Gastroenterology Book

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Hepatotoxic MedicationAka: Hepatotoxic Supplement, Hepatotoxin

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  1. See Also
    1. Toxic Hepatitis
    2. Chronic Liver Disease
    3. Medication Causes of Jaundice
  2. Medications associated with Cirrhosis
    1. Alpha-Methyldopa
    2. Amiodarone
    3. Isoniazid
    4. Methotrexate
    5. Troglitazone (no longer available in United States)
    6. Vitamin A
  3. Most common drug causes of acute hepatitis
    1. Amoxicillin-Calvulanic Acid (Augmentin)
      1. Most common cause
    2. Acetaminophen (AST often rises above 5000)
    3. Anti-Tuberculosis medications
    4. Trimethoprim-sulfamethoxazole
    5. Minocycline mimics Autoimmune Hepatitis
    6. Nitrofurantoin mimics Autoimmune Hepatitis
    7. Valproic Acid
    8. Niacin
  4. Hepatotoxic Medications
    1. Analgesics
      1. NSAIDs
        1. Avoid in patients with Chronic Liver Disease
      2. Acetaminophen (>4 grams in 24 hours in adults)
        1. Limit to 2 grams/day in Chronic Liver Disease
    2. Medications used in Diabetes Mellitus
      1. Acarbose (Precose)
      2. Pioglitazone (Actos)
      3. Sulfonylureas (e.g. Glyburide)
    3. Lipid-lowering Medications
      1. HMG-CoA Reductase Inhibitors (Statins)
      2. Nicotinic Acid (Niacin)
    4. Antihypertensives
      1. Labetolol
      2. Hydralazine
    5. Antiarrhythmics
      1. Amiodarone
      2. Procainamide
    6. Antibiotics
      1. Augmentin
      2. Erythromycin
      3. Isoniazid (INH)
      4. Nitrofurantoin (Macrobid)
      5. Penicillin
      6. Sulfonamides
      7. Tetracycline
    7. Antifungal Medications
      1. Fluconazole (Diflucan)
      2. Itraconazole (Sporanox)
      3. Ketoconazole (Nizoral)
    8. Anticonvulsant Medications
      1. Phenytoin (Dilantin)
      2. Valproic Acid
      3. Carbamazepine
    9. Psychotropic Medications
      1. Bupropion (Wellbutrin, Zyban)
      2. Tricyclic Antidepressants
      3. Chlorpromazine (Thorazine)
    10. Hormonal Medications
      1. Tamoxifen
      2. Testosterone
    11. Miscellaneous Medications
      1. Halothane
      2. Methotrexate
      3. Etretinate
      4. Protease Inhibitors
      5. Heparin
  5. Hepatotoxic Supplements
    1. Amanita Species (Mushrooms)
    2. Asafetida
    3. Chaparral leaf
    4. Comfrey
    5. Echinacea
    6. Ephedra
    7. Gentian
    8. Germander
    9. Iron
    10. Jin bu huan
    11. Kalms tablets
    12. Mistletoe
    13. Nicotinic Acid (Niacin)
    14. Pennyroyal oil
    15. Ragwort
    16. Senna fruit extract
    17. Scutellaria (skullcap)
    18. Shark Cartilage
    19. Valerian Root
    20. Vitamin A
    21. Kava Kava
  6. Monitoring for Hepatotoxicity in Chronic Liver Disease
    1. Indications
      1. Potential hepatotoxin use in Chronic Liver Disease
    2. Labs
      1. Aspartate Aminotransferase
      2. Alanine Aminotransferase
      3. Total Serum Bilirubin
      4. Alkaline Phosphatase
    3. Lab Timing
      1. Baseline
      2. Every 2 weeks for first month
      3. Every month for next three months
      4. Every three months until medication stopped
    4. Indications to stop medication
      1. Liver Function Tests increase >2x baseline
      2. Liver related symptoms develop
  7. References
    1. Lee (1995) N Engl J Med 333:1118
    2. Riley (2001) Am Fam Physician 64(9):1555
    3. Speeg (1995) Gastroenterol Clin North Am 24:1047

hepatotoxin (C0596691)

Definition (CSP)poisonous substance that damages or destroys liver cells.
ConceptsHazardous or Poisonous Substance (T131)
Englishhepatotoxin
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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