Toxicological Effects of Glycyrrhiza glabra (Licorice): A Review
Somayeh Nazari
Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Search for more papers by this authorMaryam Rameshrad
Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Search for more papers by this authorCorresponding Author
Hossein Hosseinzadeh
Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Correspondence to: Hossein Hosseinzadeh, Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
E-mail: [email protected]
Search for more papers by this authorSomayeh Nazari
Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Search for more papers by this authorMaryam Rameshrad
Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Search for more papers by this authorCorresponding Author
Hossein Hosseinzadeh
Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Correspondence to: Hossein Hosseinzadeh, Pharmaceutical Research Center, Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
E-mail: [email protected]
Search for more papers by this authorAbstract
Licorice (Glycyrrhiza glabra) has been considered as an herbal drug since ancient time. Nowadays, it is a well-known spice that possesses worth pharmacological effects. However, some relevant articles have revealed negative impacts of licorice in health. By considering the great wishes in using herbal medicine, it is important to show adverse effects of herbal medicine in health. At present, there are misunderstandings toward the safety of herbal medicines. Herein, we gathered scientific research projects on the toxicity effects of licorice and glycyrrhizin to highlight their safety. In this regards, we categorized our findings about the toxicity effects of licorice and glycyrrhizin in acute, sub-acute, sub-chronic, and chronic states. Besides, we discussed on the cytotoxicity, genotoxicity, mutagenicity, and carcinogenicity of licorice and glycyrrhizin as well as their developmental toxicity. This review disclosed that G. glabra and glycyrrhizin salts are moderately toxic. They need to be used with caution during pregnancy. G. glabra and glycyrrhizin possess selective cytotoxic effects on cancerous cells. The most important side effects of licorice and glycyrrhizin are hypertension and hypokalemic-induced secondary disorders. Licorice side effects are increased by hypokalemia, prolonged gastrointestinal transient time, decreased type 2 11-beta-hydroxysteroid dehydrogenase activities, hypertension, anorexia nervosa, old age, and female sex. Copyright © 2017 John Wiley & Sons, Ltd.
References
- Abe H, Ohya N, Yamamoto KF, et al. 1987. Effects of glycyrrhizin and glycyrrhetinic acid on growth and melanogenesis in cultured B16 melanoma cells. Eur J Cancer Clin Oncol 23: 1549–1555.
- Abudayyak M, Özdemir Nath E, Özhan G. 2015. Toxic potentials of ten herbs commonly used for aphrodisiac effect in Turkey. Turk J Med Sci 45: 496–506.
- Agarwal R, Mukhtar H. 1991. Inhibition of mouse skin tumor-initiating activity of DMBA by chronic oral feeding of glycyrrhizin in drinking water. Nutr Cancer 15: 187–193.
- Akasaka Y, Hatta A, Sato T, et al. 2008. Chronic toxicity study of monoammonium glycyrrhizinate by repeated subcutaneous administration to CD rats for 26 weeks. Jpn Pharmacol Ther 36: 1025–1037.
- Akasaka Y, Hatta A, Sato T, et al. 2009. Studies on genotoxicity of monoammonium glycyrrhizinate. Jpn Pharmacol Ther 37: 49–60.
- Al-Qarawi AA, Abdel-Rahman HA, Ali BH, et al. 2002. Liquorice (Glycyrrhiza glabra) and the adrenal-kidney-pituitary axis in rats. Food Chem Toxicol 40: 1525–1527.
- Arentz S, Smith CA, Abbott J, et al. 2017. Combined lifestyle and herbal medicine in overweight women with polycystic ovary syndrome (PCOS): a randomized controlled trial. Phytother Res.
- Armanini D, Karbowiak I, Funder JW. 1983. Affinity of liquorice derivatives for mineralocorticoid and glucocorticoid receptors. Clin Endocrinol (Oxf) 19: 609–612.
- Armanini D, Mattarello MJ, Fiore C, et al. 2004. Licorice reduces serum testosterone in healthy women. Steroids 69: 763–766.
- Baker ME. 1995. Endocrine activity of plant-derived compounds: an evolutionary perspective. Proc Soc Exp Biol Med 208: 131–138.
- Basso A, Dalla Paola L, Erle G, et al. 1994. Licorice ameliorates postural hypotension caused by diabetic autonomic neuropathy. Diabetes Care 17: 1356.
