Transaminase liver

Atovaquone 1 500 mg suspension by mouth once a day Elevated liver transaminases Nausea Rash... 

All azole antifungals carry the potential for rash, photosensitivity, and hepatotoxicity. In general, hepatotoxicity is mild and reversible, presenting as asymptomatic increases in liver transaminases. However, fulminant hepatic failure has been reported with itraconazole. Therefore, serial monitoring of liver function... 

Depressed liver transaminase activity after 60 days 10... 

Influence of CYP2D6 Genotypes on Liver Transaminase Activity... 

Table 10.9 Cytochrome P450 2D6 (C7P2 )(5)-rdated liver transaminase activity in Alzheimer s disease...

Dyspepsia is the most common side effect of zileuton. Liver transaminase levels are elevated in a small percentage of patients taking zileuton. Serum Uver transaminase levels should be monitored and treatment halted if significant elevations occur. Zileuton inhibits the metabolism of theophylline. Thus, when these agents are used concomitantly, the dose of theophylline should be reduced by approximately one-half, and plasma concentrations of theophylline should be monitored closely. Caution should also be exercised when using zileuton concomitantly with warfarin, terfenadine, or propranolol, as zileuton inhibits the metabolism of these agents. Zileuton is contraindicated in patients with acute liver disease and should be used with caution in patients who consume substantial quantities of alcohol or have a history of liver disease. 

Dose-related myelosuppression is the major adverse effect produced by 6-thioguanine. Patients deficient in thiopurine methyltransferase (TPMT), a cytosolic enzyme required for metabolism of 6-thioguanine, are at heightened risk. Other adverse effects include gastrointestinal complaints and elevations of liver transaminases. There have been rare reports of more serious he-patotoxicity, including acute hepatitis, acute cholestasis, and hepatic venoocclusive disease. 

Periodic assessment of liver transaminases in patients with significant hepatic disease... 

Cholestatic jaundice can occur during treatment with antipsychotics, and is most often reported in chlorpromazine-treated patients (Hansen et ah, 1997). Elevations in liver transaminases have also been observed in a few cases of children treated with risperi-... 

Takaike H, Uchigata Y, Iwasaki N, Iwamoto Y. Transient elevation of liver transaminase after starting insulin therapy for diabetic acidosis or ketoacidosis in newly diagnosed type 1 diabetes mellitus. Diabetes Res Clin Pract 2004 64 27-32. 

Tacrine is a non-competitive, irreversible inhibitor of both acetyl and butyryl cholinesterase, with a greater potency for the latter enzyme. Based on the outcome of placebo-controlled, double-blind studies, tacrine was the first anticholinesterase to be licensed for the symptomatic treatment of AD in the United States. The main disadvantage of tacrine lies in its hepatotoxicity (approximately 50% of patients were found to develop elevated liver transaminases which reversed on discontinuation of the drug). Because of such side effects and limited efficacy, tacrine is no longer widely prescribed. 

The twins were referred subsequently to a metabolic specialist because of the suspicion of an inborn error of metabolism. Biochemical testing revealed each had a hyperchloremic (increased blood chloride concentration) metabolic acidosis that was more profound in Elizabeth. Serum levels of glucose and liver transaminases were normal. Urinary organic acids revealed modestly increased concentrations of lactate and ketone bodies. Blood samples and fibroblasts from skin biopsies from both girls were sent to an established diagnostic laboratory for genetic mitochondrial diseases. Tests of respiratory chain complex enzymatic activities were normal. 

The efficacy of olanzapine in treatment-refractory childhood-onset schizophrenia has been examined in eight patients (mean age 15 years) over 8 weeks (22). There was a 17% improvement in the BPRS total score. Olanzapine was moderately well tolerated. The most common adverse events were increased appetite (n = 6), constipation (n = 5), nausea/vomiting (n = 6), headache (n = 6), somnolence (n = 6), insomnia (n = 7), difficulty in concentrating (n = 5), sustained tachycardia (n = 6), transient rises in liver transaminases (n = 7), and increased agitation (n = 6). 

