Display options
Share it on
Full text links
Springer

Drug Saf. 1993 Dec;9(6):441-9. doi: 10.2165/00002018-199309060-00007.

Drug-induced hepatic disorders. Incidence, management and avoidance.

Drug safety

M Døssing, J Sonne

Affiliations

  1. Medical Department P, Bispebjerg Hospital, Copenhagen, Denmark.

PMID: 8129864 DOI: 10.2165/00002018-199309060-00007

Abstract

Drug-induced liver injury has been associated with more than 800 different drugs, leading to hospital admission in 1 of 600 to 3500 admissions. This amounts to 2 to 3% of all hospitalisations due to adverse drug reactions, or about 3% of all jaundiced patients. The prognosis of clinically overt drug hepatotoxicity is relatively serious. The clinical picture is essentially nonspecific, with a highly variable latency period from days to years. Drug hepatotoxicity can mimic almost any kind of liver disease. A thorough drug history, a low threshold of suspicion and the exclusion of other causes of liver disease are important for the detection of drug-induced liver disorders. Treatment consists of discontinuation of suspected drug(s), acetylcysteine in the course of paracetamol (acetaminophen) toxicity, and liver transplantation in selected cases of fulminant liver failure. Guidelines regarding the use of selected drugs such as methotrexate and halothane should be followed. Potentially hepatotoxic drugs should be used cautiously in alcoholic patients with or without liver involvement. Patients with uncompensated liver disease should receive a reduced dose of drugs adjusted to the degree of liver function impairment. The general public should be warned against abuse of hepatotoxic drugs such as paracetamol and anabolic steroids.

Cited by

References

  1. Hepatology. 1989 Aug;10 (2):168-73 - PubMed
  2. Semin Liver Dis. 1986 May;6(2):97-106 - PubMed
  3. Med Clin North Am. 1989 Jul;73(4):775-92 - PubMed
  4. Scand J Gastroenterol. 1982 Mar;17 (2):205-11 - PubMed
  5. Am J Med. 1992 Jul;93(1):94-6 - PubMed
  6. Hepatology. 1989 May;9(5):679-85 - PubMed
  7. Br J Clin Pharmacol. 1992 Jan;33(1):61-8 - PubMed
  8. Semin Liver Dis. 1987 Aug;7(3):230-6 - PubMed
  9. Clin Pharmacokinet. 1988 Dec;15(6):396-420 - PubMed
  10. Acta Med Scand. 1979;205(6):451-6 - PubMed
  11. Ann Intern Med. 1986 Mar;104(3):399-404 - PubMed
  12. Int J Clin Pharmacol Ther Toxicol. 1990 Aug;28(8):317-22 - PubMed
  13. Epilepsia. 1991;32 Suppl 5:S74-9 - PubMed
  14. Semin Liver Dis. 1988 Feb;8(1):47-68 - PubMed
  15. Am Rev Respir Dis. 1978 Sep;118(3):628-9 - PubMed
  16. Milbank Q. 1992;70(1):155-82 - PubMed
  17. Lancet. 1982 Apr 3;1(8275):782-6 - PubMed
  18. Ann Intern Med. 1987 Sep;107(3):337-41 - PubMed
  19. Arch Intern Med. 1974 Aug;134(2):219-23 - PubMed
  20. Gastroenterology. 1977 Feb;72 (2):284-9 - PubMed
  21. N Engl J Med. 1985 Nov 21;313(21):1310-4 - PubMed
  22. Am Rev Respir Dis. 1978 Jun;117(6):991-1001 - PubMed
  23. J R Coll Gen Pract. 1975 May;25(154):337-43 - PubMed
  24. Br J Clin Pharmacol. 1983 Apr;15(4):451-8 - PubMed
  25. Gastroenterology. 1990 Feb;98 (2):502-4 - PubMed
  26. J Clin Pharmacol. 1981 Aug-Sep;21(8-9):359-64 - PubMed
  27. Hepatology. 1989 Jul;10 (1):116-7 - PubMed
  28. Drug Saf. 1990 Jan-Feb;5(1):28-38 - PubMed
  29. Baillieres Clin Gastroenterol. 1988 Apr;2(2):423-52 - PubMed
  30. Scand J Gastroenterol. 1987 Aug;22(6):701-4 - PubMed
  31. N Engl J Med. 1981 Sep 24;305(13):722-7 - PubMed
  32. Hepatology. 1990 Jun;11(6):951-6 - PubMed
  33. Br Med J. 1977 Jul 9;2(6079):94-6 - PubMed
  34. BMJ. 1992 Sep 12;305(6854):618 - PubMed
  35. Ann Intern Med. 1992 Jul 15;117(2):129-32 - PubMed
  36. Br J Clin Pharmacol. 1992 Mar;33(3):249-52 - PubMed
  37. Clin Pharmacol Ther. 1975 Jul;18(1):70-9 - PubMed
  38. J Intern Med. 1992 Aug;232(2):133-8 - PubMed
  39. Hepatology. 1988 May-Jun;8(3):463-70 - PubMed
  40. Ugeskr Laeger. 1982 Feb 15;144(7):466-8 - PubMed
  41. Drugs. 1978 Jul;16(1):25-45 - PubMed
  42. Gut. 1984 Oct;25(10 ):1057-64 - PubMed
  43. Acta Neurol Scand Suppl. 1983;97:81-90 - PubMed
  44. Gastroenterology. 1991 Jun;100(6):1701-9 - PubMed
  45. J Hepatol. 1988 Aug;7(1):111-7 - PubMed
  46. N Engl J Med. 1974 Oct 17;291(16):824-8 - PubMed
  47. Lancet. 1977 May 28;1(8022):1142-3 - PubMed
  48. Am Rev Respir Dis. 1978 Sep;118(3):461-6 - PubMed
  49. Am J Med. 1992 Apr;92(4):404-11 - PubMed
  50. Chest. 1991 Feb;99(2):465-71 - PubMed
  51. Med Clin North Am. 1979 May;63(3):567-82 - PubMed
  52. Am J Gastroenterol. 1988 Dec;83(12 ):1337-45 - PubMed
  53. Gastroenterol Clin Biol. 1992;16(1):64-88 - PubMed
  54. Hum Exp Toxicol. 1991 Nov;10 (6):435-8 - PubMed
  55. Acta Med Scand. 1967 Oct;182(4):491-501 - PubMed
  56. Ann Intern Med. 1991 Mar 1;114(5):431 - PubMed
  57. N Y State J Med. 1982 Nov;82(12 ):1745-6 - PubMed
  58. Ann Intern Med. 1990 Nov 15;113(10 ):799-800 - PubMed

Substances

MeSH terms

Publication Types

LinkOut - more resources