Which herbal supplement, when taken with ketoconazole, can cause hepatotoxicity?

Echinacea is known to potentially interact with various medications, including ketoconazole, which is an antifungal agent. Both echinacea and ketoconazole are metabolized by the liver, and when taken together, echinacea may increase the risk of hepatotoxicity. This is due to echinacea's ability to affect liver enzymes, particularly cytochrome P450 enzymes, which play a crucial role in the metabolism of many drugs. When these pathways are affected, it can lead to increased levels of ketoconazole in the body, heightening the risk of liver damage.

Other herbal supplements listed, such as garlic, ginseng, and ginger, do not have the same level of documented interaction with ketoconazole that may lead to hepatotoxicity. Therefore, while they may have other effects or interactions, echinacea stands out in this context for its potential to cause liver-associated side effects when combined with ketoconazole.