Initial trials and other observational studies with olanzapine detected transient rises in liver transaminases (SEDA-23, 65). Several other cases have further illustrated this. 

Kolpe M, Ravasia S. Effect of olanzapine on the liver transaminases. Can J Psychiatry 2003 48 210. 

Daniel, S., Ben-Menachem, T., Vasuderan, G., Ma, C.K., Blumenkehl, M. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Amer. J. Gastroenterol. 1999 94 3010—3014... 

Mathlesen, U.L., Franzen, L.E., Aselius, H., Resjo, M., Jacobsson, L., Foberg, U., Fryden, A., Bodemar, G. Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases. Dig. Dis. Sci. 2002 34 516-522... 

There are mild to moderate increases in liver transaminases during treatment with rifampicin plus isoniazid in most patients. However, biochemical hepatitis is diagnosed when transaminase activities increase to more than four times the upper limit of the reference ranges on two occasions at least 1 week apart, or more than five times on any single occasion. This calls for withdrawal of all potentially hepatotoxic drugs (rifampicin, isoniazid, and pyrazinamide) until the enzymes return to the reference ranges. During this period, streptomycin plus etham-butol, with or without cycloserine and a fluoroquinolone, is recommended in seriously ill patients. 

Ibuprofen has been rarely thought responsible for liver damage. A recent report has described three patients, 33-44 years old, with chronic hepatitis C infection who developed more than five-fold increases in serum liver transaminases after taking ibuprofen for musculoskeletal pain. In all three there were no associated symptoms of hepatitis, and serum transaminases normalized after ibuprofen was withdrawn (18). 

Even moderate but continuing alcohol consumption needs to be taken seriously in patients receiving interferon alfa, and exacerbation of previous acute alcohol hepatitis has been reported in two patients with chronic hepatitis C, despite reduced alcohol consumption (403). Liver transaminases subsequently normalized after withdrawal of interferon alfa in both patients. 

In an extensive review of the treatment of minimal lesion glomerulonephritis the use of levamisole was briefly mentioned (6). The author concluded that levamisole has a beneficial effect in this disorder, although no new studies have appeared in recent years and well-controlled studies are scarce. Levamisole appears to be well tolerated in this condition. The adverse effects were neutropenia, rash, and raised liver transaminases. 

Park YM, Kim TY, Kim HO, Kim CW. Reproducible elevation of liver transaminases by topical 8-methoxypsoralen. Photodermatol Photoimmunol Photomed 1994 10(6) 261-3. 

The most serious adverse effect of progabide is hepato-toxicity. In one study, seven of 30 patients given doses up to 45 mg/kg/day had significant disturbances of liver function tests (which returned to normal on withdrawing the drug) (2). In another study, abnormal liver function tests were reported in 8.4% of 1164 patients clinical hepato-toxicity occurred in 0.5% and three patients died. Monitoring liver function is recommended and drug withdrawal is indicated if liver transaminases exceed twice normal (SED-13,155). 

Oral human LDlq is equal to 221 mgkg Adverse acute reactions to bismuth include acute renal failure following ingestion of excessive concentrations. Bismuth can cause nausea, vomiting, and abdominal pain within hours of exposure. Muscle cramps and weakness, blurred vision, and hyperreflexia may be exhibited. Liver transaminase activities may be elevated. 

Ludwig S, Kaplowitz N. Effect of pyridoxine deficiency on serum and liver transaminases in experimental liver injury in the rat. Gastroenterology 1980 79 545-9. 

Mathiesen U, Franzen L, Fryden A, Foberg U, Bodemar G. The clinical significance of slightly to moderately increased liver transaminase values in asymptomatic patients. Scand J Gastroenterol 1999 34 85-91. 

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