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[Hepatotoxicity of medications]
J C Barbare1, A Imbert, A Benkirane
1Service d'Hépato-Gastroentérologie, Centre Hospitalier de Compiègne, 8 avenue Henri Adnot-F 60321 Compiègne. jeanclaude.barbare@freesbee.fr
Abstract:
A TIMELY TOPIC: Liver toxicity remains a common problem despite adequate information for physicians and drug watch programs. The number of recent publications reporting severe drug-induced liver disease emphasizes the need for prudence. ACUTE AND CHRONIC HEPATOTOXICITY: Cases of acute drug-induced liver disease have been described for nearly all drug classes: a few examples concern hepatitis subsequent to administration of fluoxetin, acarbose, riluzole, coumarin, or orlistat. Fulminant hepatitis is fortunately an exceptional event but has been described after administration of ketoprofene, nimesulid, and clarithyromycin. Chronic liver disease has also resulted from the use of mesalazine, minocyclin or fibrates. Nevirapin prescribed for HIV infection can cause severe liver disease. OTHER AGENTS: Certain herbal agents, such as chelidoin for example, can cause cholestasis. Certain excipients can also be toxic for the liver. Ecstasy appears to be a frequent cause of sometimes severe liver disease in younger subjects.
Insights
Drug-induced liver disease is a significant concern across many medications, including common drugs and even herbal supplements. Prudent monitoring is essential to prevent severe hepatotoxicity and manage risks effectively.
Area of Science:
- Hepatology
- Toxicology
- Pharmacology
Background:
- Liver toxicity is a persistent clinical challenge, despite available physician guidance and drug surveillance programs.
- Recent literature highlights an increasing incidence of severe drug-induced liver injury (DILI), underscoring the need for caution.
- Hepatotoxicity is associated with a wide array of pharmaceutical agents, herbal products, and even excipients.
Purpose of the Study:
- To review the spectrum of acute and chronic liver injury caused by various drugs and other agents.
- To emphasize the importance of vigilance in identifying and managing drug-induced liver disease (DILI).
- To highlight specific examples of medications and substances linked to hepatotoxicity.
Main Methods:
- Literature review of reported cases of drug-induced liver disease.
- Categorization of hepatotoxicity into acute and chronic forms.
- Identification of specific drugs, herbal agents, and excipients associated with liver injury.
Main Results:
- Acute liver injury is documented across numerous drug classes, with examples including fluoxetine, acarbose, and orlistat.
- Fulminant hepatitis, though rare, has been reported with ketoprofen, nimesulide, and clarithromycin.
- Chronic liver disease can arise from medications like mesalazine and minocycline, while nevirapine and certain herbal agents (e.g., chelidoin) and ecstasy can also cause severe liver damage.
Conclusions:
- Drug-induced liver disease necessitates ongoing physician awareness and robust drug monitoring systems.
- A broad range of substances, from pharmaceuticals to herbal remedies and recreational drugs, pose a risk of hepatotoxicity.
- Prudent clinical practice and patient education are crucial for mitigating the risks associated with liver-toxic agents.