Acute hepatitis associated with Barakol.

Barakol is a natural anxiolytic extracted from Cassia siamea, known as "Khi-lek" in Thailand. The authors studied the adverse effects of Barakol in 12 healthy Thai patients, aged 29-81 years (mean 52.5) who took Barakol 3-180 days (mean 76.9). Eight of them were admitted with the first episode of anorexia and jaundice for 4-60 days (mean 14.3) after taking 20-40 mg/day (2-4 tablets) of Barakol. There was no relationship between degree of symptom and dosage/duration of Barakol intake. Three asymptomatic cases were detected with increased aminotransferase from a routine check-up, including an 81 year old female who took half of the dosage for 120 days. The last one was a male patient who presented with low-grade fever and nausea and vomiting. All patients had neither a history of chronic liver disease nor known hepatotoxic substance ingestion. On admission, the mean total bilirubin was 5.7 mg/dl and liver function test (LFT) revealed moderate to severe hepatitis (Aspartate amino transferase (AST) range 111-1,473 U/L: mean = 692). None of them had detected viral markers. Liver biopsy was done in 3 cases and the histopathological findings were compatible with interface hepatitis. Two non-biopsy cases developed recurrent transaminitis after one-week re-challenging without informing the physician. Their symptoms and LFT completely improved within 2-20 weeks (mean 5.9) after Barakol abstinence.