Comfrey

• 分子结构分类: 有机化合物 - 生物碱及其衍生物
• 英文名称: Comfrey
• 英文别名: [7-[(E)-2-methylbut-2-enoyl]oxy-4-oxido-5,6,7,8-tetrahydro-3H-pyrrolizin-4-ium-1-yl]methyl 2-hydroxy-2-(1-hydroxyethyl)-3-methylbutanoate
• 化学式: C20H31NO7
• 分子量: 397.5
• InChiKey: MTHHNSCIBYQVSB-AWNIVKPZSA-N

计算性质

• 辛醇/水分配系数(LogP)：
  0.8
• 重原子数：
  28
• 可旋转键数：
  9
• 环数：
  2.0
• sp3杂化的碳原子比例：
  0.7
• 拓扑面积：
  111
• 氢给体数：
  2
• 氢受体数：
  7

ADMET

毒理性

• 肝毒性

口服紫草导致急性肝损伤，类似于肝窦阻塞综合征（SOS）的病例已经有所报道。损伤通常在使用紫草产品（无论是片剂形式的提取物还是大量紫草茶）后1到2个月内出现，表现为右上腹疼痛、恶心和体重增加（由于液体潴留），随后出现黄疸。血清转氨酶水平通常只是轻微升高，呈现肝细胞损伤模式，尽管在损伤早期进行测试时，它们可能会显著增加。免疫过敏和自身免疫特征通常不存在。损伤可能是严重的，迅速导致急性肝衰竭（急性肝窦阻塞综合征），但更常见的是隐匿性发作，表现为体重增加、腹水、虚弱和血清转氨酶轻微升高（亚急性或慢性肝窦阻塞综合征）。

Several cases of acute liver injury resembling sinusoidal obstruction syndrome (SOS) due to oral comfrey have been published. The injury usually arises within 1 to 2 months of starting the comfrey product (either extract in tablet form or large amounts of comfrey tea) with onset of right upper quadrant pain, nausea and weight gain (from fluid retention) followed by jaundice. Serum aminotransferase levels are usually only mildly elevated with a hepatocellular pattern of injury, although they may be markedly increased if tested during the early phases of the injury. Immunoallergic and autoimmune features are usually not present. The injury can be severe and rapidly lead to acute liver failure (acute sinusoidal obstruction syndrome), but more commonly presents insidiously with weight gain, ascites, weakness, and minimal serum aminotransferase elevations (subacute or chronic sinusoidal obstruction syndrome).

来源:LiverTox

毒理性

• 在妊娠和哺乳期间的影响

哺乳期间使用概要：紫草（Symphytum officinalis）的草药和叶子含有尿囊素和迷迭香酸；紫草还含有吡咯烷生物碱。紫草制剂已被外用用于缓解会阴切开术后的疼痛和开裂、疼痛的乳头，既可以是水制剂，也可以是乳膏和软膏。这些适应症的有效性的科学证据是微不足道的。紫草中的吡咯烷生物碱可能导致严重的肝损伤、肝癌、致突变性，甚至死亡。因此，美国食品药品监督管理局禁止在美国销售口服紫草产品。此外，大多数来源认为在哺乳期间外用紫草是禁忌的。如果用在皮肤上，应只应用于远离乳房的完整皮肤上，可能的最小面积，且时间有限。确保婴儿不直接接触到涂抹过的皮肤区域尤为重要，因为摄入可能会导致严重的肝损伤。 膳食补充剂不需要美国食品药品监督管理局的广泛市场前批准。制造商负责确保安全，但在市场销售前不需要证明膳食补充剂的安全性和有效性。膳食补充剂可能含有多种成分，标签成分或其数量与实际成分或数量之间常常存在差异。制造商可以与独立组织签订合同，以验证产品的质量或其成分，但这并不证明产品的安全或有效性。由于上述问题，一个产品的临床测试结果可能不适用于其他产品。关于膳食补充剂的更详细信息可以在LactMed网站的其它地方找到。 ◉ 对哺乳婴儿的影响：截至修订日期，没有找到相关的已发布信息。 ◉ 对哺乳和母乳的影响：截至修订日期，没有找到相关的已发布信息。

◉ Summary of Use during Lactation:Comfrey (Symphytum officinalis) herb and leaf contains allantoin and rosmarinic acid; comfrey also contains pyrrolizidine alkaloids. Comfrey preparations have been used topically for pain following episiotomy and cracked, painful nipples, either as aqueous preparations or in creams and ointments. Scientific evidence of effectiveness for these indications is minimal. The pyrrolizidine alkaloids in comfrey can cause severe liver damage, liver cancer, mutagenicity, and even death. For this reason, the U.S. Food and Drug Administration has banned the sale of oral comfrey products in the United States. Furthermore, most sources consider topical use of comfrey during breastfeeding to be contraindicated. If it is used on the skin, it should only be applied to intact skin away from the breast on the smallest area of skin possible, and for a limited duration. It is particularly important to ensure that the infant not come into direct contact with the areas of skin that have been treated, because ingestion may cause severe liver damage. Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site. ◉ Effects in Breastfed Infants:Relevant published information was not found as of the revision date. ◉ Effects on Lactation and Breastmilk:Relevant published information was not found as of the revision date.

来源:Drugs and Lactation Database (LactMed)