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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-.

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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].

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Last Update: January 20, 2023.



Cranberry is an evergreen shrub the fruits and leaves of which have been used in traditional medicine for bladder and digestive conditions, to promote wound healing, and more recently for prevention of recurrent urinary tract infections. Cranberry products have not been linked to serum aminotransferase elevations or to instances of clinically apparent liver injury with jaundice.


Cranberry products are derived from fruits and leaves of Vaccinium macrocarpon and other subspecies and have been used in traditional medicine to treat a variety of conditions, most commonly bladder symptoms and urinary tract infections. Cranberry fruit juice and extracts have a variety of constituents including anthocyanin dyes, catechins, triterpenoids, organic acids, glycosides, proteins and carbohydrates. Cranberries are commonly used as a food or condiment and in cooking. The anthocyanin pigments of cranberry are also used in commercial coloring. The active ingredients responsible for the purported medicinal properties of cranberry are not known. While cranberry has been purported to be beneficial for cognitive performance, wound healing, diabetes and stomach ailments, these effects have not been proven in human clinical trials. Cranberry products result in mild acidification of urine, and components have been shown to inhibit bacterial adherence to tissue surfaces. For these reasons, cranberry products have been extensively assessed as means of preventing recurrent urinary tract infections. While in vitro and in vivo studies suggest an effect on urinary tract infections, clinical trials have yielded conflicting results of their efficacy, some studies showing a partial effect and others none at all. Nevertheless, cranberry continues to be used for bladder symptoms and prevention of urinary tract infections. Cranberry is found in multiple commercial forms including as a fruit drink, as concentrates in tablets or capsules or as a component of multiingredient dietary supplements. The recommended daily dose ranges widely, typically 120 to 1600 mg as capsules daily or as 300 to 900 mL of cranberry juice. Cranberry is generally well tolerated without adverse events. With high doses, minor side effects may include diarrhea, abdominal discomfort and nausea. Ingestion of cranberry juice or extracts may have food-drug interactions, with reduced plasma levels and effects of proton pump inhibitors and histamine type 2 (H2) blockers.


In multiple controlled trials of cranberry products vs. placebo as therapy of multiple conditions, side effects were reported to be uncommon, generally mild, and usually no more frequent with the herbal product than with placebo. There have been no convincing reports of serum enzyme elevations, jaundice or clinically apparent liver injury associated with cranberry use.

Likelihood score: E (unlikely cause of clinically apparent liver injury).

Mechanism of Injury

The mechanism by which cranberry might cause liver injury is unknown. When liver injury arises in association with a multiingredient dietary supplement containing cranberry, the effect of other components or contaminants should be suspected as the cause of the injury.

Drug Class: Herbal and Dietary Supplements

Other names: American Cranberry, Bearberry.



Cranberry – Generic


Herbal and Dietary Supplements


Fact Sheet at National Center for Complementary and Integrative Health, NIH


Cranberry 91770-88-6 HerbalNot Applicable


References updated: 20 January 2023

Abbreviations: HDS, herbal and dietary supplements; UTIs, urinary tract infections.

