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Hepatotoxicity from green tea: a review of the literature and two unpublished cases



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.


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.


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.

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Correspondence to Gabriela Mazzanti.

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Mazzanti, G., Menniti-Ippolito, F., Moro, P.A. et al. Hepatotoxicity from green tea: a review of the literature and two unpublished cases. Eur J Clin Pharmacol 65, 331–341 (2009).

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  • Green tea
  • Camellia sinensis
  • Catechins
  • Epigallocatechin gallate
  • Hepatotoxicity
  • Herbal supplements