes	No	No	No	GOT, GPT
12	Singh et al.	1995	Rat	Apium graveolens & Hygrophila auriculata	Yes	No	No	Yes	GOT, GPT, alkaline phosphates (ALP), sorbitol dehydrogenase (SDH), glutamate dehydrogenase, bilirubin, tryglycerides
13	Thabrew et al.	1995	Mice & cutured Rat Hepatocytes	Osbeckia octandra	Yes	No	No	Yes	Blood Normotest, glutathione level, plasma aspartate amino transferase, cell viability, lactate dehydrogenase (LDH).
14	Janbaz et al.	1995	Mice & Rat	Artemisia maritima	Yes	No	Yes	No	GOT, GPT
15	Gilani et al.	1995	Mice & Rat	Cyperus scariosus	Yes	No	Yes	No	Alkaline phosphatase (ALP), GOT, GPT
16	Rasheed et al.	1995	Mice	Teucrium stocksianum	Yes	No	Yes	No	Aspartate amino transferase, bilirubin, GSH, liver weight, pento barbitone induced sleeping time.
17	Chin et al.	1996	Rat	'Ham-hong-Chho' Taiwan folk medicine (Bidens pilosa L..var minor (Blume)Sherff, B. Pilosa L. and B. Chilensis DC)	Yes	No	No	Yes	GOT, GPT
18	Gilani et al.	1996	Mice & Rat	Fumaria parviflora	Yes	No	Yes	No	ALP, GOT, GPT
19	Wang et al.	1996	Mice	Garlic	Yes	No	No	Yes	ALT, LDH & GSH
20	Lin et al.	1997	Rat	Scutellaria rivularis (Ban- zhi-lian)	Yes	No	No	Yes	GOT, GPT
21	Subramoniam et al.	1998	Rat	Trichopus zeylanicus	Yes	No	No	Yes	Serum marker enzymes, level of lipid peroxides in liver
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