- Bisogni V, Rossi GP, Calò LA. 2014. Apparent mineralcorticoid excess syndrome, an often forgotten or unrecognized cause of hypokalemia and hypertension: case report and appraisal of the pathophysiology. Blood Press 23: 189–192.
- Bone K, Mills S. 2013. Principles and practice of phytotherapy modern herbal medicine, 2nd edn. Churchill livingstone: Edinburgh (UK).
- Cantelli-Forti G, Maffei F, Hrelia P, et al. 1994. Interaction of licorice on glycyrrhizin pharmacokinetics. Environ Health Perspect 102: 65–68.
- Cartier A, Malo JL, Labrecque M. 2002. Occupational asthma due to liquorice roots. Allergy 57: 863.
- Chandrasekaran CV, Sundarajan K, Gupta A, et al. 2011. Evaluation of the genotoxic potential of standardized extract of Glycyrrhiza glabra (GutGard™). Regul Toxicol Pharmacol 61: 373–380.
- Chen J, Wang J, Qin T, et al. 2014. Efficacy and safety of Stronger Neo-Minophagen C for treatment of chronic hepatitis B: a meta-analysis of randomized controlled trials. Nan Fang Yi Ke Da Xue Xue Bao 34: 1224–1229.
- Chigurupati H, Auddy B, Biyani M, et al. 2016. Hepatoprotective effects of a proprietary glycyrrhizin product during alcohol consumption: a randomized, double-blind, placebo-controlled, crossover study. Phytother Res 30: 1943–1953.
- Choi JS, Han JY, Ahn HK, et al. 2013. Fetal and neonatal outcomes in women reporting ingestion of licorice (Glycyrrhiza uralensis) during pregnancy. Planta Med 79: 97–101.
- Chowdhury B, Bhattamisra SK, Das MC. 2013. Anti-convulsant action and amelioration of oxidative stress by Glycyrrhiza glabra root extract in pentylenetetrazole-induced seizure in albino rats. Indian J Pharm 45: 40–43.
- Chubachi A, Wakui H, Asakura K, et al. 1992. Acute renal failure following hypokalemic rhabdomyolysis due to chronic glycyrrhizic acid administration. Intern Med 31: 708–711.
- Chueh FS, Hsiao YT, Chang SJ, et al. 2012. Glycyrrhizic acid induces apoptosis in WEHI-3 mouse leukemia cells through the caspase- and mitochondria-dependent pathways. Oncol Rep 28: 2069–2076.
- Cuzzolin L, Francini-Pesenti F, Verlato G, et al. 2010. Use of herbal products among 392 Italian pregnant women: focus on pregnancy outcome. Pharmacoepidemiol Drug Saf 19: 1151–1158.
- Daniş R, Ruhi Ç, Berketoʇlu N, et al. 2015. Licorice ingestion; an unusual cause of rhabdomyolysis and acute renal failure. Turk Nephrol Dial transplant J 24: 106–109.
- De Putter R, Donck J. 2014. Low-dose liquorice ingestion resulting in severe hypokalaemic paraparesis, rhabdomyolysis and nephrogenic diabetes insipidus. Clin Kidney J 7: 73–75.
- Dietrich CG, Geier A, Oude Elferink RP. 2003. ABC of oral bioavailability: transporters as gatekeepers in the gut. Gut 52: 1788–1795.
- Dong S, Inoue A, Zhu Y, et al. 2007. Activation of rapid signaling pathways and the subsequent transcriptional regulation for the proliferation of breast cancer MCF-7 cells by the treatment with an extract of Glycyrrhiza glabra root. Food Chem Toxicol 45: 2470–2478.
- Eaton DL, Gilbert SG. 2013. Principles of toxicology. In Casarett & Doull's Toxicology the basic science of poisons, CD Kilassen (ed). MC Grow Hi education: New York; 34–37 424.
- Egashira T, Takayama F, Yufu F, et al. 2003. Pharmacokinetics of glycyrrhizin and glycyrrhetic acid following glycyrrhizin administration to rats with single and multiple doses via different routes. Jpn Pharmacol Ther 31: 75–83.
- Eid TJ, Morris AA, Shah SA. 2011. Hypertension secondary to ingestion of licorice root tea. J Pharm Technol 27: 266–268.
