Artemisinins are a class of compounds that include
artesunate,
artemether, and
artemisinin and have potent
antimalarial activity. In combination with other drugs (
artemisinin combination
therapy), these compounds are the first-line treatment recommended by the World Health Organization for Plasmodium falciparum
infections.
Artemisinins have been available in the United States without a prescription as herbal supplements for at least 10 years; these supplements are marketed for general health maintenance and for treatment of
parasitic infections and
cancers. On August 27, 2008, CDC was notified of a patient who developed
hepatitis after a 1-week course of an herbal supplement containing
artemisinin. The patient had
abdominal pain, dark urine, and laboratory results consistent with
hepatitis (e.g., serum
alanine aminotransferase of 898 IU/L [normal: 10-55 IU/L]). Samples of the supplement were sent to CDC and the Georgia Institute of Technology for analysis to determine the amount of
artemisinin and to identify any contaminants. Analysis indicated that the supplement contained 94%-97% of the 100 mg of
artemisinin stated on the packaging and the supplement contained no other common
pharmaceutical active ingredients. Given the patient's
clinical course and laboratory evaluation, CDC investigators concluded that the
hepatitis might have been associated with ingestion of the herbal supplement containing
artemisinin. More data are needed to establish any causal connection between
artemisinin and
hepatitis. Health-care providers should be aware of the possibility of hepatic toxicity in patients taking herbal supplements containing
artemisinin.