Is ""Provivo krom"" known to give hepatic side-effects?/nBackground: A woman with a history of alc

Fråga: "Is "Provivo krom" known to give hepatic side-effects? Background: A woman with a history of alcohol abuse, who had taken "Provivo krom", one tablet per day for a period of three weeks, was found to have increased liver values: ALAT 0.92 (< 0.60 ukat/L), gamma-GT 1.1 (< 0.80 ukat/L), normal values for ASAT. According to the patient, she has not used any other drugs or alcohol."

Sammanfattning: Provivo krom is a dietary supplement which contains a small amount of niacin-bound trivalent chromium. No documentation could be found to suspect that a normal use of this preparation could give rise to any hepatic side-effects. However, if no other reason for the patient´s increased liver values can be found, it may be advisable to discontinue its use.

Svar: Provivo krom is not a registered herbal medicine. It may be looked upon as a dietary supplement, that can be purchased in health food shops. One tablet of "Provivo krom" contains: 200 ug of niacin-bound trivalent chromium, 100 mg of oat fiber and some binding agents (1). Chromium in its trivalent form is an essential trace element involved in carbohydrate metabolism and although an estimated average requirement has not been set for chromium, a daily intake of 50-200 ug for adults is believed to be safe and adequate (2,3). The daily diet contains 30-100 ug of trivalent chromium, of which only about one per cent is absorbed, enough to meet any possible requirement (4). A daily intake of one tablet of "Provivo krom" doesn´t seem to exceed the upper safety limits of chromium daily intake.

No reports on hepatic side-effects after oral administration of trivalent chromium could be found. According to (5), trace elements such as chromium, copper, iron and lead may cause liver injury when ingested in toxic amounts. However, this statement was not further specified and the original reference could not be obtained. Chromium toxicity as such is primarily associated with exposure to so-called hexavalent (man-made) products (6) (mainly industrial exposure). Acute and chronic toxicity of hexavalent chromium at high doses, as well as skin hypersensitivity reactions and genotoxic and carcinogenic effects are well known among persons occupationally exposed to chromium compounds. Also, there are a number of case reports concerning hepatic injury and acute renal failure in patients receiving enemas or oral treatment with sodium or potassium dichromate (hexavalent) as a purgative (5).

For completeness, it may be added that cholestatic and hepatocellular reactions have been described with niacin therapy, especially with sustained release preparations. Most cases occur with high daily doses (over 3-4 grams) (7).