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Related Experiment Videos

Phenothiazine-induced cholestatic jaundice.

R E Regal1, J E Billi, H M Glazer

  • 1Hillsdale Community Health Center, MI 49242.

Clinical Pharmacy
|October 1, 1987
PubMed
Summary

Phenothiazine-induced cholestatic jaundice, a liver injury, is uncommon and typically resolves after drug cessation. Management focuses on symptom relief and avoiding re-exposure to phenothiazine medications.

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Area of Science:

  • Hepatology
  • Pharmacology
  • Toxicology

Background:

  • Phenothiazine medications can induce cholestatic jaundice, a form of hepatotoxicity.
  • This liver injury is classified as acute cholestatic hepatocanalicular hepatotoxicity.
  • It can occasionally progress to chronic liver disease.

Purpose of the Study:

  • To review proposed mechanisms, clinical features, prevalence, and treatment of phenothiazine-induced cholestatic jaundice.
  • To describe drug interactions that may alter the risk of cholestasis.

Main Methods:

  • Literature review of proposed mechanisms, clinical features, prevalence, and treatment.
  • Analysis of drug interactions affecting phenothiazine metabolism and cholestasis risk.

Main Results:

  • The mechanism is not fully understood but may involve physiochemical, immune, or toxic effects.
  • Prevalence of jaundice with chlorpromazine is estimated at 1-2%, likely similar for other phenothiazines.
  • Jaundice typically appears within 1-4 weeks of therapy initiation.

Conclusions:

  • Discontinuation of the offending phenothiazine is the primary treatment, with jaundice usually resolving in 2-8 weeks.
  • Symptomatic relief for pruritus can be achieved with topical corticosteroids, antihistamines, or bile acid sequestrants.
  • Delaying neuroleptic therapy and considering non-phenothiazine agents are recommended upon recurrence.

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