Clinical study of rheum emodi, ammonium chloride and potassium nittrate in drug induced hepatotoxicity of tubercular patients

ABSTRACT

A number of anti-tubercular drugs are used for the treatment of tuberculosis for a long duration of time. Most common drug combination for the short course chemotherapy is Rifampicin, Pyrazinamide, Isoniazid, and Ethambutol. In the long-term therapy, these drugs cause hepatotoxicity due to their adverse effects i.e. hepatitis, hepatic insufficiency, cholestatic hepatitis and fulminant hepatitis. Several Unani drugs have been reported as hepatoprotective agents, such as kasni, afsantin, zafran, nagar motha, gul-e-ghafis, naushader, shora qalmi, revand chini etc. In the present research work a powdered formulation containing revand chini [Rheum emodi], naushader [Ammonium chloride] and shora qalmi [Potassium nitrate] was prepared and studied clinically along with the anti-tubercular drugs during the first month of the treatment of tuberculosis in male and female subjects. The blood samples of the patients were collected before and after treatment and estimated for liver function tests i.e. serum bilirubin, serum glutamic pyruvic transaminase [SGPT] and serum alkaline phosphates [SAP]. The patients were also observed for subjective/symptomatic parameters e.g. nausea and vomiting, loss of appetite, constipation, flatulence and hepatomegaly. Hepatomegaly was examined by the physician and other parameters were recorded in the follow-up. Significant hepatoprotective effects were observed in both male and female subjects, although more prominent effects were observed in female subjects. The other symptoms such as nausea, vomiting, loss of appetite, constipation, flatulence and hepatomegaly were reduced in the ATT+Unani treatment groups as compared with anti-tuberculosis treatment alone. In conclusion, the Unani formulation along with the anti-tubercular drug treatment was found beneficial in reducing the side effects of anti-tubercular drugs on liver of the patients