Chlorpromazine:
Chlorpromazine
liver injury resembles that of infectious hepatitis with laboratory features of
obstructive jaundice rather than those of parenchymal damage. The overall
incidence of jaundice is low regardless of dose or indication of the drug. Most
cases occur 2-4 weeks after therapy. Any surgical intervention should be
withheld until extrahepatic obstruction is confirmed. It is usually promptly
reversible upon withdrawal of the medication; however chronic jaundice has been
reported. Chlorpromazine should be administered with caution to persons with
liver disease.
Methotrexate :
Methotrexate has been used for the long-term
treatment of patients with severe psoriasis, rheumatoid
arthritis, psoriatic
arthritis, and some patients with Crohn's
disease. Methotrexate has
been found to be a cause of liver cirrhosis in a dose-dependent fashion.
Patients with pre-existing liver diseases, obese patients, and those who drink
alcohol regularly are particularly at risk of developing methotrexate-induced
cirrhosis. In recent years, doctors have substantially decreased methotrexate
liver damage by using low doses of methotrexate (5-15 mg) given once a week and
by carefully monitoring liver blood tests during therapy. Some doctors also
perform liver biopsies on patients without liver symptoms after two years (or
after a cumulative dose of 4 grams of methotrexate) to look for early liver
cirrhosis.
Methyldopa:
Methyldopa is
an antihypertensive that is contraindicated in patients with active liver
disease. Periodic determination of hepatic function should be performed during
the first 6-12 weeks of therapy. Occasionally, fever may occur within 3 weeks
of methyldopa therapy, which may be associated with abnormalities in liver
function test results or eosinophilia, necessitating discontinuation. In some
patients, findings are consistent with those of cholestasis and hepatocellular
injury. Rarely, fatal hepatic necrosis has been reported after use of
methyldopa, which may represent a hypersensitivity reaction.
Oral contraceptives:
Oral contraceptives can lead to intrahepatic cholestasis
with pruritus and jaundice in a small number of patients. Patients with
recurrent idiopathic jaundice of pregnancy, severe pruritus of pregnancy, or a
family history of these disorders are more susceptible to hepatic injury. Oral
contraceptives are contraindicated in patients with a history of recurrent
jaundice of pregnancy. Benign neoplasm, rarely malignant neoplasm of the liver,
and hepatic vein occlusion have also been associated with oral contraceptive
therapy.
Antibiotics
Isoniazid
:-
Isoniazid has been used for decades to treat
latent tuberculosis (patients with positive skin tests for
tuberculosis, without signs or symptoms of active tuberculosis). Most patients
with isoniazid-induced liver disease only develop mild and reversible
elevations in blood levels of AST and ALT without symptoms, but approximately
1-2% of the patients develop isoniazid-induced hepatitis. The risk of
developing isoniazid hepatitis occurs more commonly in older patients than
younger patients. The risk of serious liver disease is 0.3% in healthy young
adults, and rises to more than 2% in patients older than 50. An estimated 5-10%
of the patients who develop hepatitis go on to develop liver failure and
require liver transplantation. The risk of isoniazid liver toxicity is
increased with chronic regular alcohol intake, and with concomitant use of
other medications such as Tylenol and rifampin.
Early symptoms of isoniazid
hepatitis are fatigue, poor appetite, nausea, and vomiting. Jaundice may then
follow. Most patients with isoniazid hepatitis recover fully and promptly after
stopping the drug. Severe liver disease and liver failure mostly occur in
patients who continue to take isoniazid after the onset of hepatitis.
Therefore, the most important treatment for isoniazid liver toxicity is early
recognition of hepatitis and discontinuation of the isoniazid before serious
liver injury has occurred.
Erythromycin:
Erythromycin may
cause hepatic dysfunction, including increased liver enzyme levels and
hepatocellular and/or cholestatic hepatitis with or without jaundice. A
cholestatic reaction is the most common adverse effect and usually begins
within 2-3 weeks of therapy. The liver principally excretes erythromycin;
exercise caution when this drug is administered to patients with impaired liver
function. The use of erythromycin in patients concurrently taking drugs
metabolized by the P-450 system may be associated with elevations in the serum
levels of other drugs.
Ciprofloxacin:
Cholestatic
jaundice has been reported with repeated use of quinolones. Approximately 1.9%
of patients taking ciprofloxacin show elevated SGPT levels, 1.7% have elevated
SGOT levels, 0.8% have increased alkaline phosphatase levels, and 0.3% have
elevated bilirubin levels. Jaundice is transient, and enzyme levels return to
the reference range.
Nitrofurantoin.
Nitrofurantoin
is an anti-bacterial drug that is used to treat urinary tract infections caused
by many gram-negative and some gram-positive bacteria.There are three forms of nitrofurantoin
available: a microcrystalline form, a macrocrystalline form, and a sustained
release, macrocrystalline form used twice daily.
Nitrofurantoin
can cause acute and chronic liver disease. Most commonly, nitrofurantoin causes
mild and reversible elevations in blood levels of liver enzymes without
symptoms. In rare instances, nitrofurantoin can cause hepatitis.
Symptoms
of nitrofurantoin hepatitis include:
·
fatigue,
·
fever,
·
muscle and joint aches,
·
poor appetite,
·
nausea,
·
weight
loss,
·
vomiting,
·
jaundice, and
·
sometimes itching.
Some
patients with hepatitis also have a rash,
enlarged lymph glands, and nitrofurantoin-induced pneumonia (with symptoms of cough and shortness
of breath).
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