From the Guidelines
Drugs such as carbamazepine, methyldopa, minocycline, macrolide antibiotics, nitrofurantoin, statins, sulfonamides, terbinafine, chlorpromazine, and methotrexate can cause liver failure, and their use requires careful monitoring of liver function to prevent dose-dependent liver fibrosis and other complications. When considering the potential for liver failure, it's essential to recognize that various medications can be hepatotoxic, and the risk of liver injury may be increased in patients with pre-existing liver disease, alcohol use, age, and genetic factors 1. Some key points to consider include:
- The liver metabolizes most medications, and damage typically occurs through direct toxicity or immune-mediated reactions.
- Risk factors for drug-induced liver injury include pre-existing liver disease, alcohol use, age, and genetic factors.
- Signs of drug-induced liver injury include fatigue, nausea, abdominal pain, jaundice, and dark urine.
- If medication-related liver problems are suspected, it's crucial to contact a healthcare provider immediately, but patients should not stop prescribed medications without medical advice.
- Regular liver function monitoring is vital when taking potentially hepatotoxic medications, such as methotrexate, which requires special care to prevent dose-dependent liver fibrosis, and non-invasive markers of fibrosis should be monitored 1. The most recent and highest quality study, published in 2019, suggests that patients with pre-existing liver disease, including nonalcoholic steatohepatitis (NASH), may be at higher risk for complicated courses and adverse outcomes from drug-induced liver injury (DILI), although the evidence is still limited and conflicting 1. However, statins are considered safe in patients with pre-existing abnormal liver enzymes, and their use is not typically associated with an increased risk of liver injury 1. In clinical practice, it's essential to exercise caution when prescribing potentially hepatotoxic medications, particularly in patients with pre-existing liver disease, and to carefully monitor liver function to prevent complications.
From the FDA Drug Label
ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice or hepatitis and progresses to fulminant hepatic necrosis and sometimes death. Drugs that can cause liver failure include ACE inhibitors, such as Lisinopril.
- Key points:
- ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice or hepatitis and progresses to fulminant hepatic necrosis and sometimes death.
- Patients receiving ACE inhibitors who develop jaundice or marked elevations of hepatic enzymes should discontinue the ACE inhibitor and receive appropriate medical treatment. 2 2
From the Research
Drugs that Cause Liver Failure
- Acetaminophen is a common cause of liver failure, with studies showing that it accounts for 50% of all cases of acute liver failure (ALF) in the United States 3.
- The annual percentage of acetaminophen-related ALF has been increasing, with a rise from 28% in 1998 to 51% in 2003 4.
- Other analgesics, including nonsteroidal anti-inflammatory drugs, opiates, tricyclic antidepressants, and anticonvulsants, rarely cause liver injury 5.
Risk Factors for Acetaminophen-Induced Liver Failure
- Unintentional overdoses, often due to overuse of acetaminophen-containing compounds for pain relief, account for a significant proportion of cases 4, 3.
- Concomitant depression, chronic pain, alcohol or narcotic use, and/or taking several preparations simultaneously increase the risk of acetaminophen hepatotoxicity 4.
- Women are more likely to experience acetaminophen-induced ALI or ALF, and have a higher risk of severe hepatic encephalopathy (HE) 6.