Drug induced hepatitis mimicking Wilson’s disease secondary to the use of complex naturopathic regimens: a case report

Table 1 Natural health regimens from January to May 2019

Drug	Dose	Route	Duration	Liver Toxicity Score	Interactions
Ashwagandha	600 mg	PO	5 days	C	None available
Copper	Unknown	PO	1 month	A	No interaction
Ascorbic Acid	3.75–7.25 g	IV	Three treatments	E	No interaction
L-Carnitine	1.25 g–3.75 g	IV	Three treatments	No reports/unknown	No interaction
Acetylcysteine	0.5 g to 2.75 g	IV	Three treatments	E	No interaction
B-Complex 100	0.50 mL to 1.00 mL	IV	Three treatments	No reports/unknown	No interaction
Magnesium Sulfide	0.25 g	IV	Three treatments	No reports/unknown	No interaction
Selenium Chloride	100mcg to 200mcg	PO	BID for 4 months	Cirrhosis in animal studies, no studies in humans	No interaction
Bicarbonate 8.4%	1.25 mL	IV	Three treatments	No reports/unknown	Not available
Rivaroxaban	15 mg	PO	Daily, 2014 to Feb. 2019	B	No interaction
Combined Ingredients of Herbal medications (Herbalife)	N/A	N/A	N/A	A	Not available

Risk defined by Livertox database, which is an evidenced based database from the National Institutes of Health [7]. Drug interactions were tested on all available drugs below using IBM Micromedex drug reference version v2080. A = Well established cause of clinically apparent liver injury. B=Highly likely cause of clinically apparent liver injury. C=Probable cause of clinically apparent liver injury. E = Unlikely cause of clinically apparently liver injury

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