Acute liver injury due to flavocoxid (Limbrel), a medical food for osteoarthritis: a case series.

Journal Article (Journal Article)

BACKGROUND: Flavocoxid is a prescription medical food that is used to treat osteoarthritis. It is a proprietary blend of 2 flavonoids, baicalin and catechins, which are derived from the botanicals Scutellaria baicalensis and Acacia catechu, respectively. OBJECTIVE: To describe characteristics of patients with acute liver injury suspected of being caused by flavocoxid. DESIGN: Case series. SETTING: Drug-Induced Liver Injury Network Prospective Study ongoing at multiple academic medical centers since 2004. PATIENTS: Four adults with liver injury. MEASUREMENTS: Clinical characteristics, liver biochemistry values, and outcomes. RESULTS: Among 877 patients enrolled in the prospective study, 4 had liver injury suspected to have been caused by flavocoxid. All were women; ages ranged from 57 to 68 years. All developed symptoms and signs of liver injury within 1 to 3 months after initiating flavocoxid. Liver injury was characterized by marked elevations in levels of alanine aminotransferase (mean peak, 1268 U/L; range, 741 to 1540 U/L), alkaline phosphatase (mean peak, 510 U/L; range, 286 to 770 U/L), and serum bilirubin (mean peak, 160.7 µmol/L [9.4 mg/dL]; range, 34.2 to 356 µmol/L [2.0 to 20.8 mg/dL]). Liver biochemistry values decreased to the normal range within 3 to 12 weeks after flavocoxid was stopped, and all patients recovered without experiencing acute liver failure or chronic liver injury. Causality was adjudicated as highly likely in 3 patients and as possible in 1 patient. LIMITATION: The frequency and mechanism of liver injury could not be assessed. CONCLUSION: Flavocoxid can cause clinically significant liver injury, which seems to resolve within weeks after cessation.

Full Text

Duke Authors

Cited Authors

  • Chalasani, N; Vuppalanchi, R; Navarro, V; Fontana, R; Bonkovsky, H; Barnhart, H; Kleiner, DE; Hoofnagle, JH

Published Date

  • June 19, 2012

Published In

Volume / Issue

  • 156 / 12

Start / End Page

  • 857 - W300

PubMed ID

  • 22711078

Pubmed Central ID

  • PMC3825458

Electronic International Standard Serial Number (EISSN)

  • 1539-3704

Digital Object Identifier (DOI)

  • 10.7326/0003-4819-156-12-201206190-00006


  • eng

Conference Location

  • United States