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Review article: drug hepatotoxicity.

Abstract

BACKGROUND

Drug toxicity is the leading cause of acute liver failure in the United States. Further understanding of hepatotoxicity is becoming increasingly important as more drugs come to market.

AIMS

(i) To provide an update on recent advances in our understanding of hepatotoxicity of select commonly used drug classes. (ii) To assess the safety of these medications in patients with pre-existing liver disease and in the post-liver transplant setting. (iii) To review relevant advances in toxicogenomics which contribute to the current understanding of hepatotoxic drugs.

METHODS

A Medline search was performed to identify relevant literature using search terms including 'drug toxicity, hepatotoxicity, statins, thiazolidinediones, antibiotics, antiretroviral drugs and toxicogenomics'.

RESULTS

Amoxicillin-clavulanic acid is one of the most frequently implicated causes of drug-induced liver injury worldwide. Statins rarely cause clinically significant liver injury, even in patients with underlying liver disease. Newer thiazolidinediones are not associated with the degree of liver toxicity observed with troglitazone. Careful monitoring for liver toxicity is warranted in patients who are taking antiretrovirals, especially patients who are co-infected with hepatitis B and C. Genetic polymorphisms among enzymes involved in drug metabolism and HLA types may account for some of the differences in individual susceptibility to drug hepatotoxicity.

CONCLUSIONS

Drug-induced hepatotoxicity will remain a problem that carries both clinical and regulatory significance as long as new drugs continue to enter the market. Future results from ongoing multicentre collaborative efforts may help contribute to our current understanding of hepatotoxicity associated with drugs.

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  • Authors+Show Affiliations

    ,

    The Division of Liver Diseases, Department of Internal Medicine, The Mount Sinai School of Medicine, New York, NY 10029-6574, USA. charissa.chang@mssm.edu

    Source

    Alimentary pharmacology & therapeutics 25:10 2007 May 15 pg 1135-51

    MeSH

    Anti-Bacterial Agents
    Antiviral Agents
    Chemical and Drug Induced Liver Injury
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Liver
    Liver Diseases
    Thiazolidinediones

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    17451560

    Citation

    Chang, C Y., and T D. Schiano. "Review Article: Drug Hepatotoxicity." Alimentary Pharmacology & Therapeutics, vol. 25, no. 10, 2007, pp. 1135-51.
    Chang CY, Schiano TD. Review article: drug hepatotoxicity. Aliment Pharmacol Ther. 2007;25(10):1135-51.
    Chang, C. Y., & Schiano, T. D. (2007). Review article: drug hepatotoxicity. Alimentary Pharmacology & Therapeutics, 25(10), pp. 1135-51.
    Chang CY, Schiano TD. Review Article: Drug Hepatotoxicity. Aliment Pharmacol Ther. 2007 May 15;25(10):1135-51. PubMed PMID: 17451560.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Review article: drug hepatotoxicity. AU - Chang,C Y, AU - Schiano,T D, PY - 2007/4/25/pubmed PY - 2007/8/19/medline PY - 2007/4/25/entrez SP - 1135 EP - 51 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 25 IS - 10 N2 - BACKGROUND: Drug toxicity is the leading cause of acute liver failure in the United States. Further understanding of hepatotoxicity is becoming increasingly important as more drugs come to market. AIMS: (i) To provide an update on recent advances in our understanding of hepatotoxicity of select commonly used drug classes. (ii) To assess the safety of these medications in patients with pre-existing liver disease and in the post-liver transplant setting. (iii) To review relevant advances in toxicogenomics which contribute to the current understanding of hepatotoxic drugs. METHODS: A Medline search was performed to identify relevant literature using search terms including 'drug toxicity, hepatotoxicity, statins, thiazolidinediones, antibiotics, antiretroviral drugs and toxicogenomics'. RESULTS: Amoxicillin-clavulanic acid is one of the most frequently implicated causes of drug-induced liver injury worldwide. Statins rarely cause clinically significant liver injury, even in patients with underlying liver disease. Newer thiazolidinediones are not associated with the degree of liver toxicity observed with troglitazone. Careful monitoring for liver toxicity is warranted in patients who are taking antiretrovirals, especially patients who are co-infected with hepatitis B and C. Genetic polymorphisms among enzymes involved in drug metabolism and HLA types may account for some of the differences in individual susceptibility to drug hepatotoxicity. CONCLUSIONS: Drug-induced hepatotoxicity will remain a problem that carries both clinical and regulatory significance as long as new drugs continue to enter the market. Future results from ongoing multicentre collaborative efforts may help contribute to our current understanding of hepatotoxicity associated with drugs. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/17451560/full_citation L2 - https://doi.org/10.1111/j.1365-2036.2007.03307.x DB - PRIME DP - Unbound Medicine ER -