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

Echinacea is known to have potential hepatotoxic effects, especially when combined with certain medications, including ketoconazole, which is an antifungal agent that can affect liver function. Echinacea may lead to an increase in liver enzyme levels, indicating stress on the liver. The concern arises because ketoconazole itself can cause liver toxicity, and when taken with Echinacea, there is a potential for an additive effect, heightening the risk of liver damage.

In contrast, other herbal supplements listed have different safety profiles and are not primarily associated with an increased risk of hepatotoxicity when combined with ketoconazole. Ginseng, for example, is commonly used for its energizing properties and does not have a strong, documented association with liver toxicity under these circumstances. Gingko is often used for cognitive enhancement but also lacks a direct connection to complications with liver function when used with ketoconazole. St. John's Wort, while it does interact with several medications, primarily affects the metabolism of drugs through cytochrome P450 pathways but does not demonstrate the same level of hepatotoxic concern when paired with ketoconazole.

Understanding the interactions and side effects of herbal supplements is crucial for ensuring patient safety, particularly when used alongside other medications that are known to