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Related Concept Videos

Hepatic Encephalopathy01:29

Hepatic Encephalopathy

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DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic...
53
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists01:28

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists

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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Physical Properties of Amines01:26

Physical Properties of Amines

3.2K
Amines with low molecular weight are usually gaseous at room temperature, while those with high molecular weight are liquid or solids in nature. Usually, low molecular weight amines have a rotten fish-like smell. Diamines typically have a pungent smell. For instance, cadaverine and putrescine, depicted in Figure 1, are two molecules responsible for decaying tissue.
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Drug Toxicity: Risk factors01:24

Drug Toxicity: Risk factors

229
Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
229
Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

379
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Related Experiment Video

Updated: May 1, 2026

Drug-Induced Senescence in Liver Cells Promotes M2 Macrophage Polarization: Implications for Tyrosine Kinase Inhibitor-Associated Hepatotoxicity
09:32

Drug-Induced Senescence in Liver Cells Promotes M2 Macrophage Polarization: Implications for Tyrosine Kinase Inhibitor-Associated Hepatotoxicity

Published on: October 17, 2025

661

Regorafenib-induced hyperammonemic encephalopathy.

J C Kuo1, S Parakh, D Yip

  • 1Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia.

Journal of Clinical Pharmacy and Therapeutics
|April 9, 2014
PubMed
Summary
This summary is machine-generated.

Regorafenib, a cancer drug, may cause hyperammonemic encephalopathy in patients with metastatic gastrointestinal stromal tumors (GIST). This condition, marked by confusion and high ammonia levels, resolved upon drug withdrawal.

Keywords:
adverse drug reactionsbiological therapygastrointestinal stromal tumourshepatic encephalopathy

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Area of Science:

  • Oncology
  • Pharmacology
  • Neurology

Background:

  • Regorafenib is a multitargeted tyrosine kinase inhibitor (TKI) used for metastatic gastrointestinal stromal tumors (GIST).
  • Expected adverse events of regorafenib are similar to other TKIs like imatinib, sunitinib, and sorafenib.
  • Metastatic GIST treatment often involves late-line therapies such as regorafenib.

Observation:

  • A 61-year-old male patient with metastatic GIST on regorafenib presented with acute confusion.
  • Confusion resolved upon discontinuation of regorafenib.
  • Confusion and hyperammonemia recurred upon re-initiation of regorafenib, resolving again after cessation.

Findings:

  • This case demonstrates a probable relationship between regorafenib and metabolic encephalopathy.
  • The patient experienced reversible hyperammonemic encephalopathy.
  • Withdrawal and re-challenge with regorafenib correlated with the patient's confusional state and hyperammonemia.

Implications:

  • Regorafenib may induce hyperammonemic encephalopathy, a potential adverse effect not previously reported.
  • A class effect for metabolic encephalopathy among multitargeted TKIs may be postulated.
  • Clinicians should consider monitoring for metabolic encephalopathy in patients treated with regorafenib or similar TKIs.