Drug-induced hepatitis

Toxic hepatitis

The liver helps the body break down certain drugs. However, the way it does so differs from person to person. Therefore, many different drugs can cause drug-induced hepatitis.

Painkillers and fever reducers that contain acetaminophen are a common cause of liver inflammation. These medications can damage the liver when taken in doses that are not much greater than the recommended therapeutic dose.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may also cause drug-induced hepatitis.

Other drugs that can lead to liver inflammation include:

• Amiodarone
• Anabolic steroids
• Birth control pills
• Chlorpromazine
• Erythromycin
• Halothane
• Methyldopa
• Isoniazid (used to treat tuberculosis)
• Methotrexate
• Statins

• Abdominal pain
• Dark urine
• Diarrhea
• Headache
• Jaundice
• Fatigue
• Loss of appetite
• Nausea and vomiting
• White or clay-colored stools

Blood tests will be done to check liver function. Liver enzymes may be increased.

A physical exam may reveal an enlarged liver and abdominal tenderness in the right upper part of the belly area.

There is no specific treatment for drug-induced hepatitis other than stopping the drug that is causing the problem.

You should rest during the acute phase of the disease, when the symptoms are most severe. If you have significant nausea and vomiting, fluids given through a vein may be needed.

Those with acute hepatitis should avoid physical exertion, alcohol, acetaminophen, and any other substances that are harmful to the liver.

Usually, drug-related hepatitis goes away within days or weeks after the offending drug is stopped.

Liver failure is a possible but rare complication of drug-induced hepatitis.

Call your health care provider if symptoms of hepatitis develop after you start a new medication.

Call your health care provider if you have been diagnosed with drug-induced hepatitis and symptoms do not improve after the offending medication is stopped. Also call if any new symptoms develop.

If you use over-the-counter medications containing acetaminophen (Tylenol), never use more than the recommended dose. If you drink heavily or regularly, you should completely avoid these medications or discuss safe doses with your physician.

If you have liver disease, it is extremely important to tell your doctor about all the medicines you take. You should avoid the following medications if you have liver disease:

• 6 - Mercaptopurine
• Acetaminophen
• Alcohol
• Allopurinol
• Androgens
• Birth control pills
• Carbamazepine
• Chlorpromazine
• Halothane
• Hydralazine
• Isoniazid
• Methotrexate
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
• Phenytoin
• Valproic acid

This list is not all-inclusive.

Your health care provider can recommend safe medications, including over-the-counter medications, for other medical conditions you may have.

Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.