Drug Induced Liver Disease (cont.)
Acute liver failure
Rarely, drugs cause acute liver failure (fulminant hepatitis). These patients
are extremely ill with the symptoms of acute hepatitis and the additional
problems of confusion or coma (encephalopathy) and bruising or bleeding
(coagulopathy). In fact, up to 80% of people with fulminant hepatitis die within
days to weeks. In the U. S., acetaminophen (Tylenol) is the most common cause of
acute liver failure.
Cholestasis
Cholestasis is a condition in which the secretion and/or
flow of bile is reduced. Bilirubin and bile acids normally secreted by the liver
into bile and eliminated from the body via the intestine, collect in the body
leading to jaundice and itching, respectively. Drugs causing cholestasis
typically interfere with the liver cell's secretion of bile without causing
hepatitis or liver cell necrosis (death). Patients with drug-induced cholestasis
typically have elevated blood levels of bilirubin but have normal or mildly
elevated AST and ALT levels. Blood levels of alkaline phosphate (an enzyme made by bile
ducts) increase because the cells of the bile ducts also are dysfunctional and
leak the enzyme. Aside from itching and jaundice, patients usually are not as
sick as patients with acute hepatitis.
Examples of drugs that have been reported to cause
cholestasis include erythromycin (E-Mycin, Ilosone), chlorpromazine (Thorazine),
sulfamethoxazole and trimethoprim (Bactrim; Septra), amitriptyline (Elavil,
Endep), carbamazepine (Tegretol), ampicillin (Omnipen; Polycillin; Principen),
ampicillin/clavulanic acid (Augmentin), rifampin (Rifadin), estradiol (Estrace;
Climara; Estraderm; Menostar), captopril (Capoten),
birth control pills (oral
contraceptives), anabolic steroids, naproxen (Naprosyn), amiodarone (Cordarone),
haloperidol (Haldol), imipramine (Tofranil), tetracycline (Achromycin), and phenytoin (Dilantin).
Most patients with drug-induced cholestasis will recover fully within weeks
after stopping the drug, but in some patients, jaundice, itching, and abnormal
liver tests can last months after stopping the drug. An occasional patient can
develop chronic liver disease and liver failure. Drug-induced jaundice and
cholestasis lasting longer than 3 months is called chronic cholestasis.
Next: Steatosis (fatty liver) »
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