Thursday, December 02, 2010

Drug Induced Liver Injuries from Anti-microbial Medications

This month there will be a report released in Hepatology journal that suggest that anti-microbial medications are a common cause of drug-induced liver injury (DILI) leading to acute liver failure or ALF. Acute liver failure is the appearance of severe complications rapidly after the first signs of liver disease (such as jaundice), and indicates that the liver has sustained severe damage (loss of function of 80-90% of liver cells). The complications are hepatic encephalopathy and impaired protein synthesis (as measured by the levels of serum albumin and the prothrombin time in the blood). Source

What could be the cause? More than 1100 drugs, herbal remedies, natural products, vitamins, minerals, and dietary supplements are known to cause liver injury.
(You may find the abstract here:

Detailed case reports were collected from 1,198 subjects with ALF enrolled at 23 sites participating in the National Institutes of Health-funded Acute Liver Failure Study Group. The findings included evidence that showed high female predominance in DILI ALF, suggesting that women may be more susceptible to liver injury or use more prescription drugs than men.

What were the types of drugs and products? More than sixty, alone or in combination, could cause liver injury and failure in the study population. Anti-microbial agents were found to be the most common cause of DILI ALF cases and included anti-tuberculosis drugs (25), sulphur-containing drugs (12), nitrofurantoin (12), other antibiotics (7), antifungal agents (6), and anti-retroviral drugs (4).

So, what type of drugs/brand names might make this sub group of 60? Examples of drugs that can cause acute liver hepatitis include acetaminophen (Tylenol), phenytoin (Dilantin), aspirin, isoniazid (Nydrazid, Laniazid), diclofenac (Voltaren), and amoxicillin/clavulanic acid (Augmentin). Examples of drugs that can cause chronic hepatitis include minocycline (Minocin), nitrofurantoin (Furadantin, Macrodantin), phenytoin (Dilantin), propylthiouracil, and fenofibrate (Tricor). The Merck Manual has a comprehensive list as well:


Patients who develop ALF after taking these  typically did not experience a spontaneous recovery—the transplant-free survival rate in this study was 27%. 

Stay tuned for the full article.