Reactions 1315 - 21 Aug 2010

SDietary supplement

Hepatotoxicity following treatment with ‘MoveFree Advanced’ products in elderly patients:2 case reports

Two women developed hepatotoxicity duringosteoarthritis treatment with Move Free Advanced or MoveFree Advanced plus MSM. The OTC products containedunknown quantities of Scutellaria extract [Chinese skullcap;Scutellaria baicalensis], glucosamine hydrochloride,chondroitin sulfate, hyaluronic acid and Acacia catechu;Move Free Advanced plus MSM also contained dimethylsulfone.

A 71-year-old woman started taking Move FreeAdvanced 2 tablets/day. Approximately 3 weeks later, shepresented with diarrhoea for 3–4 days, and a 2-weekhistory of progressive fatigue and mild depression. Herliver values were severely elevated (up to 9 times the uppernormal limit), and had worsened further 4–5 weeks later. Atweek 6, an ultrasound revealed only mild fatty liverinfiltration, and hepatitis serologies were negative. Mild-to-moderate abdominal cramps and diarrhoea persisted, withorange-coloured morning urine and fatigue. However, atsome point between 4 and 5 weeks from her initialpresentation, she decided to stop taking Move FreeAdvanced. Her diarrhoea resolved within a few days, andher fatigue and mood improved within 1–2 weeks. Her liverfunction improved 3–4 weeks after cessation of thesupplement, and normalised after about 12 weeks. She hadno serious sequelae.

An 85-year-old woman started taking Move FreeAdvanced plus MSM 2 tablets twice daily; after 2 weeks,she decreased her intake to 2 tablets/day. About 3 weeksafter therapy initiation, her liver values were found to beslightly elevated. She was advised to discontinue thesupplement, and her liver values were essentially normal7 weeks after therapy cessation.

Author comment: "Based on a score of 6 on the Naranjoadverse drug reaction probability scale, it is probable that theMove Free Advanced supplement caused the hepatotoxicity inboth of our patients.. . . Although it is possible that any ofthe ingredients could be the cause of the hepatotoxicity, ourliterature search points to Chinese skullcap as the most likelycause."Linnebur SA, et al. Hepatotoxicity associated with Chinese skullcap contained inmove free advanced dietary supplement: Two case reports and review of theliterature. Pharmacotherapy 30: 258e-262e, No. 7, Jul 2010 - USA 803033225

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Reactions 21 Aug 2010 No. 13150114-9954/10/1315-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved