Hepatitis corticosteroids

Corticosteroids [P] Increased corticosteroid hepatic metabolism reduced corticosteroid effect. 

Rifampin Induction of hepatic microsomal drug-metabolizing enzymes. Corticosteroids [P] Increased corticosteroid hepatic metabolism reduced corticosteroid effect. 

Thiazides and related diuretics are used in the treatment of hypertension, edema caused by CHF, hepatic cirrhosis, corticosteroid and estrogen therapy, and renal dysfunction. 

Corticosteroid therapy for patients with alcoholic hepatitis (steatonecrosis) with or without hepatic encephalopathy... 

Agents targeting the excessive immune response or cytokines involved in IBD are potential treatment options (Table 16-3). Azathioprine and its active metabolite 6-mercaptopurine (6-MP) are inhibitors of purine biosynthesis and reduce IBD-associated GI inflammation. They are most useful for maintaining remission of IBD or reducing the need for long-term use of corticosteroids. Use in active disease is limited by their slow onset of action, which may be as long as 3 to 12 months. Adverse effects associated with azathioprine and 6-MP include hypersensitivity reactions resulting in pancreatitis, fever, rash, hepatitis, and leukopenia.25,26... 

In the hepatic cytosol, citrulline reacts with aspartate to form argininosuccinate, catalyzed by argininosuccinate synthetase (AS Fig. 40-5 reaction 3). The mRNA for this enzyme is increased by starvation, corticosteroids or cyclic-AMP. Citrulline itself potently induces the mRNA. 

Argininosuccinate lyase (AL) (Fig. 40-5 reaction 4) cleaves argininosuccinate to form fumarate, which is oxidized in the tricarboxylic acid cycle, and arginine, which is hydrolyzed to urea and ornithine via hepatic arginase. Both AL and arginase are induced by starvation, dibutyryl cyclic-AMP and corticosteroids. 

Eingerote RJ, Abecassis M, Phillips MJ, et al. Loss of resistance to murine hepatitis virus strain 3 infection after treatment with corticosteroids is associated with induction of macrophage procoagulant activity. J Virol 1996 70 4275 282. 

Several types of immunosuppression have also been tried. Azathioprine alone was found to have no effect on PBC [82], but additional benificial effects were found in combination with ursodeoxychohc add and corticosteroids [78]. Cyclosporin showed some success, espe-dally in corticosteroid-resistant autoimmune hepatitis [83], but its use is generally considerably hmited by severe side-effects. Corticosteroids were effective in the management of several types of autoimmune chronic active hepatitis [84,85] and in the management of acute al-cohohc hepatitis [86]. Their use, however, has to be brief hi order to minimize side-effects. In the treatment of PBC, corticosteroids alone were found to be toxic and had only limited efficacy [77]. 

K6. Keller, N., Richardson, U. I., and Yates, F. E., Protein binding and the biological activity of corticosteroids in vivo induction of hepatic and pancreatic alanine aminotransferases by corticosteroids in normal and estrogen-treated rats. Endocrinology 84, 49-62 (1969). 

Hepatitis Corticosteroids may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. 

Edema Adjunctive therapy in edema associated with congestive heart failure (CHF), hepatic cirrhosis, and corticosteroid and estrogen therapy. Useful in edema due to renal dysfunction (eg, nephrotic syndrome, acute glomerulonephritis, chronic renal failure). 

Rifampin is known to induce the hepatic microsomal enzymes that metabolize various drugs such as acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta blockers, chloramphenicol, clofibrate, oral contraceptives, corticosteroids, cyclosporine, disopyramide, estrogens, hydantoins, mexiletine, quinidine, sulfones, sulfonylureas, theophyllines, tocainide, verapamil, digoxin, enalapril, morphine, nifedipine, ondansetron, progestins, protease inhibitors, buspirone, delavirdine, doxycycline, fluoroquinolones, losartan, macrolides, sulfonylureas, tacrolimus, thyroid hormones, TCAs, zolpidem, zidovudine, and ketoconazole. The therapeutic effects of these drugs may be decreased. 

Renal, cardiac, and hepatic transplant Mycophenolate is indicated for the prophylaxis of organ rejection in patients receiving allogeneic renal, cardiac, or hepatic transplants. Use mycophenolate concomitantly with cyclosporine and corticosteroids. 

Cardiac/hepatic allograft rejection, steroid resistant 5 mg/day for 10 to 14 days. Begin treatment when it is determined that a rejection has not been reversed by an adequate course of corticosteroid therapy. 

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