Drug-Related
Liver Disease
What
is it?
Drug-related liver disease
occurs when the flow of bile from the liver is
stopped or slowed, called cholestasis, because of
the effects of certain drugs that can be toxic to
the liver.
Even though there is no bile flow, the liver continues to
process bilirubin, a bile pigment.
Because the bile is not flowing where it
should, the bilirubin builds up and passes into
the bloodstream where it causes a condition called
jaundice. Jaundice
is a yellow coloration of the skin and eyes.
Who
gets it?
People who are taking drugs
that can be toxic to the liver are at risk for
developing cholestasis.
However, most cases of drug-related
cholestasis occur in a small percentage of
patients who have a hypersensitivity to the drug
or during the first year of treatment.
What
causes it?
There are over 800 drugs that
can cause liver disease. It is seen most often
with cyclosporine, colchicine, chlorpromazine,
isoniazid, and clavulanic acid. It
occurs in approximately 1 in 100 patients taking
isoniazid and chlorpromazine, 1 in 1,000 patients
taking the drug phenytoin, 1 in 10,000 plus
patients taking the drugs sulindac and
troglitazone, and 1 in 100,000 patients taking the
drug diclofenac.
Taking acetaminophen and drinking alcohol
has also been proven to cause liver disease.
What
are the symptoms?
Jaundice and dark urine are
the main symptoms of drug-related cholestasis.
Other symptoms include severe itching,
diarrhea, pale and/or fatty stools, and poor
absorption of fat and fat-soluble vitamins.
How
is it diagnosed?
Blood tests will reveal
elevated bilirubin and alkaline phosphatase.
However, symptoms and the results of
diagnostic tests can be very similar to other
types of liver disease such as acute or chronic
hepatitis, alcoholic liver disease, and acute or
chronic cholestatic liver disease. For
this reason, physicians diagnose drug-related
cholestasis based upon the absence of any other
possible cause except a drug with potential liver
toxicity. It
is important that your doctor is aware of all
drugs that you are taking.
Each drug that can cause drug-related
cholestasis has a typical pattern of injury to the
liver.
What
is the treatment?
Your doctor will stop the
drug that caused the symptoms and may give you
something to stop the itching.
If the drug that caused the cholestasis is
absolutely necessary, your doctor may try
reintroducing the drug at smaller doses.
However, there is no medical treatment to
reverse the cholestasis.
Most patients recover, but severe cases may
lead to liver failure and require a liver
transplant. If
the condition was caused by acetaminophen, a drug
called N-acetylcysteine can prevent significant
liver damage if given with the first 10 hours, but
can be given as late as up to 48 hours after the
onset of symptoms.
Self-care
tips
If you are taking a drug that
has the potential to cause drug-related
cholestasis, call your healthcare provider if you
notice that your skin or eyes are yellow or you
experience severe itching.
Early detection is key to preventing severe liver damage.
Your doctor should carefully monitor your
treatment if you are taking a drug that can cause
cholestasis.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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