II. Causes: Medications associated with Cirrhosis
- Alpha-Methyldopa
- Amiodarone
- Isoniazid
- Methotrexate
- Troglitazone (no longer available in United States)
- Vitamin A
III. Causes: Most common drug causes of Acute Hepatitis
- Amoxicillin-Clavulanic Acid (Augmentin, most common cause)
- Acetaminophen (AST often rises above 5000, most common cause of Acute Liver Failure in U.S.)
- Anti-Tuberculosis medications
- Trimethoprim-sulfamethoxazole
- Minocycline (mimics Autoimmune Hepatitis)
- Nitrofurantoin (mimics Autoimmune Hepatitis)
- Valproic Acid
- Niacin
IV. Causes: Hepatotoxic Medications (including mild transaminase elevations)
-
Analgesics
- NSAIDs
- Avoid in patients with Chronic Liver Disease
- Acetaminophen (>4 grams in 24 hours in adults)
- Limit to 2 grams/day in Chronic Liver Disease
- Allopurinol
- Baclofen
- Methotrexate
- NSAIDs
- Medications used in Diabetes Mellitus
- Acarbose (Precose)
- Pioglitazone (Actos)
- Sulfonylureas (e.g. Glyburide)
- Lipid-lowering Medications
- Antihypertensives
- Labetolol
- Hydralazine
- Lisinopril
- Losartan (Cozaar)
- Antiarrhythmics
- Antibiotics
-
Chemotherapy
- Imatinib (Gleevec)
- Methotrexate
- Antifungal Medications
- Anticonvulsant Medications
- Psychotropic Medications
- Bupropion (Wellbutrin, Zyban)
- Tricyclic Antidepressants
- Chlorpromazine (Thorazine)
- Risperidone (Risperdal)
- Selective Serotonin Reuptake Inhibitors
- Trazodone
- Hormonal Medications
- Tamoxifen
- Testosterone
- Miscellaneous Medications
- Halothane
- Etretinate
- Protease Inhibitors
- Heparin
- Omeprazole
V. Causes: Hepatotoxic Supplements
- Amanita Species (Mushrooms)
- Asafetida
- Chaparral leaf
- Comfrey
- Echinacea
- Ephedra
- Gentian
- Germander
- Iron
- Jin bu huan
- Kalms tablets
- Mistletoe
- Nicotinic Acid (Niacin)
- Pennyroyal oil
- Ragwort
- Senna fruit extract
- Scutellaria (skullcap)
- Shark Cartilage
- Valerian Root
- Vitamin A
- Kava Kava
VI. Managment: Monitoring for Hepatotoxicity in Chronic Liver Disease
- See mild Liver Function Test Abnormality
- Indications
- Potential Hepatotoxin use in Chronic Liver Disease
- Labs
- Lab Timing
- Baseline
- Every 2 weeks for first month
- Every month for next three months
- Every three months until medication stopped
- Indications to stop medication
- Liver Function Tests increase >2x baseline
- Liver related symptoms develop
VII. Resources
- NIDDK/NLM Liver Tox
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| Definition (CSP) | poisonous substance that damages or destroys liver cells. |
| Concepts | Hazardous or Poisonous Substance (T131) |
| English | hepatotoxin, hepatotoxins |
