Abnormal Liver Function

The liver plays an important role in the endocrine system. The concentrations of hormones in plasma, and the activity of the glands which secrete them, are determined by the rate at which they are deactivated by the liver. The liver also has a major function in female reproduction since it is the target tissue of ovarian estrogen, to which it responds by producing the yolk protein vitellogenin. Xenobiotics that affect either of these functions can therefore be considered to be potential endocrine disrupters. 

Iwama and T. Nakanishi (eds), The Fish Immune System, Academic Press, San Diego, 1996. C. R. Tyler, J. P. Sumpter, H. Kawauchi and P. Swanson, Gen. Comp. Endocrinol., 1991, 84, 291. 

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Administration may result in nausea, vomiting, headache, diarrhea, abdominal pain, and skin rash. Abnormal liver function tests may be seen and may require follow-up tests to determine if liver function has been affected. 

Hepatic Effects. Jaundice and abnormal liver function tests including increases in serum transaminase levels have been reported in individuals occupationally exposed to trichloroethylene by both dermal and inhalation exposure (Bauer and Rabens 1974 Phoon et al. 1984). 

Isoniazid Adults S mg/kg (300 mg) Children 1 0-1 S mg/kg (300 mg) Asymptomatic elevation of aminotransferases, clinical hepatitis, fatal hepatitis, peripheral neurotoxicity, CNS system effects, lupus-like syndrome, hypersensitivity, monoamine poisoning, diarrhea LFT monthly in patients who have preexisting liver disease or who develop abnormal liver function that does not require discontinuation of drug Dosage adjustments may be necessary in patients receiving anticonvulsants or warfarin... 

ALFT Abnormal liver function test BE Barium enema... 

Currently, there are a number of systemic and intestine-selective MTP inhibitors, including lomitapide (23, BMS-201038, AEGR-733), implitapide (24), JTT-130, SLx-4090, and R-256918 (latter three structures not disclosed) believed to be in active development [60]. In a meta-analysis of three Phase II clinical trials, lomitapide as monotherapy or in combination with ezetimibe, atorvastatin, or fenofibrate significantly reduced LDL cholesterol (up to 35% as monotherapy and 66% in combination with atorvastatin) and was well tolerated with less than 2% discontinuation due to abnormal liver function [61]. Lomitapide has also been granted orphan drug status for the treatment of homozygous familial hypercholesterolemia [59]. Results of a Phase II study of JTT-130 for type 2 diabetes are expected in August 2010 [59,60]. 

A 60-year-old diabetic male on an oral hypoglycemic agent develops abnormal liver function tests. Which of the following agents can cause this finding ... 

Acute or chronic hepatocellular disease with abnormal liver function, cirrhosis, hepatic adenomas, or hepatic carcinomas... 

Abnormal liver function tests (elevated ALT, AST, Aik Phos, Bili)... 

In order to assess the potential extent of human exposures and health effects, members of dairy farm families who consumed raw dairy products known to be contaminated with heptachlor epoxide were studied (Stehr-Green et al. 1986). These individuals and an unexposed urban reference population were compared with regard to serum pesticide levels and liver toxicity. The farm family members had significantly higher mean serum levels of heptachlor epoxide (0.81 0.94 ppb), oxychlordane (0.70 0.75 ppb), and transnonachlor (0.79 0.60 ppb) than the unexposed population. This study is limited because exposure level, duration, and frequency of exposure are not known. There was no increase in prevalence of abnormal liver function tests in the dairy farm families... 

A high prevalence of abnormal liver functions tests (SCOT and SGPT) was observed among 614 Michigan adults compared with 141 Wisconsin adults considered as controls. ... 

In addition to drugs administered specifically to produce a metabolic effect, there are drug-related physiological changes that cause laboratory test abnormalities. Many drugs have been associated with the appearance of abnormal liver function tests in a fashion that simulates extrahepatic obstruction. These drugs include, among others, chlorpromazine, cinco-phen, methyltestosterone, thiouracil, p-aminosalicylic acid, sulfadiazine, reserpine, meprobromate, novobiocin, caffeine, and phenacemide (L7, L8, S6). 

Hepatic function impairment Since mexiletine is metabolized in the liver, and hepatic impairment prolongs the elimination half-life, carefully monitor patients with liver disease. Observe caution in patients with hepatic dysfunction secondary to CHF. Abnormal liver function tests have been reported, some in the first few weeks of therapy with mexiletine. Most have occurred along with CHF or ischemia their relationship to mexiletine has not been established. 

Ora/-Adverse reactions requiring discontinuation include Pulmonary infiltrates or fibrosis paroxysmal ventricular tachycardia CHF elevation of liver enzymes visual disturbances solar dermatitis blue discoloration of skin hyperthyroidism hypothyroidism. Adverse reactions occurring in at least 3% of patients include CFIF Gl complaints (nausea, vomiting, constipation, anorexia) dermatologic reactions (photosensitivity, solar dermatitis) neurologic problems (malaise, fatigue, tremor/abnormal involuntary movements, lack of coordination, abnormal gait/ataxia, dizziness, paresthesias) abnormal liver function tests. 

