II. Causes: Medications associated with Cirrhosis

  1. Alpha-Methyldopa
  2. Amiodarone
  3. Isoniazid
  4. Methotrexate
  5. Troglitazone (no longer available in United States)
  6. Vitamin A

III. Causes: Most common drug causes of Acute Hepatitis

  1. Amoxicillin-Clavulanic Acid (Augmentin, most common cause)
  2. Acetaminophen (AST often rises above 5000, most common cause of Acute Liver Failure in U.S.)
  3. Anti-Tuberculosis medications
  4. Trimethoprim-sulfamethoxazole
  5. Minocycline (mimics Autoimmune Hepatitis)
  6. Nitrofurantoin (mimics Autoimmune Hepatitis)
  7. Valproic Acid
  8. Niacin

IV. Causes: Hepatotoxic Medications (including mild transaminase elevations)

V. Causes: Hepatotoxic Supplements

  1. Amanita Species (Mushrooms)
  2. Asafetida
  3. Chaparral leaf
  4. Comfrey
  5. Colloidal Silver
  6. Echinacea
  7. Ephedra
  8. Gentian
  9. Germander
  10. Green Tea Extract (but standard Green Tea is safe)
  11. Iron
  12. Jin bu huan
  13. Kalms tablets
  14. Kava
  15. Mistletoe
  16. Nicotinic Acid (Niacin)
  17. Pennyroyal oil
  18. Ragwort
  19. Senna fruit extract
  20. Scutellaria (skullcap)
  21. Shark Cartilage
  22. Valerian Root
  23. Vitamin A
  24. Kava Kava

VI. Managment: Monitoring for Hepatotoxicity in Chronic Liver Disease

  1. See mild Liver Function Test Abnormality
  2. Indications
    1. Potential Hepatotoxin use in Chronic Liver Disease
  3. Labs
    1. Aspartate Aminotransferase
    2. Alanine Aminotransferase
    3. Total Serum Bilirubin
    4. Alkaline Phosphatase
  4. 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
  5. Indications to stop medication
    1. Liver Function Tests increase >2x baseline
    2. Liver related symptoms develop

VII. Resources

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Related Studies

Ontology: hepatotoxin (C0596691)

Definition (CSP) poisonous substance that damages or destroys liver cells.
Concepts Hazardous or Poisonous Substance (T131)
English hepatotoxin, hepatotoxins