Case Report: Herba Epimedium (Horny Goat Weed) Toxicity with Severe Muscle Spasms and Elevated Creatine Kinase and Creatinine

Here we present the case of a 33-year-old male who presented to the emergency department (ED) with a complaint of severe muscle spasms of a ten-hour duration. He noted that he took a supplement which he purchased over the internet called Epimedium, also known as Horny Goat Weed, for the purpose of improving his mood and sense of energy and reducing his sense of anxiety. He noted that he started this supplement one month prior to ED presentation, coincident with the first episodes of muscle cramps. In the ED, he had elevations of his CK and creatinine and required hospital admission. He was given instructions to stop taking horny goat weed supplements. Epimedium contains a wide variety of chemicals that vary somewhat by individual species. Over 200 chemical constituents have been identified in various species of Epimedium, including flavonoids, lignans, ionones, phenol glycosides and sesquiterpines. Epimedium is sold in health stores and on the internet, in a variety of forms, using various species and sometimes in combination with known vitamins and other botanicals . However, a number of online, non-peer reviewed sources note muscle spasms and muscle cramps to be a side effect of Epimedium. To our knowledge, this is the first specific case report of severe muscle spasms with associated elevation of CK and creatinine. This case reinforces the importance of asking a patient about all medications, including over-the-internet, over the counter and herbal medications