10.1177/875512251102700605 Google Scholar
- Farese RVJ, Biglieri EG, Shackleton CHL, et al. 1991. Licorice-induced hypermineralocorticoidism. N Engl J Med 325: 1223–1227.
- Federation of American Societies for Experimental B & United S. 1974. Evaluation of the health aspects of licorice, glycyrrhiza and ammoniated glycyrrhizin as food ingredients, edn edn. Bethesda, Md: Life Sciences Research Office.
- Finney RS, Somers GF, Wilkinson JH. 1958. The pharmacological properties of glycyrrhetinic acid: a new anti-inflammatory drug. J Pharm Pharmacol 10: 687–695.
- Fiore C, Eisenhut M, Ragazzi E, et al. 2005. A history of the therapeutic use of liquorice in Europe. J Ethnopharmacol 99: 317–324.
- Fugh-Berman A, Ernst E. 2001. Herb-drug interactions: review and assessment of report reliability. Br J Clin Pharmacol 52: 587–595.
- Gaur R, Gupta VK, Singh P, et al. 2016. Drug resistance reversal potential of isoliquiritigenin and liquiritigenin isolated from Glycyrrhiza glabra against methicillin-resistant Staphylococcus aureus (MRSA). Phytother Res 30: 1708–1715.
- Gupta M, Sasmal SK, Karmakar N, et al. 2016. Experimental evaluation of antioxidant action of aqueous extract of glycyrrhiza glabra linn. Roots in potassium dichromate induced oxidative stress by assessment of reactive oxygen species levels. Int J Pharmacogn Phytochem Res 8: 1325–1333.
- Hamta A, Shariatzadeh SMA, Soleimani Mehranjani M, et al. 2014. The cytotoxic effects of Glycyrrhiza glabra L. root extract on 4T1 cell line derived from BALB/c mice mammary tumors. J Med Plant 13: 92–103.
- Harada T, Ohtaki E, Misu K, et al. 2002. Congestive heart failure caused by digitalis toxicity in an elderly man taking a licorice-containing chinese herbal laxative. Cardiology 98: 218.
- Hauksdottir D, Sigurjonsdottir HA, Arnadottir M, et al. 2015. Severe, very early onset pre-eclampsia associated with liquorice consumption. Hypertens Pregnancy 34: 221–226.
- Hawthorne S, Gallagher S. 2008. Effects of glycyrrhetinic acid and liquorice extract on cell proliferation and prostate-specific antigen secretion in LNCaP prostate cancer cells. J Pharm Pharmacol 60: 661–666.
- Hayashi H, Sudo H. 2009. Economic importance of licorice. Plant Biotechnol 26: 101–104.
- Heidemann HT, Kreuzfelder E. 1983. Hypokalemic rhabdomyolysis with myoglobinuria due to licorice ingestion and diuretic treatment. Klin Wochenschr 61: 303–305.
- Hibasami H, Iwase H, Yoshioka K, et al. 2005. Glycyrrhizin induces apoptosis in human stomach cancer KATO III and human promyelotic leukemia HL-60 cells. Int J Mol Med 16: 233–236.
- Hibasami H, Iwase H, Yoshioka K, et al. 2006. Glycyrrhetic acid (a metabolic substance and aglycon of glycyrrhizin) induces apoptosis in human hepatoma, promyelotic leukemia and stomach cancer cells. Int J Mol Med 17: 215–219.
- Hosseinzadeh H, Nassiri Asl M. 2015. Pharmacological effects of Glycyrrhiza spp. and its bioactive constituents: update and review. Phytother Res 29: 1868–1886.
- Hosseinzadeh H, Nassiri Asl M, Parvardeh S. 2005. The effects of carbenoxolone, a semisynthetic derivative of glycyrrhizinic acid, on peripheral and central ischemia-reperfusion injuries in the skeletal muscle and hippocampus of rats. Phytomedicine 12: 632–637.
- Hosseinzadeh H, Sadeghi Shakib S, Khadem Sameni A, et al. 2013. Acute and subacute toxicity of safranal, a constituent of saffron, in mice and rats. Iran J Pharm Res 12: 93–99.
- Hou YC, Lin SP, Chao PD. 2012. Liquorice reduced cyclosporine bioavailability by activating P-glycoprotein and CYP 3A. Food Chem 135: 2307–2312.
