Ingestion of 5 g or more of Napa may lead to liver damage if the patient has following risk factors: If the patient is on long term treatment with Carbamazepine, Phenobarbitone, Phenytoin, Primidone, Rifampicin, St Johns Wort or other drugs that induce liver enzymes, or regularly consumes Ethanol in excess of recommended amounts, or is likely to be Glutathione deplete e.g
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Mutation of the c-Cbl TKB domain binding site on the Met receptor tyrosine kinase converts it into a transforming protein
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"Elevation of Serum Gamma-Glutamyl Transpeptidase in End-Stage Chronic Renal Failure"
Program adherence: Some people find that a structured clinic visit supports routine and accountability, which can indirectly help lifestyle changes