Adjuvant Phytotherapy against Antitubercular Drug Induced Hepatotoxicity

Tuberculosis was declared as a global pandemic and panic because the causative Mycobacterium tuberculosis can kill an incredible number of individuals which formulate a major obstacle to social and economic development of the country. Most of the developing countries are affected by tuberculosis. Antitubercular therapy involves the use of Directly Observed Therapy Short (DOTS) course for 6-9 months. Antitubercular drug induced hepatic damage may occur with DOTS combination regimen which consists of an initial 2-month phase of 1st line combination therapy with pyrazinamide (PZA), isoniazid (INH), rifampin (RIF) and ethambutol (E) followed by a continuation phase of treatment lasting 4 months with INH and RIF [1]. Metabolic idiosyncratic reactions appear to be responsible for most drugs induced liver injury from the first-line antitubercular medications and fluoroquinolones [2]. Knowledge of the mechanisms of antitubercular drug-induced liver injury or hepatotoxicity is incomplete. Herbal drugs have gained importance and popularity in recent years because of their safety, efficacy and cost effectiveness. The association of medical plants with other plants in their habitat also influences their medicinal values in some cases. One of the important and well-documented uses of ethno medicinal plant products is their use as hepatoprotective agents which become ever increasing need for the treatment of antitubercular compounds induced hepatic cell damage. It was reported that antitubercular drugs-induced hepatotoxicity can be treated by administering extracts of herbal medicinal plants enlisted in Table 1. The present editorial presents the herbs which contain active principles of secondary metabolites responsible for producing biochemical mechanisms of hepatoprotective activities against antitubercular drug regimen induced hepatotoxicity in mouse model. A number of experimental studies concerning phyto extracts obtained from several plants have been carried out to reduce hepatotoxicity in this context.