Is medication with Rhodiola rosea extracts (common name in English: golden root, Swedish: rosenrot)

Fråga: Is medication with Rhodiola rosea extracts (common name in English: golden root, Swedish: rosenrot) contraindicated in chronic active hepatitis C infection? A 40-year-old woman has chronic fatigue and hepatitis C with slightly impaired liver function tests. She has periodically used Rhodiola with very good effect on her fatigue. The questioner is now concerned this herbal medicine might further impair her liver function.

Sammanfattning: Rhodiola rosea has been shown to have some hepatoprotective effects in rats, but has not been studied thoroughly in man. Hence it could not be recommended, neither considered contraindicated.

Svar: Rhodiola rosea is a common plant in mountains of Northern Scandinavia, Russia and Tibet (1,2). Sometimes it is incorrectly assigned to the genus Sedum (Swedish: fetblad) and then called Sedum roseum, hence the name of the root: sedi rosei rhizoma (3). It is also called by several synonyms including Rhodiola sachaliensis (4) or sachalinensis after the Russian island Sakhalin. The root contains the glucoside salidroside and several other compounds (5).

A Korean group has shown that an aqueous extract of Rhodiola rosea has anti-oxidative and anti-fibrotic properties in rat livers and diminishes histological and biochemical markers of hepatic injury induced by carbon tetrachloride (CCl4) (2). A Chinese group has shown that a compound herb extract containing Rhodiola sachalinensis and Sophora flavescens (yellow mountain laurel) inhibits CCl4-induced hepatic expression of TGF-beta and the sodium-calcium exchanger and also diminishes histological fibrosis as well as the rise in liver function tests, serum levels of type III procollagen, type IV collagen.

Hence Rhodiola seems to have some hepatoprotective effects on experimentally induced liver damage in rats (6). These effects have not been scientifically studied in man and so the use of this herb cannot be advised, but on the other hand there is nothing to say that it should be contraindicated.

In the Swedish database of adverse drug reactions (7) there is one case of cholestasis judged to be possibly related to the use of a compound herbal remedy containing Schisandra chinensis, Eleutherococcus senticosus and Rhodiola rosea, and one case of increased liver function tests possibly related to the use of Schisandra and Eleutherococcus without Rhodiola. There is also an unclassifiable case of simultaneous use of Rhodiola, ginseng, Andrographis paniculata, and various vitamins and minerals as well as a suspected alcohol abuse. Hence it is not possible to ascribe these adverse drug reactions to Rhodiola alone.

Since Rhodiola extracts contain several compounds the effect on pharmacokinetics of other drugs is difficult to predict. If concomitantly used with i.e. ribavirin, therapeutic drug monitoring of the latter is strongly recommended.