Adverse drug reactions liver disease

As with any adverse drug reaction, drug-induced liver disease can be described as intrinsic or idiosyncratic. Intrinsic reactions occnr when... 

Hepatotoxicity is not a particularly common form of adverse drug reaction and a patient with pre-existing liver disease does not have increased susceptibility to hepatic injury when taking drugs known to cause liver damage [1]. Therefore, drugs that are known to be hepato-toxic should not be contraindicated in this group of patients. There are... 

Based on their pharmacokinetic profile alone, the safest statins in chronic compensated liver disease and a history of decompensation are prohahly pravastatin and rosnvastatin. However, clinical experience with rosnvastatin in liver disease is lacking, and so it cannot be recommended. In addition, the true rate of post-marketing adverse drug reactions is not yet clear. Pravastatin is therefore the drug of choice in these patients, where treatment is deemed necessary. It should, however, be avoided in acute episodes until liver function or transaminases stabilise/return to normal. 

Dossing M, Andreasen P. Drug-induced liver disease in Denmark. An analysis of 572 cases of hepatotoxic-ity reported to the Danish Board of Adverse Reactions to Drugs. Scand J Gastroenterol 1982 17 205-11. 

Lawson JA, Farhood A, Hopper RD, Bajt ML, Jaeschke H (2000) The hepatic mflammatoTy response after acetaminophen overdose role of neutrophils. Toxicol Sci 54 509-516 Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients a meta-analysis of prospective studies. JAMA 279 1200-1205 Lazerow SK, Abdi MS, Lewis JH (2005) Drug-induced liver disease 2004. Curr Opin Gastroenterol 21 283-292... 

One woman experienced repeated attacks of sweating, nausea, colicky abdominal pain, diarrhea, vomiting, weakness, and collapse after taking a milk thistle product (Adverse Drug Reactions Advisory Committee 1999). Other cases of adverse events, reported without details, include a case of abdominal pain, nausea, listlessness, and insomnia and one case of thrombocytopenia (Adverse Drug Reactions Advisory Committee 1999). The symptoms in these reports are similar to those associated with liver disease, for which the patients may have been taking milk thistle. 

Other potential adverse responses include malignancy (e.g., lymphoma), liver disease, heart failure, lupuslike disease, irritation around the injection site, and demyelinating disorders that mimic multiple sclerosis.34,70 88 The incidence of these adverse effects, however, seems to be fairly low. For the most part, these drugs provide an acceptable risk-to-benefit ratio for most people with rheumatoid arthritis. Patients should, however, be screened carefully for any risk factors before beginning drug therapy, and should likewise be monitored periodically for any potential adverse reactions to these drugs. 

Because ADRs are more likely to occur in the very young and the elderly, lower drug dosages may be indicated at these two extremes of the human life span. The elderly are more likely to have diseases such as cancer, coronary heart disease, dementia, diabetes mellitus, hypertension, and osteoporosis and may also have adverse nutritional reactions. Deficiencies in liver and kidney function can result in marked delay of drug detoxification and elimination. Constant review of established diagnoses and treatments is important to minimize the number of drugs administered, and care must be taken to determine whether other nutritional supplements and herbal products are being incorporated into self-treatment. 

Friedmann PS, Strickland I, Pirmohamed M, Park BK (1994) Investigation of mechanisms in toxic epidermal necrolysis induced by carbamazepine. Arch Dermatol 130 598-604 Fujino S, Andoh A, Bamba S, Ogawa A, Hata K, Araki Y, Bamba T, Fujiyama Y (2003) Increased expression of interleukin 17 in inflammatory bowel disease. Gut 52 65-70 Ganey PE, Luyendyk JP, Maddox JF, Roth RA (2004) Adverse hepatic drug reactions inflammatory episodes as consequence and contributOT. Chem Biol Interact 150 35-51 Gao B (2005) Cytokines, STATs and liver disease. Cell Mol Immunol 2 92—100... 

Phenylbutazone (Butazolidin) is metabolized to oxy-phenbutazone (Phlogistol), and both compounds have all of the activities associated with the NSAIDs. Their use is accompanied by serious adverse reactions, such as anemia, nephritis, renal failure or necrosis, and liver damage. Because of their toxicity, they are prescribed only for the treatment of pain associated with gout or phlebitis or as a last resort for other painful inflammatory diseases resistant to newer and less toxic treatments. Interactions with a large number of other drugs... 

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