DISCLAIMER: This publication is aimed at health professionals. The information is meant to provide updates on medication safety issues, and not as a substitute for clinical judgement. While reasonable care has been taken to verify the accuracy of the information at the time of publication, NPRA shall not be held liable for any loss whatsoever arising from the use of or reliance on this publication.

 

Note: This safety issue concerns oral health supplements and natural products containing turmeric or curcuminoids. It does not relate to turmeric consumed as a culinary spice in typical dietary amounts.

 

Overview of Product(s)

Turmeric is derived from the rhizome of Curcuma longa plant, a member of the ginger family native to Asia.¹ Its principal active constituents are curcuminoids (including curcumin), which are also found in related species like Curcuma aromatica, Curcuma zanthorrhiza, and Curcuma zedoaria.² Known for their antioxidant properties, both turmeric and curcuminoids have been used for potential health benefits, including relief from joint pain, inflammation, and indigestion.¹

In Malaysia, turmeric, or Curcuma spp. containing curcuminoids, are registered as health supplements or natural products in various dosage forms, including capsules, tablets, powders, and liquid preparations, mainly in combination with other ingredients.³ There are currently 804 natural products and 139 health supplements containing Curcuma spp. and curcuminoids registered with the Drug Control Authority (DCA).

 

Overview of Safety Concern

Hepatotoxicity is characterised by hepatic impairment or injury resulting from exposure to pharmaceutical products, botanical extracts, or chemical compounds, with severe presentations potentially culminating in liver failure.^1,4 Contrary to the common perception that natural health products are inherently safe and harmless, some have been suspected of being associated with rare but serious adverse reactions, such as hepatotoxicity.⁵

 

Source of Safety Concern

The National Pharmaceutical Regulatory Agency (NPRA) became aware of safety reviews conducted by international regulatory agencies regarding the risk of hepatotoxicity associated with the oral use of turmeric- or curcuminoid-containing natural health products.

Health Canada conducted a safety review based on post-marketing adverse event reports, published literature, and information from foreign regulatory agencies.¹ The review identified a possible association between the oral use of turmeric- and curcuminoid-containing natural health products and hepatotoxicity. In response, Health Canada updated its relevant monographs to include this risk and expects license holders to update the risk information on product labels.

The Australian Therapeutic Goods Administration (TGA) has also completed a safety investigation after receiving reports of liver problems associated with turmeric and/or curcumin.² Following the investigation, the TGA mandated safety warning labels on products containing these active ingredients to alert consumers to the potential risk of liver injury.⁶

 

Background of the Safety Issue

Available evidence suggests that hepatotoxicity associated with turmeric- or curcuminoid-containing oral products is idiosyncratic.¹ The onset of these reactions is unpredictable and does not appear to be consistently related to the dose or duration of use. Their severity may vary considerably among individuals.⁵ Although hepatotoxicity is reversible in most cases upon discontinuation of the product, continued use may lead to more severe outcomes.^1,6

Health Canada’s safety review did not apply to turmeric or curcuminoids as food ingredients, colouring agents, or in topical products.¹ Turmeric consumed in food as a culinary spice at typical dietary amounts is considered to provide relatively lower exposure compared with products containing concentrated turmeric or curcuminoid preparations.^1,7 When applied topically, turmeric or curcuminoids are less likely to be absorbed through the skin, resulting in limited systemic exposure.¹

Nevertheless, the risk of liver injury may be increased with higher doses or with products designed for enhanced absorption or bioavailability, such as those formulated with piperine, a bioactive constituent of black pepper.^2,7 In addition, individuals with existing or previous liver pathologies may be more susceptible to developing this rare adverse event.²

 

Local Adverse Drug Reaction Reports⁸

To date, the NPRA has received a total of 32 ADR reports with 71 adverse events suspected to be related to Curcuma spp. or curcuminoids, either as single-ingredient or combination products. No reports specifically described as hepatotoxicity have been received. However, several liver-related adverse events have been reported locally, including transaminitis (2), acute liver injury (1), hepatomegaly (1), hepatosplenomegaly (1), jaundice (1), skin coloring yellow (1), transaminases increased (1), urine color abnormal (1), and faeces pale (1).

 

Advice for Health Care Professionals

1. While NPRA continues to review this safety issue, be aware that rare but serious cases of hepatotoxicity have been associated with oral health supplements and natural products containing Curcuma spp. or curcuminoids (such as curcumin).
2. Be vigilant when taking patients’ medication history, and specifically ask about the use of health supplements and natural products.
3. Advise patients with existing or previous liver pathologies to avoid oral products containing turmeric or curcuminoids.
4. Advise patients to watch for signs and symptoms of hepatotoxicity, including persistent nausea or vomiting, unusual fatigue or weakness, itching, yellowing of the skin or eyes, dark urine, abdominal pain (particularly in the right upper quadrant), and loss of appetite. Advise them to discontinue use and seek medical attention if these symptoms occur.
5. Report all suspected adverse events associated with turmeric- or curcuminoid-containing products to the NPRA.

 

References:

1. Health Canada. Summary safety review – Turmeric and curcuminoids for oral use – Assessing the potential risk of hepatotoxicity [Internet]. 2025 Oct 13 [cited 2026 Jul 7]. Available from: https://dhpp.hpfb-dgpsa.ca/review-documents/resource/SSR1758121117867
2. Therapeutic Goods Administration (TGA). Medicines containing turmeric or curcumin – Risk of liver injury [Internet]. 2023 Aug 15 [cited 2026 Jul 7]. Available from: https://www.tga.gov.au/safety/safety-monitoring-and-information/safety-alerts/medicines-containing-turmeric-or-curcumin-risk-liver-injury
3. National Pharmaceutical Regulatory Agency (NPRA). QUEST3+ Product Search [Internet]. 2025 [cited 2026 Mar 24]. Available from: https://www.npra.gov.my
4. Yale Medicine. Hepatotoxicity (liver toxicity) [Internet]. 2025 [cited 2026 Sep 3]. Available from: https://www.yalemedicine.org/clinical-keywords/hepatotoxicity
5. Health Canada. Health Product InfoWatch [Internet]. 2026 Jan [cited 2026 Sep 3]. Available from: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-health-products/medeffect-canada/health-product-infowatch/january-2026/infojan2026-en.pdf
6. Therapeutic Goods Administration (TGA). Proposed changes to requirements for listed medicine ingredients: Annual low-negligible risk changes 2023-2024 final decisions, version 1.0 [Internet]. 2023 Dec [cited 2026 Sep 3]. Available from: https://consultations.tga.gov.au/medicines-regulation-division/low-neg-risk-2023-2024/user_uploads/cmes---low-negligible-risk-annual-consultation---2023-2024---final-decisions-document.pdf
7. French Agency for Food, Environmental and Occupational Health & Safety (ANSES). Expert Assessment. Adverse effects associated with the consumption of food supplements containing turmeric [Internet]. 2022 Jun 27 [cited 2026 Jul 7]. Available from: https://www.anses.fr/en/content/adverse-effects-associated-consumption-food-supplements-containing-turmeric
8. National Pharmaceutical Regulatory Agency (NPRA). The Malaysian National ADR Database (QUEST) [Internet]. 2025 [cited 2026 May 14]. Available from: https://www.npra.gov.my (access restricted)

 

Written by: Wang Khee Ing    

Reviewed/Edited by: Lim Sze Gee, Dr Rema Panickar, Noor'ain Shamsuddin, Norleen Mohamed Ali