- Hrelia P, Fimognari C, Maffei F, et al. 1996. Potential antimutagenic activity of Glycyrrhiza glabra extract. Phytother Res 10: S101–S103.
- Hundertmark S, Dill A, Buhler H, et al. 2002. 11beta-hydroxysteroid dehydrogenase type 1: a new regulator of fetal lung maturation. Horm Metab Res 34: 537–544.
- Hussein E. 2013. Biochemical and histopathological studies on the liver of rats administrated with different concentrations of aqueous extract of Glycyrrhiza glabrous. Glob Vet 10: 491–495.
- Iida R, Otsuka Y, Matsumoto K, et al. 2006. Pseudoaldosteronism due to the concurrent use of two herbal medicines containing glycyrrhizin: interaction of glycyrrhizin with angiotensin-converting enzyme inhibitor. Clin Exp Nephrol 10: 131–135.
- Inami K, Mine Y, Kojo Y, et al. 2017. Antimutagenic components in Glycyrrhiza against N-methyl-N-nitrosourea in the Ames assay. Nat Prod Res 31: 691–695.
- Isbrucker RA, Burdock GA. 2006. Risk and safety assessment on the consumption of Licorice root (Glycyrrhiza sp.), its extract and powder as a food ingredient, with emphasis on the pharmacology and toxicology of glycyrrhizin. Regul Toxicol Pharmacol 46: 167–192.
- Ishida S, Sakiya Y, Ichikawa T, et al. 1989. Pharmacokinetics of glycyrrhetic acid, a major metabolite of glycyrrhizin, in rats. Chem Pharm Bull 37: 2509–2513.
- Ishida S, Sakiya Y, Ichikawa T, et al. 1992. Dose-dependent pharmacokinetics of glycyrrhizin in rats. Chem Pharm Bull 40: 1917–1920.
- Ishidate M, Sofuni T, Yoshikawa K, et al. 1984. Primary mutagenicity screening of food additives currently used in Japan. Food Chem Toxicol 22: 623–636.
- Ishiguchi T, Mikita N, Iwata T, et al. 2004. Myoclonus and metabolic alkalosis from licorice in antacid. Intern Med 43: 59–62.
- Itami T, Ema M, Kanoh S. 1985. Effect of disodium glycyrrhizinate on pregnant rats and their offspring studies on the fetal toxicity of food additives. III. Shokuhin Eiseigaku Zasshi 26: 460–464_461.
- Jo EH, Kim SH, Ra JC, et al. 2005. Chemopreventive properties of the ethanol extract of chinese licorice (Glycyrrhiza uralensis) root: induction of apoptosis and G1 cell cycle arrest in MCF-7 human breast cancer cells. Cancer Lett 230: 239–247.
- Kageyama Y, Suzuki H, Saruta T. 1994. Role of glucocorticoid in the development of glycyrrhizin-induced hypertension. Clin Exp Hypertens 16: 761–778.
- Kent UM, Aviram M, Rosenblat M, et al. 2002. The licorice root derived isoflavan glabridin inhibits the activities of human cytochrome P450S 3A4, 2B6, and 2C9. Drug Metab Dispos 30: 709–715.
- Khazraei-Moradian S, Andalib A, Ganjalikhani-Hakemi M, et al. 2014. The effect of protein extract of licorice root in proliferation of HT-29 and CT26 cancer cell lines. Majallahi Danishkadahi Pizishkii Isfahan 32: 1338–1346.
- Khazraei-Moradian S, Ganjalikhani-Hakemi M, Andalib A, et al. 2017. The effect of licorice protein fractions on proliferation and apoptosis of gastrointestinal cancer cell lines. Nutr Cancer 69: 330–339.
- Kinoshita T, Tamura Y, Mizutani K. 2005. The isolation and structure elucidation of minor isoflavonoids from licorice of Glycyrrhiza glabra origin. Chem Pharm Bull 53: 847–849.
- Kobuke T, Inai K, Nambu S, et al. 1985. Tumorigenicity study of disodium glycyrrhizinate administered orally to mice. Food Chem Toxicol 23: 979–983.
- Koga K, Tomoyama M, Ohyanagi K, et al. 2008. Pharmacokinetics of glycyrrhizin in normal and albumin-deficient rats. Biopharm Drug Dispos 29: 373–381.
