Hepatitis Temporally Associated With an Herbal Supplement Containing Artemisinin—Washington, 2008

KEYWORDS:
• ANTIMALARIALS
• ARTEMISININE
• COMPLEMENTARY THERAPIES
• DIETARY SUPPLEMENTS
• DRUG TOXICITY
• HEPATITIS
• HERBALS
• MALARIA
• WASHINGTON

MMWR. 2009;58:854-856

Artemisinins are a class of compounds that include artesunate, artemether, and artemisinin and have potent antimalarial activity. In combination with other drugs (artemisinin combination therapy), these compounds are the first-line treatment recommended by the World Health Organization for Plasmodium falciparum infections. Artemisinins have been available in the United States without a prescription as herbal supplements for at least 10 years; these supplements are marketed for general health maintenance and for treatment of parasitic infections and cancers. On August 27, 2008, CDC was notified of a patient who developed hepatitis after a 1-week course of an herbal supplement containing artemisinin. The patient had abdominal pain, dark urine, and laboratory results consistent with hepatitis (e.g., serum alanine aminotransferase of 898 IU/L [normal: 10-55 IU/L]). Samples of the supplement were sent to CDC and the Georgia Institute of Technology for analysis to determine the amount of artemisinin and to identify any …