Hepatotoxicity
From Anvita Health Wiki
Contents |
Introduction
- Toxic to the liver.
Etiology
- hepatotoxic pharmaceutical agents include:
- acetaminophen ( paracetamol)
- allopurinol
- aminosalicylate
- amoxicillin/clavulanate ( Augmentin)
- chlorpromazine
- dapsone
- didanosine
- erythromycin estolate
- estrogens
- ethionamide
- glyburide
- halothane
- isoniazid
- ketoconazole
- methimazole
- methotrexate
- methoxyflurane
- methyldopa
- monoamine oxidase ( MAO) inhibitors
- niacin ( nicotinic acid)
- nifedipine
- nitrofurantoin
- phenytoin
- propoxyphene
- propylthiouracil
- pyridium
- rifampin
- salicylates
- sulfonamides
- tamoxifen
- tetracyclines
- trimethoprim/sulfamethoxazole
- valproic acid ( sodium valproate)
- vitamin A
- zidovudine
Epidemiology
- single prescription medication in 73% of subjects
- dietary supplement in 9%
- more that 1 prescription medication (or a prescription plus a dietary supplement) in 18%
- most commonly implicated drug classes were antibiotics (46%) & central nervous system agents, i.e. antiseizure or psychotropic drugs (15%)
- most commonly implicated single agent was amoxicillin/clavulanate (23 cases)
- nitrofurantoin, isoniazid, & trimethoprim/sulfamethoxazole were implicated in 13 cases each
- as defined by specified patterns of serum ALT & serum ALP,
- 57% of cases hepatocellular
- 23% cholestatic
- 20% were mixed
- 69% of patients developed jaundice,
- 60% were hospitalized
- 8% died within 6 months [2]
Pathology
-
- chronic liver injury
Differential-diagnosis
- viral hepatitis, especially acute hepatitis C infection
More General Terms
References
- Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
- Chalasani N et al. for the Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008 Dec; 135:1924. PMID: [1]
- Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