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    (Expert review of hepatotoxicity published in 1999; several herbal medications are discussed, but not cranberry).
  • Liu LU, Schiano TD. Hepatotoxicity of herbal medicines, vitamins and natural hepatotoxins. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 2nd ed. New York: Informa Healthcare USA, 2007, pp. 733-54.
    (Review of hepatotoxicity of herbal and dietary supplements [HDS] published in 2007; no mention of cranberry).
  • Cranberry. In, PDR for Herbal Medicines. 4th ed. Montvale, New Jersey: Thomson Healthcare Inc. 2007: pp. 238-41.
    (Compilation of short monographs on herbal medications and dietary supplements).
  • McMurdo ME, Bissett LY, Price RJ, Phillips G, Crombie IK. Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? A double-blind, placebo-controlled trial. Age Ageing. 2005;34:256–61. [PubMed: 15863410]
    (Among 376 elderly hospitalized patients treated with cranberry juice [300 mL] or placebo daily, rates of urinary tract infections [UTIs] and adverse events were similar in the two groups, although numerically lower rates of UTIs occurred in the cranberry group [3.7% vs 7.5%], the overall rate was quite low).
  • Jacobsson I, Jönsson AK, Gerdén B, Hägg S. Spontaneously reported adverse reactions in association with complementary and alternative medicine substances in Sweden. Pharmacoepidemiol Drug Saf. 2009;18:1039–47. [PubMed: 19650152]
    (Review of 778 spontaneous reports of adverse reactions to herbals to Swedish Registry does not list cranberry among the agents mentioned in reports of adverse reactions).
  • Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology. 2010;52:2065–76. [PMC free article: PMC3992250] [PubMed: 20949552]
    (Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 [11%] were attributed to drug induced liver injury of which 12 [9%] were due to herbals, including several herbal mixtures, usnic acid, Ma Huang, black cohosh, and Hydroxycut, but not cranberry).
  • Stickel F, Kessebohm K, Weimann R, Seitz HK. Review of liver injury associated with dietary supplements. Liver Int. 2011;31:595–605. [PubMed: 21457433]
    (Review of current understanding of liver injury from herbals and dietary supplements focusing upon Herbalife and Hydroxycut products, green tea, usnic acid, noni juice, Chinese herbs, vitamin A and anabolic steroids; cranberry is not discussed).
  • Teschke R, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: a tabular compilation of reported cases. Liver Int. 2012;32:1543–56. [PubMed: 22928722]
    (A systematic compilation of all publications on the hepatotoxicity of specific herbals identified 185 publications on 60 different herbs, herbal drugs and supplements but does not list or mention cranberry).
  • Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology. 2013;144:1419–25. [PubMed: 23419359]
    (In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, 15 of which [16%] were attributed to HDS products, but none were listed as containing cranberry).
  • Bunchorntavakul C, Reddy KR. Review article: herbal and dietary supplement hepatotoxicity. Aliment Pharmacol Ther. 2013;37:3–17. [PubMed: 23121117]
    (Systematic review of literature on HDS associated liver injury does not mention cranberry).
  • Navarro VJ, Seeff LB. Liver injury induced by herbal complementary and alternative medicine. Clin Liver Dis. 2013;17:715–35. [PubMed: 24099027]
    (Review of the epidemiology, regulatory status, diagnosis, pathogenesis and causes of liver injury from herbal products with specific discussion of conjugated linoleic acid, ephedra, germander, green tea, usnic acid, flavocoxid, aloe vera, chaparral, greater celandine, black cohosh, comfrey, kava, skullcap, valerian, noni juice, pennyroyal and traditional herbal remedies).
  • Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, Reddy KR, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology. 2014;60:1399–408. [PMC free article: PMC4293199] [PubMed: 25043597]
    (Among 839 cases of liver injury from drugs collected in the US between 2004 and 2013, 130 were due to HDS products, including 45 from body building agents [probably anabolic steroids] and 85 from diverse HDS products, but no case was attributed specifically to cranberry).
  • Juthani-Mehta M, Van Ness PH, Bianco L, Rink A, Rubeck S, Ginter S, Argraves S, et al. Effect of cranberry capsules on bacteriuria plus pyuria among older women in nursing homes: a randomized clinical trial. JAMA. 2016;316:1879–1887. [PMC free article: PMC5300771] [PubMed: 27787564]