Adverse events occurring in at least 3% include abnormal liver function tests, increased ALT and AST, increased creatine phosphokinase, respiratory disorder, abdominal pain, back pain, headache. 

Adverse reactions occurring in 3% or more of patients with RA include the following Nausea, dyspepsia, rash, headache, abdominal pain, vomiting, fever, dizziness, stomatitis, pruritus, abnormal liver function tests, and leukopenia. One report showed a 10% rate of immunoglobulin suppression, which was slowly reversible and rarely accompanied by clinical findings. 

Hepatic effects Prescribe with care in patients with current evidence or history of abnormal liver function indicated by significant abnormalities in serum transaminase, bilirubin, and gamma-glutamyl transpeptidase levels. 

Abnormal liver function tests as well as blood dyscrasias have been reported with benzodiazepines. 

Adverse reactions may include abdominal pain, abnormal involuntary movements, abnormal liver function tests, aching joints or muscles, acute urinary retention, adenopathy or lymphadenopathy, aggravation of coronary artery disease, aggravation of disseminated lupus erythematosus, agranulocytosis, albuminuria, alopecia, alterations in pigmentation, anorexia, aplastic anemia, arrhythmias, asthma, AV P.729... 

Hepatic Toxicity Hepatic toxicity including hepatic failure resulting in transplantation or death has been reported. Severe and sometimes fatal hepatitis associated with disulfiram therapy may develop even after many months of therapy. Hepatic toxicity has occurred in patients with or without prior history of abnormal liver function. Advise patients to immediately notify their physician of any early symptoms of hepatitis (eg, fatigue, weakness, malaise, anorexia, nausea, vomiting, jaundice, dark urine). 

Liver and kidney disease Use with extreme caution in patients with advanced hepatorenal disease and in all patients with abnormal liver function tests because hepatic coma may be precipitated. 

Adverse drug reactions occurring in at least 3% of patients receiving daptomycin include abnormal liver function tests, constipation, diarrhea, headache, injection-site reactions, insomnia, nausea, rash, and vomiting. 

Evaluate liver function tests at the start of and during the course of voriconazole therapy. Monitor patients who develop abnormal liver function tests during voriconazole therapy for the development of more severe hepatic injury. Discontinuation of voriconazole must be considered if clinical signs and symptoms consistent with liver disease develop that may be attributable to voriconazole. Hepatic function impairment It is recommended that the standard loading dose regimens be used but that the maintenance dose be halved in patients with mild to moderate hepatic cirrhosis (Child-Pugh class A and B) receiving voriconazole. 

Monitor patients who develop abnormal liver function tests during concomitant therapy with cyclosporine, and evaluate the risk/benefit of continuing therapy. Pregnancy Category C. 

Lab test abnormalities Liver function test abnormalities, CPK or creatinine elevations, lymphopenia, triglyceride elevations occurred in at least 3% of patients. 

The most frequent adverse events related to nevirapine therapy are abnormal liver function tests, fatigue, headache, nausea, and rash. 

Liver Methotrexate causes hepatotoxicity, fibrosis, and cirrhosis, but generally only after prolonged use. Acutely, liver enzyme elevations are frequent, usually transient and asymptomatic, and also do not appear predictive of subsequent hepatic disease. Liver biopsy after sustained use often shows histologic changes, and fibrosis and cirrhosis have occurred these latter lesions often are not preceded by symptoms or abnormal liver function tests (see Precautions). For this reason, periodic liver biopsies are usually recommended for psoriatic patients who are under long-term treatment. Persistent abnormalities in liver function tests may precede appearance of fibrosis or cirrhosis in the RA population. 

Paclitaxel s large volume of distribution indicates significant tissue binding. The drug is extensively metabolized by the liver, and doses must be reduced in patients with abnormal liver function or with extensive liver metastases. Very little of the drug is excreted in the urine. 

The major advantage of carboplatin over cisplatin is a markedly reduced risk of toxicity to the kidneys, peripheral nerves, and hearing additionally, it produces less nausea and vomiting. It is, however, more myelo-suppressive than cisplatin. Other adverse effects include anemia, abnormal liver function tests, and occasional allergic reactions. 

Hydatid Abnormal liver function tests, abdominal pain, nausea, vomiting Occasional... 

Hepatotoxicity (abnormal liver function test results, jaundice, hepatitis), hemolytic anemia, unexplained fever, and flu-like symptoms may occur. If these conditions appear, discontinue the medication and contact the physician. 

Abnormal liver function tests have been reported, some in the first few weeks of therapy with mexiletine. 

Abnormal liver function tests and serious hepatotoxity... 

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