Drugs that Cause Hepatotoxicity (Liver Disease)
Antifungal agent-related hepatotoxicity (liver disease) is in the news.
Recently, the FDA alerted healthcare providers about Nizoral (ketoconazole) oral tablets, and urged the limiting of the drug’s use, warning that it can cause severe liver injury. Did these cases of liver disease occur because of poor monitoring or poor patient selection? Could the physician or pharmacist have done more to prevent the combined consumption of alcohol or acetaminophen with this antifungal agent?
The FDA Mandated medication guide clearly states that liver problems (hepatotoxicity), can occur in those treated with oral ketoconazole. Were the medication guides never given out, discussed, read or believed? Will the warnings of serious liver disease that have even led to death or the need for a liver transplant convince physicians and pharmacists to screen patients better?
It is well known that drug-induced liver injury (DILI) is a significant possibility with the long-term use of many of the antiretroviral drugs. They are very effective and important components in of HIV therapeutic management. Unfortunately, many HIV patients are forced to discontinue some of these treatments due to side effects, including hepatic enzyme elevations.
Most pharmacists in this country are quick to counsel patients on the relevant warnings about avoiding alcohol while on the antiprotozoal agent Flagyl (metronidazole). Most pharmacists also apply a “DO NOT DRINK ALCOHOL” warnings sticker to bottles of this drug due the potential for a “disulfiram” reaction with this medication. Physicians and pharmacists should BROADEN their “avoidance of alcohol” warning and include many of the medications that show a well-known potential for hepatotoxicity.
Identification of high-risk patients is crucial to preventing this life-threatening complication. Physicians and Pharmacists must continue to monitor and question about possible co-morbid conditions such as alcoholism, hepatitis, and use of acetaminophen for pain management. Here is a list of drugs that are known to cause liver disease.
Next: List Of Drugs That Cause Liver Toxicity