    (Among 185 women, aged 65 years or older, in nursing homes who were treated with cranberry capsules [72 mg daily] or placebo for 1 year, UTIs occurred in 25% receiving cranberry and 29.5% placebo, with similar rates of symptomatic UTIs in the two groups; no description of adverse events).
  • Nicolle LE. Cranberry for prevention of urinary tract infection?: time to move on. JAMA. 2016;316:1873–1874. [PubMed: 27787544]
    (Editorial in response to Juthani-Mehta [2016] concludes that cranberry should not be recommended as a means of preventing recurrent urinary tract infections, agents with known efficacy being available).
  • Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. Food Chem Toxicol. 2017;107:472–501. [PubMed: 27402097]
    (Description of an online compendium of cases of liver toxicity attributed to HDS products, does not list or discuss cranberry).
  • Fu Z, Liska D, Talan D, Chung M. Cranberry reduces the risk of urinary tract infection recurrence in otherwise healthy women: a systematic review and meta-analysis. J Nutr. 2017;147:2282–2288. [PubMed: 29046404]
    (Systematic review of the literature on cranberry for prevention of recurrent UTIs in women, identified 7 randomized controlled trials in 1498 patients that suggested a 26% decrease in UTIs rates with cranberry; adverse events were reported in only 5 studies, among which adverse events were similar or less common with cranberry vs placebo, and there were no serious adverse events: no mention of ALT elevations or hepatotoxicity).
  • Barclay J, Veeratterapillay R, Harding C. Non-antibiotic options for recurrent urinary tract infections in women. BMJ. 2017;359:j5193. [PubMed: 29170359]
    (Review of non-antibiotic options for prevention of UTIs mentions that the efficacy of cranberry remains in doubt, but adverse events are typically no more frequent than with placebo; no mention of ALT elevations or hepatotoxicity).
  • Sihra N, Goodman A, Zakri R, Sahai A, Malde S. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. 2018;15:750–776. [PubMed: 30361493]
    (Review of non-antibiotic means of management of recurrent urinary tract infections, mentions that studies of the efficacy of cranberry have had mixed results; no discussion of adverse events).
  • Masnadi Shirazi K, Shirinpour E, Masnadi Shirazi A, Nikniaz Z. Effect of cranberry supplementation on liver enzymes and cardiometabolic risk factors in patients with NAFLD: a randomized clinical trial. BMC Complement Med Ther. 2021;21:283. [PMC free article: PMC8603491] [PubMed: 34798892]
    (Among 94 adults with nonalcoholic fatty liver disease treated with cranberry capsules [144 mg] or placebo daily for 6 months found that serum ALT levels fell in both groups, but that hepatic steatosis was less with cranberry; no mention of ALT elevations or hepatotoxicity).
  • Medina-Caliz I, Garcia-Cortes M, Gonzalez-Jimenez A, Cabello MR, Robles-Diaz M, Sanabria-Cabrera J, Sanjuan-Jimenez R, et al. Spanish DILI Registry. Herbal and dietary supplement-induced liver injuries in the Spanish DILI Registry. Clin Gastroenterol Hepatol. 2018;16:1495–1502. [PubMed: 29307848]
    (Among 856 cases of hepatotoxicity enrolled in the Spanish DILI Registry between 1994 and 2016, 32 were attributed to herbal products, the most frequent cause being green tea [n=8] and Herbalife products [n=6], while one anicteric, self-limited hepatocellular case was scored as probably due to cranberry).
  • Bessone F, García-Cortés M, Medina-Caliz I, Hernandez N, Parana R, Mendizabal M, Schinoni MI, et al. Herbal and dietary supplements-induced liver injury in Latin America: experience from the LATINDILI Network. Clin Gastroenterol Hepatol. 2022;20:e548–e563. [PubMed: 33434654]
    (Among 367 cases of hepatotoxicity enrolled in the Latin American DILI Network between 2011 and 2019, 29 [8%] were attributed to herbal products, the most frequent being green tea [n=7], Herbalife products [n=5] and garcinia [n=3], while cranberry was not implicated in any cases).
  • Ballotin VR, Bigarella LG, Brandão ABM, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: systematic review and meta-analysis. World J Clin Cases. 2021;9:5490–5513. [PMC free article: PMC8281430] [PubMed: 34307603]
    (Systematic review of the literature on herb induced liver injury identified 446 references describing 936 cases of liver injury due to 79 different herbal products, the most common being He Shou Wu [n=91], green tea [90] Herbalife products [64], kava kava [62] and greater celandine [48]; cranberry was not implicated in any cases).


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