Some natural health products may increase the risk of hepatotoxicity

Natural health products (NHPs) are widely used across Canada and are often perceived by consumers as “safe or harmless.” However, some NHPs have been associated with rare serious adverse reactions, including hepatotoxicity, with cases continuing to be reported in Canada and internationally.Hepatotoxicity from NHP use is not well defined. It may be hepatocellular, cholestatic or mixed, and the etiology is generally considered idiosyncratic. Many adverse reaction reports involve multiple NHPs or provide insufficient information, which makes it difficult to attribute hepatotoxicity to specific ingredients. Common symptoms of hepatotoxicity resulting from NHP use are often nonspecific and can vary in severity. Symptoms can include fatigue, nausea and vomiting, loss of appetite, jaundice, dark urine, pale stools, pruritus, right upper quadrant abdominal pain, fever, rash or elevated liver enzymes. Severe or late symptoms may include hepatic encephalopathy, coagulopathy, ascites or edema. Most cases of NHP-associated hepatotoxicity are asymptomatic and often resolve with the discontinuation of the suspected product(s); however, the outcomes can vary. In rare cases, certain NHPs have been associated with more serious outcomes such as liver transplantation or death. Health Canada has previously reviewed and/or communicated on the safety of several NHPs in relation to hepatotoxicity risk. These include Aloe vera, Artemisia annua, black cohosh, green tea extract, Pelargonium species and Polygonum species. More recently, Health Canada reviewed Canadian and international evidence supporting a possible link between the use of NHPs containing Garcinia gummi-gutta or hydroxycitric acid, as well as those containing turmeric or curcuminoids for oral use, and the risk of hepatotoxicity. Health Canada has updated the relevant monographs for these products to include information on hepatotoxicity risk. Licence holders of these products are also expected to update product labels to include this risk information.Health Canada advises healthcare professionals to counsel patients taking NHPs to be aware of the warning signs and symptoms of hepatotoxicity, including jaundice, dark urine, persistent nausea, vomiting or abdominal pain. If symptoms occur, patients should be advised to stop using the product(s) and consult a healthcare professional as soon as possible. Healthcare providers should routinely ask patients about NHP use, in addition to prescription and nonprescription drugs, and document NHP use on patient profiles, to facilitate checking for potential interactions and monitoring for adverse effects.Health Canada encourages healthcare providers to report suspected cases of NHP hepatotoxicity to the Canada Vigilance Program. This will assist Health Canada in monitoring NHP safety and identifying emerging risks.Reference:Government of Canada. The use of some natural health products and the potential risk of hepatotoxicity. Health Product InfoWatch: January 2026. (accessed February 5, 2026).

Some natural health products may increase the risk of hepatotoxicity

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