Use of fresh plant products may cause stomach upset.²⁵ Topical use has been associated with intense itching and a rash in one case.²⁶ Greater celandine should be avoided during pregnancy and in children under age 12.²⁵ A recent report of ten women in Germany suffering from acute hepatitis following supplementation with a standardized extract of greater celandine (dosage was not given) suggest this herb should be avoided by people with hepatitis or impaired liver function. Greater celandine should be used cautiously and under the supervision of a healthcare professional until more is understood about its potential liver toxicity.²⁸