- Kraus SD. 1958. Glycyrrhizin-induced inhibition of the pituitary-adrenal stress response. J Exp Med 108: 325–328.
- Kuroda M, Mimaki Y, Honda S, et al. 2010. Phenolics from Glycyrrhiza glabra roots and their PPAR-gamma ligand-binding activity. Bioorg Med Chem 18: 962–970.
- Lee Ching H, Lin Ruey H, Liu SH, et al. 1996. Mutual interactions among ingredients of betel quid in inducing genotoxicity on Chinese hamster ovary cells. Mutat Res 367: 99–104.
- Lee KW, Ho WS. 2013. 18β-glycyrrhetinic acid induces UDP-glucuronosyltransferase in rats. Protein Pept Lett 20: 1360–1364.
- Lee CK, Park KK, Lim SS, et al. 2007. Effects of the licorice extract against tumor growth and cisplatin-induced toxicity in a mouse xenograft model of colon cancer. Biol Pharm Bull 30: 2191–2195.
- Lee CS, Kim YJ, Lee MS, et al. 2008. 18β-Glycyrrhetinic acid induces apoptotic cell death in SiHa cells and exhibits a synergistic effect against antibiotic anti-cancer drug toxicity. Life Sci 83: 481–489.
- Lee SK, Park KK, Park JHY, et al. 2013. The inhibitory effect of roasted licorice extract on human metastatic breast cancer cell-induced bone destruction. Phytother Res 27: 1776–1783.
- Li HY, Xu W, Su J, et al. 2010. In vitro and in vivo inhibitory effects of glycyrrhetinic acid on cytochrome P450 3A activity. Pharmacology 86: 287–292.
- Liao S, Jin X, Li J, et al. 2016. Effects of silymarin, glycyrrhizin, and oxymatrine on the pharmacokinetics of ribavirin and its major metabolite in rats. Phytother Res 30: 618–626.
- Lin JH, Yamazaki M. 2003. Role of P-glycoprotein in pharmacokinetics: clinical implications. Clin Pharmacokinet 42: 59–98.
- Liu L, Xiao J, Peng ZH, et al. 2011. In vitro metabolism of glycyrrhetic acid by human cytochrome P450. Yao Xue Xue Bao 46: 81–87.
- Lockwood CJ. 2002. Predicting premature delivery—no easy task. N Engl J Med 346: 282–284.
- Lüde S, Vecchio S, Sinno-Tellier S, et al. 2016. Adverse effects of plant food supplements and plants consumed as food: results from the poisons centres-based PlantLIBRA study. Phytother Res 30: 988–996.
- Luyckx VA. 2012. Nephrotoxicity of alternative medicine practice. Adv Chronic Kidney Dis 19: 129–141.
- Lv Q-L, Wang G-H, Chen S-H, et al. 2016. In vitro and in vivo inhibitory effects of glycyrrhetinic acid in mice and human cytochrome P450 3A4. Int J Environ Res Public Health 13: 84.
- Mantovani A, Ricciardi C, Stazi AV, et al. 1988. Teratogenicity study of ammonium glycyrrhizinate in the Sprague-Dawley rat. Food Chem Toxicol 26: 435–440.
- Martínez A, Ikken Y, Cambero MI, et al. 1999. Mutagenicity and cytotoxicity of fruits and vegetables evaluated by the Ames test and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Food Sci Technol Int 5: 431–437.
- Mehdinejadiani K, Shirzad H, Fakhari S, et al. 2015. An evaluation the effect of glycyrrhetinic and glycyrrhizic acids derived from licorice extract on gastric cancer cell lines. J Babol Univ Med Sci 17: 53–59.
- Nabekura T, Yamaki T, Ueno K, et al. 2008. Inhibition of P-glycoprotein and multidrug resistance protein 1 by dietary phytochemicals. Cancer Chemother Pharmacol 62: 867–873.
- Nakagawa K, Hidaka T, Kitano M, et al. 2008a. Genotoxicity studies on licorice flavonoid oil (LFO). Food Chem Toxicol 46: 2525–2532.
- Nakagawa K, Kitano M, Kishida H, et al. 2008b. 90-Day repeated-dose toxicity study of licorice flavonoid oil (LFO) in rats. Food Chem Toxicol 46: 2349–2357.
