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Drug-Induced Liver Injury in Critically Ill Children Taking Antiepileptic Drugs: A Retrospective Study

Kannan Sridharan1, Amal Al Daylami2, Reema Ajjawi2

  • 1Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.

Current Therapeutic Research, Clinical and Experimental
|April 14, 2020
PubMed

Insights

Antiepileptic drugs cause drug-induced liver injury (DILI) in critically ill children. Higher DILI risk was linked to concomitant hepatotoxic drugs and elevated drug levels in pediatric intensive care units.

Area of Science:

  • Pediatric Intensive Care
  • Hepatotoxicity
  • Pharmacovigilance

Background:

  • Antiepileptic drugs (AEDs) are a primary cause of drug-induced liver injury (DILI).
  • Critically ill children in intensive care units (ICUs) face heightened susceptibility to DILI.

Purpose of the Study:

  • To investigate the association between AED use and DILI in a pediatric ICU.
  • To identify factors contributing to DILI in this vulnerable population.

Main Methods:

  • Observational retrospective study of children on AEDs in a tertiary care hospital's ICU.
  • Data collection included demographics, AEDs, serum levels, liver function tests, and hospital stay.
  • DILI definitions (CIOMS), hepatotoxicity assessment (LiverTox, DILIrank), and regression models were utilized.

Main Results:

  • High incidence of DILI (hepatocellular injury/abnormalities) observed with phenobarbitone, phenytoin, and combination therapies.
  • No cholestatic or mixed liver injury types were reported.
  • Concomitant use of Category B hepatotoxic drugs and toxic drug levels significantly increased DILI risk.

Conclusions:

  • A substantial number of critically ill children on AEDs develop DILI.
  • Urgent need for guidelines on using AEDs with lower hepatotoxicity risk in pediatric ICUs.
Abstract

Keywords:
CarbamazepineDrug-induced liver injuryPhenobarbitonePhenytoinValproate

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