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Department of Pharmacognosy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-Dori, Mizuho-ku, Nagoya, Japan (R.S., K.I., Y.T., T.M.); Center for Kampo Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan (T.Y., K.F., K.W.); Department of Japanese Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan (T.N.); Department of Japanese Traditional (Kampo) Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa-City, Ishikawa, Japan (K.O.-O.); Kampo Clinical Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan (K.O.-O.); Department of Oriental Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan (K.M.); Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan (K.F.)

Article Synopsis
  • Licorice is commonly used in traditional Japanese medicine and as a sweetener, but it can cause a side effect known as pseudoaldosteronism (PsA), which leads to symptoms like low potassium, high blood pressure, and fluid retention.
  • A study examined 78 patients using Kampo medicines with licorice, finding multiple glycyrrhizinic acid metabolites in their blood and urine, including some newly identified ones.
  • Individual differences were noted in the levels of these metabolites, suggesting they may influence susceptibility to PsA, with specific metabolites like 3--GA and 3-GA30G potentially playing a significant role.
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The clinical manifestations of licorice-induced pseudoaldosteronism include muscle weakness, periodic paralysis, hypokalemia, and hypertension. Excessive licorice consumption can lead to adverse reactions affecting multiple systems, including the endocrine, cardiovascular, nervous, digestive, and immune systems. Although licorice is a frequently used Chinese herbal medicine, life-threatening adverse reactions have been reported among its users.

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Article Synopsis
  • Drug-induced pseudoaldosteronism can occur as an adverse effect of Kampo formulas, with a study analyzing reports from the Japanese Adverse Drug Event Report database showing specific risk factors.
  • The research identified 210 reports of pseudoaldosteronism among 6334 adverse event reports related to Kampo formulas, with a high prevalence in older females.
  • Key associated factors included older age, female sex, low body weight, diuretic use, hypertension, and dementia, along with the dosage and duration of Glycyrrhiza, which is often included in these formulas.
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