- Nassiri Asl M, Hosseinzadeh H. 2007. Review of antiviral effects of Glycyrrhiza glabra L. and its active component, glycyrrhizin. J Med Plant 6: 1–12.
- Nassiri Asl M, Hosseinzadeh H. 2008. Review of pharmacological effects of glycyrrhiza sp. and its bioactive compounds. Phytother Res 22: 709–724.
- Nokhodchi A, Nazemiyeh H, Ghafourian T, et al. 2002. The effect of glycyrrhizin on the release rate and skin penetration of diclofenac sodium from topical formulations. Farmacoterapia 57: 883–888.
- Nourazarian SM, Nourazarian A, Majidinia M, et al. 2016. Effect of root extracts of medicinal herb Glycyrrhiza glabra on HSP90 gene expression and apoptosis in the HT-29 colon cancer cell line. Asian Pac J Cancer Prev 16: 8563–8566.
10.7314/APJCP.2015.16.18.8563 Google Scholar
- O'Connell RL, White IR, White JM, et al. 2008. Liquorice extract in a cosmetic product causing contact allergy. Contact Derm 59: 1600–0536.
- Ohno H, Araho D, Uesawa Y, et al. 2013. Evaluation of cytotoxiciy and tumor-specificity of licorice flavonoids based on chemical structure. Anticancer Res 33: 3061–3068.
- Okimasu E, Moromizato Y, Watanabe S, et al. 1983. Inhibition of phospholipase A2 and platelet aggregation by glycyrrhizin, an antiinflammation drug. Acta Med Okayama 37: 385–391.
- Panduranga P, Al-Rawahi N. 2013. Licorice-induced severe hypokalemia with recurrent torsade de pointes. Ann Noninvasive Electrocardiol 18: 593–596.
- Paolini M, Pozzetti L, Sapone A, et al. 1998. Effect of licorice and glycyrrhizin on murine liver CYP-dependent monooxygenases. Life Sci 62: 571–582.
- Paolini M, Barillari J, Broccoli M, et al. 1999. Effect of liquorice and glycyrrhizin on rat liver carcinogen metabolizing enzymes. Cancer Lett 145: 35–42.
- Park D, Yang YH, Choi EK, et al. 2011. Licorice extract increases cyclophosphamide teratogenicity by upregulating the expression of cytochrome P-450 2B mRNA. Birth Defects Res B Dev Reprod Toxicol 92: 553–559.
- Ploeger B, Mensinga T, Sips A, et al. 2001. The pharmacokinetics of glycyrrhizic acid evaluated by physiologically based pharmacokinetic modeling. Drug Metab Rev 33: 125–147.
- Radhakrishnan N, Phil M, Gnanamani A, et al. 2005. Effect of licorice (Glycyhrriza glabra Linn.), a skin-whitening agent on black molly (Poecilia latipinnaa). J Appl Cosmetol 23: 149–158.
- Raikkonen K, Pesonen AK, Heinonen K, et al. 2009. Maternal licorice consumption and detrimental cognitive and psychiatric outcomes in children. Am J Epidemiol 170: 1137–1146.
- Räikkönen K, Seckl JR, Heinonen K, et al. 2010. Maternal prenatal licorice consumption alters hypothalamic-pituitary-adrenocortical axis function in children. Psychoneuroendocrinology 35: 1587–1593.
- Rossi T, Fano RA, Castelli M, et al. 1999. Correlation between high Intake of glycyrrhizin and myolysis of the papillary muscles: an experimental in vivo study. Pharmacol Toxicol 85: 221–229.
- Ruszymah BHI, Nabishah BM, Aminuddin S, et al. 1995. Effects of glycyrrhizic acid on right atrial pressure and pulmonary vasculature in rats. Clin Exp Hypertens 17: 575–591.
- Saito T, Tsuboi Y, Fujisawa G, et al. 1994. An autopsy case of licorice-induced hypokalemic rhabdomyolysis associated with acute renal failure: special reference to profound calcium deposition in skeletal and cardiac muscle. Nihon Jinzo Gakkai Shi 36: 1308–1314.
- Sasaki YF, Kawaguchi S, Kamaya A, et al. 2002. The comet assay with 8 mouse organs: results with 39 currently used food additives. Mutat Res 519: 103–119.
