Drug-related hepatitis, which is liver damage caused by drugs or their metabolites, is a non-viral hepatitis. Drug-related liver damage is a common cause of liver function abnormalities, but it is not contagious and usually heals quickly with drug withdrawal, rest and liver-protective treatment.
The various drugs we take are generally absorbed from the intestine and then reach the liver via the portal vein. The liver is the main organ of drug concentration, transformation and metabolism, especially oral drugs are absorbed from the gastrointestinal tract and enter the liver, and the concentration in the liver is higher than that in the blood and other organs. Due to the toxic effects of drugs and metabolites or allergic reactions of the body to drugs, damage to the liver is caused by drug-related hepatitis.
Theoretically, any drug can cause drug-related hepatitis. According to a large amount of domestic and foreign information has been found that about 600 kinds of commonly used drugs have hepatotoxic side effects in varying degrees. Including.
①Metallic drugs: antimony, mercury, arsenic, etc.
②Anesthetic sedative drugs: ether, chloroform, morphine, dormant, barbiturate sleeping drugs; phenytoin sodium and other anti-epileptic drugs.
③Antipyretic and analgesic drugs: Pau d’Arco, compound aspirin, paracetamol and anti-inflammatory pain, etc.
④Antibacterial drugs: sulfonamides, furans, tetracyclines, chloramphenicol, erythromycin, ampicillin, vincristine, etc.
⑤Anti-tuberculosis drugs: isoniazid, sodium para-aminosalicylate, rifampin, etc.
(6) Diuretics: dihydrocoumarol, diuretic acid, etc.
⑦Anti-tumor drugs: mitomycin, rehabilitated tomycin, cyclophosphamide, etc.
(8) Commonly used drugs in endocrinology: hypoglycemic drugs such as euglycemia, metformin and bactrim; antithyroid drugs such as tabazol, hyperthyroidism and propylthioxypyrimethamine.
⑨ Cardiovascular drugs: Isoptin, etc.
⑩Chinese medicine and proprietary Chinese medicine: Qing Dai, Chuan Guo Zi, Shan Dou Root, Shan Ci Gu, Lei Gong Vine, Cang Er Zi, He Shou Wu, Jin Bu Xie, Strong Bone and Joint Pills, Ke Yin Wan, Compound Qing Dai Wan, Nucleation Tablets, Hua Tuo Zai Zai Wan, Da Wu Luo Dan, Noma San, etc.
The type of drug is an important aspect in determining whether it can cause drug-related hepatitis, but not everyone taking the above drugs will develop drug-related hepatitis, which also involves other factors affecting drug hepatotoxicity.
①Dose of the drug: Generally, the higher the applied dose of a drug with direct toxicity to liver cells, the more serious the liver damage.
② Time of application: Some drugs cause liver damage related to the time of administration, such as taking furantoin often in the use of more than 6 months of chronic liver damage; and isoniazid in the use of more than 3 months can develop; taking methyldopa, 1 to 4 weeks that may cause chronic active hepatitis.
③ Age of the patient. Generally, elderly people are prone to drug hepatotoxicity, mainly because of the reduced activity of microsomal enzyme system in liver cells and the reduced metabolism ability of certain drugs. The elderly often use a variety of drugs in combination, and the drugs interfere with each other. The glomerular filtration of the elderly is reduced, some drugs excreted by the kidneys, due to reduced excretion, resulting in increased blood concentration, may appear compensatory bile excretion increased. There are also a number of currently unknown factors that make the elderly more susceptible to drug-related liver injury.
④Gender: drug-related liver damage caused by specific metabolic reactions is mostly seen in women.
⑤ Nutritional status. Nutritional deficiencies, especially protein deficiencies, can reduce the hepatic protective effect of glutathione and other factors, increasing the susceptibility of the body to drug hepatotoxicity.
(6) Pre-existing disease of the liver. For example, the metabolism of many drugs is reduced in patients with cirrhosis, so that the drugs tend to accumulate in the liver and cause liver damage. Patients with liver disease with severe impairment of liver function are often particularly sensitive to general doses of analgesics (such as morphine drugs) and may even induce hepatic encephalopathy.
The specific manifestations of drug-related hepatitis are roughly the same as those of other hepatitis, which can manifest as acute hepatitis or even acute (subacute) liver failure, chronic hepatitis, liver fibrosis, and cirrhosis depending on the severity and duration of the disease. The most dangerous is acute liver failure, where the liver cells suddenly die in large numbers and the rate of liver repair cannot catch up with the rate of destruction, so the condition takes a sharp turn and the patient may die in a short time.
