Drugs and liver disease



In general, adverse hepatic drug reactions are ‘idiosyncratic’—that is, they are unpredictable. The clinical spectrum of drug-induced liver disease varies greatly.

Drug-related hepatotoxicity can mimic clinically and histologically almost any type of liver disease (Table 41.1). Presenting symptoms are similarly diverse, from asymptomatic elevations of liver function tests to coma secondary to fulminant hepatic failure. Anorexia and tiredness can be the presentations of hepatitic reactions while itch, dark urine and jaundice occur in more severe cholestatic syndromes.

TABLE 41.1 Drug-induced liver disease

Condition Drug
Acute hepatocellular necrosis Isoniazid, cloxacillin, halothane, methyldopa, paracetamol
Fatty liver Tetracycline, valproic acid, corticosteroids, non-steroidal antiinflammatory drugs, perhexiline, amiodarone
Granulomatous reactions Hydralazine, allopurinol, carbamazepine
Acute cholestasis Oral contraceptive steroids, anabolic androgens, chlorpromazine, flucloxacillin
Chronic cholestasis Chlorpromazine, flucloxacillin, amitriptyline
Chronic hepatitis/necrosis Methyldopa, nitrofurantoin, dantrolene
Fibrosis and cirrhosis Methotrexate
Vascular disorders Oral contraceptive steroids, anabolic androgens, azathioprine

Mar 29, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Drugs and liver disease
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