Glycyrrhizin preparations in liver diseases: a narrative review of mechanisms and therapeutic potential

Glycyrrhizin preparations (GLPS), derived from Glycyrrhiza uralensis (licorice), are widely used hepatoprotective agents in clinical practice. Their primary active components, 18α- and 18β-glycyrrhetinic acid (GA), are represented by formulations including diammonium glycyrrhizinate (DG), compound glycyrrhizin (CG), and magnesium isoglycyrrhizinate (MgIG). This review provides a comprehensive overview of the pharmacokinetic properties of GLPS and their multi-target pharmacological mechanisms, comprising anti-inflammatory, membrane-stabilizing, antioxidant, anti-apoptotic, immunomodulatory, and anti-fibrotic effects that collectively underpin their hepatoprotective activity. We critically evaluate clinical evidence across major liver diseases, including viral hepatitis, drug-induced liver injury, alcoholic liver disease, non-alcoholic fatty liver disease, and autoimmune hepatitis, while highlighting heterogeneity in study designs, geographical concentration of evidence, and the predominance of positive findings that may reflect publication bias. Safety considerations, particularly the risk of pseudoaldosteronism and potential drug interactions, are also discussed. Finally, we outline future research directions, emphasizing the need for large-scale, multicenter randomized controlled trials with standardized outcomes to establish more robust evidence base and support broader international clinical adoption.