Healthy Skepticism Library item: 9926

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Publication type: Journal Article

Szelag A, Merwid-lad A, Trocha M, Skrzypiec M, Smereka A.
Pathomechanisms of drug hepatotoxicity
Gastroenterologia Polska 2003; 10:(5):425-9

Abstract:

Hepatotoxicity is a potential side effect of most prescribed drugs. Medicines likely account for up to 20% of fulminant liver failure cases but the actual figure is unknown due to substancial difficulties in determination of drug-related etiology. Hepatotoxic effects of pharmacotherapy may by caused by direct toxicity of a drug or its metabolites. More often, however, idiosyncratic reactions difficult to predict are observed. The risk of drug-induced liver injuries can be increased by many factors, including age, sex and concomitant diseases. Acute course is typical for most liver injuries, with rapid decline of symptoms observed after drug withdrawal. Fulminant or chronic courses are also possible. Depending on the level of the liver enzymes, drug injuries can be classified as hepatocyte injuries (necrosis and(or) steatosis), cholestatic injuries (bile secretion disturbances on the hepatocytes level and(or) bile flow disturbances through bile ducts) and mixed disorders. Liver vessels are rarely involved in drug lesions. Tumors, granulomas and liver fibrosis are found in isolated cases. Although almost all substances with proven strong hepatotoxicity have been withdrawn from the pharmaceutical market, wide use of drugs showing relatively weak hepatotoxicity can also be dangerous. Antibiotics and nonsteroidal antiinflamatory drugs are considered to be responsible for almost 50% liver injuries. Polypragmasy and the use of new drugs, whose adverse effects are not well known, may also be major reasons of liver injury.