- Schröder T, Hubold C, Muck P, et al. 2015. A hypertensive emergency with acute visual impairment due to excessive liquorice consumption. Neth J Med 73: 82–85.
- Shankel DM, Clarke CH. 1990. Specificity of antimutagens against chemical mutagens in microbial systems. Basic Life Sci 52: 457–460.
- Shen H, Zeng G, Sun B, et al. 2015. A polysaccharide from Glycyrrhiza inflata Licorice inhibits proliferation of human oral cancer cells by inducing apoptosis via mitochondrial pathway. Tumour Biol 36: 4825–4831.
- Sheu CW, Cain KT, Rushbrook CJ, et al. 1986. Tests for mutagenic effects of ammoniated glycyrrhizin, butylated hydroxytoluene, and gum Arabic in rodent germ cells. Environ Mutagen 8: 357–367.
- Shibata S, Inoue H, Iwata S, et al. 1991. Inhibitory effects of licochalcone A isolated from Glycyrrhiza inflata root on inflammatory ear edema and tumour promotion in mice. Planta Med 57: 221–224.
- Shin SH, Cho DH, Jang JY, et al. 2005. Effects of licorice on embryonic and fetal development in rats. Toxicol Res 21: 325–332.
- Shin S, Jang JY, Choi BI, et al. 2008. Licorice extract does not impair the male reproductive function of rats. Exp Anim 57: 11–17.
- Shiota G, Harada KI, Ishida M, et al. 1999. Inhibition of hepatocellular carcinoma by glycyrrhizin in diethylnitrosamine-treated mice. Carcinogenesis 20: 59–63.
- Sil R, Chakraborti AS. 2016. Oxidative inactivation of liver mitochondria in high fructose diet-induced metabolic syndrome in rats: effect of glycyrrhizin treatment. Phytother Res 30: 1503–1512.
- Sontia B, Mooney J, Gaudet L, et al. 2008. Pseudohyperaldosteronism, liquorice, and hypertension. J Clin Hypertens 10: 153–157.
- Strandberg TE, Jarvenpaa AL, Vanhanen H, et al. 2001. Birth outcome in relation to licorice consumption during pregnancy. Am J Epidemiol 153: 1085–1088.
- Strandberg TE, Andersson S, Jarvenpaa AL, et al. 2002. Preterm birth and licorice consumption during pregnancy. Am J Epidemiol 156: 803–805.
- Tacconi P, Paribello A, Cannas A, et al. 2009. Carpal tunnel syndrome triggered by excessive licorice consumption. J Peripher Nerv Syst 14: 64–65.
- Takeuchi T, Nishii O, Okamura T, et al. 1991. Effect of paeoniflorin, glycyrrhizin and glycyrrhetic acid on ovarian androgen production. Am J Chin Med 19: 73–78.
- Tanaka M, Mano N, Akazai E, et al. 1987. Inhibition of mutagenicity by glycyrrhiza extract and glycyrrhizin. J Pharmacobiodyn 10: 685–688.
- Teelucksingh S, Mackie AD, Burt D, et al. 1990. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet 335: 1060–1063.
- Thirugnanam S, Xu L, Ramaswamy K, et al. 2008. Glycyrrhizin induces apoptosis in prostate cancer cell lines DU-145 and LNCaP. Oncol Rep 20: 1387–1392.
- Thiugnanam S, Xu L, Ramaswamy K, et al. 2008. Glycyrrhizin induces apoptosis in prostate cancer cell lines DU-145 and LNCaP. Oncol Rep 20: 1387–1392.
- Tsai TH, Liao JF, Shum AY, et al. 1992. Pharmacokinetics of glycyrrhizin after intravenous administration to rats. J Pharm Sci 81: 961–963.
- Tsukamoto S, Aburatani M, Yoshida T, et al. 2005. CYP3A4 inhibitors isolated from licorice. Biol Pharm Bull 28: 2000–2002.
- Tu JH, He YJ, Chen Y, et al. 2010. Effect of glycyrrhizin on the activity of CYP3A enzyme in humans. Eur J Clin Pharmacol 66: 805–810.
- Van Rossum TGJ, Vulto AG, Hop WCJ, et al. 1999. Pharmacokinetics of intravenous glycyrrhizin after single and multiple doses in patients with chronic hepatitis C infection. Clin Ther 21: 2080–2090.
