drug-induced hepatitis

Hepatitis, Drug-Induced

 

Definition

Inflammation of the liver due to an adverse reaction with a drug.

Description

The liver is a very important organ to the body. It is a large internal organ weighing more than three pounds in the average adult. It performs over 100 functions including formation of bile, detoxification of harmful substances, vitamin storage and metabolism of carbohydrates, fats and proteins. Serious complications could arise when the liver becomes inflamed due to hepatitis when it is not able to perform these tasks. A virus most often causes hepatitis but certain drugs can also induce it.
Drug-induced hepatitis (also called toxic hepatitis) occurs in eight in every 10,000 people because the liver reacts abnormally during drug exposure, leading to liver damage. This pathology causes the liver not to function properly and the symptoms can begin to be seen. Women tend to be affected almost twice as often as men. Older people are more prone to this type of hepatitis because their bodies aren't able to repair themselves as fast as younger people. Drugs that can be associated with drug-induced hepatitis include acetaminophen, vitamin A, and PTU (a drug treatment for tuberculosis).

Causes and symptoms

There are three general types of drug-induced hepatitis: toxic, metabolic idiosyncrasy and immunologic idiosyncrasy. With toxic hepatitis liver damage as the result of a drug complication with hepatotoxins happens to everyone who takes that particular drug. On the other hand, hepatitis resulting from a metabolic or immunologic idiosyncrasy only happens to certain people, those predisposed to particular idiosyncrasy.
In patients with a metabolic idiosyncrasy the person metabolizes the drug differently than most people causing a harmful by-product that damages the liver. A metabolic idiosyncrasy is seen in 0.1-2% of people and it is complicated by use of alcohol.
With an immunologic idiosyncrasy the patient's body recognizes the metabolized drug by-products as foreign. This leads to the destruction of liver cells containing the by-product via the immune system resulting in hepatitis. An immunologic idiosyncrasy is seen in less than one person per 10,000 (0.01%) people and is more than twice as common in women.
The symptoms of drug-induced hepatitis are similar to viral hepatitis. Drug induced hepatitis tends to be acute. If it is not caught soon enough the damage could be permanent resulting in chronic hepatitis. Some of the common symptoms are:
  • nausea
  • vomiting
  • headache
  • anorexia
  • jaundice
  • clay color stools
  • dark urine
  • hepatomegaly

Diagnosis

Diagnosis is typically made through a physical exam along with a patient history to identify any possible hepatotoxins. Blood tests are usually done as well. An increased white blood cell count is typical.

Treatment

There isn't any specific treatment other than immediate discontinuance of the causative agent. Rest during the acute phase of the disease is vital along with the intake of fluids to maintain hydration.

Prognosis

Usually the symptoms will go away after the drug has been eliminated due to the liver repairing itself. A full recovery is typically expected unless it wasn't treated quickly resulting in more liver damage being done than normal.

Prevention

If there is a history of liver damage certain medications should not be taken. Doctors will be familiar with these.

Resources

Books

Feldman, Sleisenger, and Scharschmidt. "Liver Diseases Caused by Drugs, Anesthetics, and Toxins." In Gastrointestinal and Liver Disease. Philadelphia: W.B. Saunders Company, 2001, pp. 1232-1237.
Holmes, Nancy H. "Hepatobiliary Disorders." In Diseases. Pennsylvania: Springhouse Corporation, 2001, pp.744-53.

Periodicals

Hautekeete, Horsmans, Van Waeyenberge, Demanet, Henrion, Verbist, Brenard, Sempoux, Michielsen, Yap, Rahier, and Geubel. "HLA Association of Amoxicillin-Clavulanate—Induced Hepatitis." Gastroenterology November 1999: 1181-86.

Key terms

Hepatitis — General inflammation of the liver.
Hepatomegaly — General swelling of the liver.
Hepatotoxin — A substance that is toxic to the liver.
Idiosyncrasy — A defect in that particular pathway resulting in an abnormality.

drug-in·duced hep·a·ti·tis

hepatocellular damage produced by a drug.
References in periodicals archive ?
Drug-induced hepatitis is increasing and is the most common cause overall.
The cause of death was drug-induced hepatitis, with prostate cancer and diabetes mellitus recorded as factors.
He died in July and the cause of death was drug-induced hepatitis, with prostate cancer and diabetes mellitus recorded as factors.
We enrolled patients (January 2007 to March 2009) with features suggestive of drug-induced hepatitis (DIH) while on anti-TB treatment.
DISCUSSION: Infectious hepatitis and drug-induced hepatitis were excluded by laboratory findings, as well as the clinical course of hepatitis.
Physicians at the Carolinas Medical Center physicians notified the FDA that one patient died, one required a liver transplant, and a third developed drug-induced hepatitis but later recovered, either during treatment or shortly after the patients started taking Ketek.
The most common adverse events were rash and drug fever; drug-induced hepatitis occurred in 12 patients.
First, this combination is one of the most prescribed antibiotics worldwide; second, the hepatic injury exhibited an hepatocellular pattern rather than a cholestatic one, the latter being the most common form of drug-induced hepatitis.
Drug-Induced Hepatitis - Few medications still in use and several that have been withdrawn from the market can also cause chronic hepatitic (CAH).
A small number of patients experienced asymptomatic elevations of hepatic transaminase; none of these patients developed jaundice or drug-induced hepatitis.
Elevation of this enzyme may be found in a large number of disorders as common as gallstone disease, alcohol abuse, and drug-induced hepatitis, or in less common disorders such as primary biliary cirrhosis or biliary tumors.
These types of the hepatitis are known respectively as alcoholic, toxic and drug-induced hepatitis.
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