①Acute hepatitis: It can be further divided into three specific categories as follows.
Hepatitis type: mainly liver cell damage, manifested by fatigue, loss of appetite, nausea and vomiting, yellow urine, discomfort in the liver area, liver enlargement with pressure pain, elevated transaminases, and elevated eosinophils in the blood picture.
Cholestasis type: There is mainly bile stasis, manifested as bile stasis in small intrahepatic bile ducts with hepatocellular damage, manifested as yellow staining of skin, sclera and urine, itching of skin, light color of stool, etc.
Mixed type: both of the above two types.
② Chronic hepatitis.
Chronic diseases with long-term medication such as hypertension, tuberculosis, chronic urinary tract infection in patients taking methyldopa, isoniazid, furantoin, etc. can often cause drug-related chronic active hepatitis. The clinical manifestations and pathological features are similar to those of chronic active hepatitis caused by other causes, mostly with slow onset, symptoms like chronic viral hepatitis, and some with extrahepatic manifestations, which are often not easily distinguishable from each other. Therefore, patients with chronic disease who are on long-term medication should have their liver function checked regularly.
If it is clear that the cause of abnormal liver function is due to the toxic side effects of the medication, then treatment is targeted and often more effective than for viral hepatitis. The most important thing is to discontinue and prevent the re-giving of drugs that cause liver injury, drugs belonging to the same biochemical family, especially those that have interactions due to induction or inhibition of drug metabolizing enzymes, such as CYP450 inhibitors cimetidine, ketoconazole and inducers rifampin, barbiturates, phenytoin, dexamethasone, omeprazole, etc. should be used with caution. Dosing should be controlled in patients with malnutrition and reduced detoxification capacity for drugs and in patients with alcoholism.
Drugs used in the treatment of drug-related liver disease are antioxidants, precursors of protective substances (e.g. glutathione), intervening agents that block the process of injury occurrence or repair agents of membrane damage (e.g. ezetimibe). N-acetylcysteine is particularly effective in patients with paracetamol overdose, detoxifying reactive metabolites that have developed, and maximum protective effect is obtained when administered within 10 hours. In severe cases leading to liver failure, severe cholestasis and chronic liver injury progressing to cirrhosis, artificial liver support and liver transplantation may be considered.
The combination of prevention and treatment is fundamental. The first and foremost point to prevent drug-related hepatitis is to maintain a high degree of alertness to drug-related hepatitis and to avoid random use and overdose of drugs. If there are symptoms such as fever, poor appetite, malaise, itchy skin, jaundice, rash, etc., and there was a history of taking medication 1 to 4 weeks before, everyone should think about the possibility of drug-related liver damage. The following 10 points are available for your reference.
①See a hepatologist as soon as possible.
② Stop unnecessary medication immediately. Unnecessary medication” means medication that is not prescribed by your physician, but rather medication that you have purchased or recommended by others.
③Check the name of the medication you are taking and double-check that you are taking the correct dosage.
④If you have chronic hepatitis B or chronic hepatitis C, no matter which disease you go to the hospital for, please inform the physician before he prescribes the medication to try to avoid aggravating liver damage by taking the medication.
Do not think that these medicines are “mild” and will not have hepatotoxicity. As long as it is a medicine, it may produce hepatotoxicity. Those prescriptions that claim to “protect the liver” or “strengthen the liver” can in fact be hepatotoxic, so please be careful.
(6) Make a habit of keeping detailed records of your medications (including herbs and supplements). Detailed medication records can help your doctor determine if liver disease is related to medication.
(7) Some medications are not very hepatotoxic when taken alone, but may enhance hepatotoxicity when taken in combination. Therefore, at each visit, please give the physician a detailed description of the medications you are currently taking (including Chinese, herbal and complementary medicines).
(8) Please abstain from alcohol. Alcohol can enhance the hepatotoxicity of drugs.
⑨Please have your blood drawn to check whether you have viral hepatitis (e.g. hepatitis B, hepatitis C) in order to rule out that the liver disease is caused by the hepatitis virus.
⑩Liver puncture may be helpful in the diagnosis of drug-related liver disease. If your hepatobiliary specialist recommends a liver puncture, do not refuse.
Most cases of drug-induced hepatitis have no obvious symptoms and patients continue to take medications without realizing it, which can easily delay the disease. The best way to prevent it is to use less medication, be careful with medication (including Chinese, herbal, and complementary medications), use medications that you have used before, and don’t just buy and take your own medications.