- Velickovic-Radovanovic RM, Mitic B, Kitic D, et al. 2011. Acute renal failure after licorice ingestion: a case report. Cent Eur J Med 6: 113–116.
- Wang ZY, Nixon DW. 2001. Licorice and cancer. Nutr Cancer 39: 1–11.
- Wang ZY, Agarwal R, Zhou ZC, et al. 1991. Inhibition of mutagenicity in salmonella typhimurium and skin tumor initiating and tumor promoting activities in SENCAR mice by glycyrrhetinic acid: comparison of 18α- and 18β-stereoisomers. Carcinogenesis 12: 187–192.
- Wang HF, Zhu ZF, Gao Y, et al. 2015. Effect of glycyrrhizin on gastric cancer BGC-823 cell proliferation. Shi Jie Hua Ren Xiao Hua Za Zhi 23: 2868–2873.
- West LG, Nonnamaker BJ, Greger JL. 1979. Effect of ammoniated glycyrrhizin on the mineral utilization of rats. J Food Sci 44: 1558–1559.
- Y S, H N & S S. 2005. Glycyrrhetinic acid and related compounds induce G1 arrest and apoptosis in human hepatocellular carcinoma HepG2. Anticancer Res 25: 4043–4047.
- Yamamura Y, Kawakami J, Santa T, et al. 1992. Pharmacokinetic profile of glycyrrhizin in healthy volunteers by a new high-performance liquid chromatographic method. J Pharm Sci 81: 1042–1046.
- Yamamura Y, Tanaka N, Santa T, et al. 1995. The relationship between pharmacokinetic behaviour of glycyrrhizin and hepatic function in patients with acute hepatitis and liver cirrhosis. Biopharm Drug Dispos 16: 13–21.
- Yang RF, Zhang FH, Sun SH, et al. 2015. Metabolomics to analyze the therapy and adverse effect of glycyrrhizin capsules towards liver cancer. Lat Am J Pharm 34: 1677–1679.
- Yazdi A, Sardari S, Sayyah M, et al. 2011. Evaluation of the anticonvulsant activity of the leaves of glycyrrhiza glabra var. glandulifera grown in Iran, as a possible renewable source for anticonvulsant compounds. Iran J Pharm Res 10: 75–82.
- Ye L, Gho WM, Chan FL, et al. 2009. Dietary administration of the licorice flavonoid isoliquiritigenin deters the growth of MCF-7 cells overexpressing aromatase. Int J Cancer 124: 1028–1036.
- Yo YY, Shieh GS, Hsu KF, et al. 2009. Licorice and licochalcone-a induce autophagy in lncap prostate cancer cells by suppression of bcl-2 expression and the mtor pathway. J Agric Food Chem 57: 8266–8273.
- Yoshida N, Koizumi M, Adachi I, et al. 2006. Inhibition of P-glycoprotein-mediated transport by terpenoids contained in herbal medicines and natural products. Food Chem Toxicol 44: 2033–2039.
- Yoshida T, Hatta A, Akasaka Y, et al. 2011. Reproductive and developmental toxicity studies of monoammonium glycyrrhizinate by intravenous administration in rats and rabbits. Jpn Pharmacol Ther 39: 309–327.
- Yu T, Yamaguchi H, Noshita T, et al. 2010. Selective cytotoxicity of glycyrrhetinic acid against tumorigenic r/m HM-SFME-1 cells: Potential involvement of H-Ras downregulation. Toxicol Lett 192: 425–430.
- Zani F, Cuzzoni MT, Daglia M, et al. 1993. Inhibition of mutagenicity in Salmonella typhimurium by Glycyrrhiza glabra extract, glycyrrhizinic acid, 18α- and 18β-glycyrrhetinic acids. Planta Med 59: 502–507.
- Zha J, Badri PS, Ding B, et al. 2015. Drug interactions between hepatoprotective agents ursodeoxycholic acid or glycyrrhizin and ombitasvir/paritaprevir/ritonavir in healthy Japanese subjects. Clin Ther 37: 2560–2571.
- Zhang X, Yang H, Yue S, et al. 2017. The mTOR inhibition in concurrence with ERK1/2 activation is involved in excessive autophagy induced by glycyrrhizin in hepatocellular carcinoma. Cancer Med .