Hepatitis drug-induced

Table VI lists several drugs Inducing hepatic microsomal enzymes (5). These enzymes can metabolize the drug as well as other substrates. Barbiturates, grlseofulvln, and glutethlmlde Induce enzymes which metabolize coumarln and phenlndlone derivatives and thus reduce their anticoagulant activity. Dlphenylhydantoln and phenylbutazone stimulate cortisol hydroxylase activity and Increase the urinary excretion of B-hydroxy cortisol and decrease the concentration of cortisol In the plasma.

Popper H, Schaffner F. 1959. Drug induced hepatic injury. Ann Intern Med 51 1230-1252. 

When taken in therapeutic doses (approximately 4 g 60mg/kg body weight) paracetamol (N-acetyl-para-ami nophenol, acetaminophen) is a safe and effective analgesic, but overdosage, possibly with the intent of self-harm, is a major cause of drug-induced hepatic toxicity. The cellular damage which may not be evident for up to... 

Hepatitis In 1 retrospective study of 7492 patients on rapidly absorbed aminosalicylic acid preparations, drug-induced hepatitis occurred in 38 patients (0.5%) in these 38, the first symptom usually appeared within 3 months of the start of therapy with a rash as the most common event followed by fever and much less freguently by Gl disturbances of anorexia, nausea, or diarrhea. 

The members of this class are derivatives of the parent compound thiazolidinedione, and include rosiglitazone, pioglitazone and troglitazone which was withdrawn from the market due to an increased incidence of drug-induced hepatitis. 

If recognized promptly, drug-induced hepatitis resolves quickly 21 % mortality if the... 

Monitor carefully in first 3 mo of therapy for signs of intolerance/drug-induced hepatitis (rash, fever, jaundice, hepatomegaly)... 

It may be prudent to consider liver function testing of patients being treated with nefazodone. Periodic serum transaminase testing has not been proven to prevent serious injury, but it is generally believed that early detection of drug-induced hepatic injury, along with immediate discontinuation of the medication enhances the likelihood for recovery. 

This case report (Figures 6-4Ato 6-4C) (McDermut et al. 1995) of selective response to dihydropyridine CCBs but not a phenylalkylamine CCB is of considerable interest in relationship to the patient s history of nonre-sponsivity to multiple tricyclic antidepressants, the selective serotonin reuptake inhibitors, lithium, carbamazepine (the patient developed drug-induced hepatitis on carbamazepine and was unable to be evaluated), alprazolam, trazodone, and phenelzine. This suggests that patients with refractory mood disorders may have differential responses to various CCBs and that nonresponse to one CCB does not preclude response to another CCB, particularly if the other CCB is from a different category (Table 6-3). 

Huang Y-S, Chern HD, Su WJ, et al. Polymorphism of the N-acetyltransferase 2 gene as a susceptibility risk factor for anti tuberculosis drug-induced hepatitis. Hepatology 2002 35 883-889. 

Henkin Y, Johnson KC, Segrest JP. Rechallenge with crystalline niacin after drug-induced hepatitis from sustained-release niacin. JAMA 1990 264(2) 241-3. 

JS was diagnosed as having drug-induced hepatitis and all anti-TB medication was stopped. 

Strieker BHCH (1992) Drug-induced Hepatic Injury, 2nd edn. Amsterdam Elsevier Science. Zimmerman Hj (ed) (1999) Hepatotoxicity The adverse effects of drugs and other chemicals on the liver. Philadelphia Lippincott Williams Wilkins. 

Strieker BHCH (1992) Drug-induced Hepatic Injury, 2nd edn. Amsterdam Elsevier... 

Ishak, K. G., and Zimmerman, H. J. Morphologic spectrum of drug-induced hepatic disease. Gastroenterol. Clin. North Am. 24, 759, 1995. 

Kluender CN, Klein R, Kohler B (2003) Dramatic increase in bilirubin after ERCP - pethidine as a possible cause of drug-induced hepatitis. Zeitschr Gastroenterol 41 1157—1160. 

Beaune P, Dansette PM, Mansuy D, Kiffel L, Einck M, Amar C et al. Human anti-endoplasmic reticulum autoantibodies appearing in a drug-induced hepatitis are directed against a human liver cytochrome P-450 that hydroxylates the drug. Proc Natl Acad Sci USA 1987 84 551-5. 

Friis, H., Andreasen, RB. Drug-induced hepatic injury an analysis of 1100 cases reported to the Danish Committee on Adverse Drug Reactions between 1978 and 1987. J. Intern. Med. 1992 232 133-138... 

Pessayre, D. Role of reactive metabolites in drug-induced hepatitis. J. Hepatol. 1995 23 (Suppl. 1) 16-24... 

C., Lenoir, C., Lemoine, A., Hillon, R Incidence of drug-induced hepatic injuries a French population-based study. Hepatology 2002 36 451-455... 

A 77-year-old man took amlodipine for 1 month and developed jaundice and raised aspartate transaminase, alanine transaminase, and bilirubin (9). A liver biopsy suggested a drug-induced hepatitis and the amlodipine was withdrawn. His symptoms and laboratory values normalized. Other drugs (metformin, fluindione, and omeprazole) were not withdrawn. 

Several herbal products have been claimed to mitigate drug-induced hepatitis caused by antituberculosis agents. However, few of them have undergone rigorous randomized controlled trials. 

Glycyrrhizin is widely used in Japan for the treatment of chronic hepatitis, but in a non-randomized trial in 24 patients who developed drug-induced hepatitis while undergoing antituberculosis chemotherapy, there was no difference in the time required for recovery between the patients who were treated with or without intravenous glycyrrhizin 40 mhday (28). 

Miyazawa N, Takahashi H, Yoshiike Y, Ogura T, Watanuki Y, Sato M, Kakemizu N, Yamakawa Y, U CH, Goto H, Odagiri S. [Effect of glycyrrhizin on anti-tuberculosis drug-induced hepatitis.] Kekkaku 2003 78(l) 15-9. 

Pomiersky C, Blaich E. Arzneimittelbedingte Hepatitis mit Cholestase nach Therapie mit Chlormezanon.. [Drug-induced hepatitis with cholestasis following therapy with chlormezanone.] Z Gastroenterol 1985 23(12) 684-6. 

A 44-year-old woman developed acute hepatitis while taking gatifloxacin for chronic sinusitis (23). After 5 days she developed nausea, lethargy, and abdominal pain, all of which progressed over the next few days. Liver function tests were abnormal, and the bilirubin peaked at 161 pmol/l. A percutaneous liver biopsy showed acute hepatitis with eosinophilic infiltrates, consistent with drug-induced hepatitis. 

A 49-year-old Japanese woman had taken oral Tsumura for about 6 weeks to treat internal hemorrhoids when she felt unwell. Her liver enzymes were raised and a diagnosis of drug-induced hepatic damage caused by Angelica radix and Bupleuri radix contained in the mixture was made. The liver function tests normalized 4 months after withdrawal. 

A 76-year-old woman with previous exposure to isoflurane 3 years earlier underwent an above-knee amputation for a liposarcoma using isoflurane anesthesia. On day 3 postoperatively she became febrile and confused. Bacterial cultures later showed Staphylococcus aureus in the sputum and Escherichia coli in the urine. Associated hypotension for 2 hours resolved with inotropic support and here renal function remained normal. On day 6 she became jaundiced and developed further hypotension. Despite intensive care treatment she died on day 7. An autopsy showed centrilobular necrosis consistent with drug-induced hepatitis. All liver serology was negative. 

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