Amoxicillin and clavulanic acid:-
Amoxicillin is an antibiotic
that is related to penicillin and ampicillin. It is effective
against many bacteria such as H.
influenzae, N. gonorrhea, E. coli, Pneumococci,
Streptococci, and certain strains of Staphylococci . Addition of clavulanic acid to
amoxicillin amoxicillin and clavulanic acid enhances the effectiveness of
amoxicillin against many other bacteria that are ordinarily resistant to
amoxicillin.
Amoxicillin
and clavulanic acid has been reported to cause cholestasis with or without
hepatitis. Amoxicillin and clavulanic acid-induced cholestasis is rare;
approximately 150 cases of liver disease associated with Amoxicillin and
clavulanic acid have been reported. Symptoms of cholestasis (jaundice, nausea,
itching) usually occur 1-6 weeks after starting Amoxicillin and clavulanic acid,
but the onset of liver disease can occur weeks after stopping the Amoxicillin
and clavulanic acid. Most patients recover fully in weeks to months after
stopping the medication, but rare cases of liver failure, cirrhosis, and liver
transplantation have been reported.
Other antibiotics have been reported to
cause liver disease. Some examples include minocycline (an antibiotic related
to tetracycline), and Cotrimoxazole (a combination ofsulfamethoxazole
and trimethoprim).
Amoxicillin:
Amoxicillin causes a moderate
rise in SGOT levels, SGPT levels, or both, but the significance of this finding
is unknown. Hepatic dysfunction, including jaundice, hepatic cholestasis, and
acute cytolytic hepatitis, have been reported.
Nonsteroidal antiinflammatory drugs
(NSAIDs):
Nonsteroidal
antiinflammatory drugs (NSAIDs) are
commonly prescribed for the bone and joint-related inflammation such as arthritis,
tendinitis and bursitis.
Examples of NSAIDs include aspirin, indomethacin, ibuprofen,
naproxen, piroxicam,
and nabumetone.
NSAIDs are safe when used
properly and as prescribed by doctors; however, patients with cirrhosis and
advanced liver disease should avoid NSAIDs since they can worsen liver function
(and cause kidney
failure as well).
Serious liver disease (such as
hepatitis) from NSAIDs, occur rarely (in approximately 1-10 patients per
100,000 who use the drugs). Diclofenac is an example of an NSAID that has been
reported to cause hepatitis slightly more frequently, in approximately 1-5 per
100,000 users of the drug. Hepatitis usually resolves completely after stopping
the drug. Acute liver failure and chronic liver disease, such as cirrhosis,
have been reported rarely.
Tacrine:
Tacrine
(Cognex) is an oral medication
used for treating Alzheimer's
disease. (The FDA approved tacrine in 1993.) Tacrine has been reported to
cause abnormal elevations in blood liver enzymes commonly. Patients may report
nausea, but hepatitis and serious liver disease are rare. Abnormal tests
usually become normal after tacrine is stopped.
Disulfiram:
Disulfiram is a medication occasionally
prescribed to treat alcoholism. It discourages drinking by causing nausea,
vomiting, and other unpleasant physical reactions when alcohol is ingested.
Disulfiram has been reported to cause acute hepatitis. In rare cases,
disulfiram-induced hepatitis can lead to acute liver failure and liver
transplantation.
Rifampin:
Rifampin is usually
administered with INH. On its own, rifampin may cause mild hepatitis, but this
is usually in the context of a general hypersensitivity reaction. Fatalities
associated with jaundice have occurred in patients with liver disease and in patients
taking rifampin with other hepatotoxic agents. Careful monitoring of liver
function (especially SGPT/SGOT) should be performed prior to therapy and then
every 2-4 weeks during therapy. In some cases, hyperbilirubinemia resulting
from competition between rifampin and bilirubin for excretory pathways of the
liver can occur in the early days of treatment. Isolated cholestasis also may
occur. An isolated report showing a moderate rise in bilirubin and/or
transaminase levels is not in itself an indication for interrupting treatment.
Rather, the decision should be based on repeated test results and trends in
conjunction with the patient's clinical condition.
Valproic acid and divalproex sodium:
- Microvesicular steatosis is observed with alcohol, aspirin, valproic acid, amiodarone, piroxicam, stavudine, didanosine, nevirapine, and high doses of tetracycline. Prolonged therapy with methotrexate, INH, ticrynafen, perhexiline, enalapril, and valproic acid may lead to cirrhosis. Valproic acid typically causes microsteatosis. This drug should not be administered to patients with hepatic disease; exercise caution in patients with a prior history of hepatic disease. Those at particular risk include children younger than 2 years, those with congenital metabolic disorders or organic brain disease, and those with seizure disorders treated with multiple anticonvulsants.
- Hepatic failures resulting in fatalities have occurred in patients receiving valproic acid. These incidents usually occur during the first 6 months of treatment and are preceded by nonspecific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, vomiting, and even loss of seizure control. Liver function tests should be performed prior to therapy and at frequent intervals, especially in the first 6 months. Physicians should not rely totally on laboratory results; they should also consider findings from the medical history and physical examination.
No comments:
Post a Comment