European Journal of Clinical Pharmacology

, Volume 65, Issue 4, pp 331–341

Hepatotoxicity from green tea: a review of the literature and two unpublished cases

  • Gabriela Mazzanti
  • Francesca Menniti-Ippolito
  • Paola Angela Moro
  • Federica Cassetti
  • Roberto Raschetti
  • Carmela Santuccio
  • Sabina Mastrangelo
Review Article

DOI: 10.1007/s00228-008-0610-7

Cite this article as:
Mazzanti, G., Menniti-Ippolito, F., Moro, P.A. et al. Eur J Clin Pharmacol (2009) 65: 331. doi:10.1007/s00228-008-0610-7

Abstract

Purpose

To review the current literature on suspected green tea-related hepatic reactions and to describe two new cases reported within the framework of the Italian surveillance system of natural health products.

Results

A literature search of publication between 1999 and October 2008 retrieved 34 cases of hepatitis. Histological examination of the liver revealed inflammatory reactions, cholestasis, occasional steatosis, and necrosis. A positive dechallenge was reported in 29 cases. There was one reported death. A positive rechallenge occurred in seven cases (20%). In the two new cases, the causality assessment was judged as “possible” according to the RUCAM score.

Conclusions

Our analysis of the published case reports suggests a causal association between green tea and liver damage. The hepatotoxicity is probably due to (-)-epigallocatechin gallate or its metabolites which, under particular conditions related to the patient’s metabolism, can induce oxidative stress in the liver. In a few cases, toxicity related to concomitant medications could also be involved.

Keywords

Green teaCamellia sinensisCatechinsEpigallocatechin gallateHepatotoxicityHerbal supplements

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Gabriela Mazzanti
    • 1
  • Francesca Menniti-Ippolito
    • 2
  • Paola Angela Moro
    • 3
  • Federica Cassetti
    • 3
  • Roberto Raschetti
    • 2
  • Carmela Santuccio
    • 4
  • Sabina Mastrangelo
    • 1
  1. 1.Department of Physiology and PharmacologySapienza, University of RomeRomeItaly
  2. 2.National Center for EpidemiologyNational Institute of HealthRomeItaly
  3. 3.Poison Control CenterNiguarda Ca’ Granda HospitalMilanItaly
  4. 4.Pharmacovigilance UnitItalian Medicines AgencyRomeItaly