From the FDA Drug Label
ADVERSE REACTIONS ... Hepatic Transient rise in SGOT, SGPT, and alkaline phosphatase levels has been observed. As with other cephalosporins, reports of hepatitis have been received
- Hepatotoxicity is a potential adverse reaction of Cefazolin, as evidenced by reports of hepatitis and transient rises in liver enzyme levels.
- The FDA drug label for Cefazolin indicates that hepatic dysfunction, including cholestasis, has also been reported for cephalosporin-class antibiotics, which includes Cefazolin 1.
- Therefore, Cefazolin can cause hepatotoxicity.
From the Research
Cefazolin and Hepatotoxicity
- Cefazolin, a first-generation cephalosporin antibiotic, has been associated with hepatotoxicity, although it is considered rare 2, 3.
- Studies have shown that cefazolin can cause drug-induced liver injury (DILI) with a single dose, characterized by a latency period of 1 to 3 weeks after exposure, a cholestatic biochemical pattern, and a self-limited moderate to severe clinical course 2, 3.
- The clinical features of cefazolin-induced liver injury include itching, jaundice, nausea, fever, and rash, with laboratory abnormalities such as a mixed or cholestatic pattern of serum enzyme increases 2.
- Other cephalosporins can also cause similar liver injury, but with more severe courses, including deaths from liver failure 2.
Risk Factors and Mechanisms
- The exact mechanisms of cefazolin-induced hepatotoxicity are not fully understood, but it is thought to be related to the formation of toxic metabolites or an immune-mediated response 3.
- Blast overpressure injury has been shown to alter cefazolin pharmacokinetics in mice, potentially increasing the risk of liver injury, although the clinical significance of this finding is unclear 4.
- Certain patient populations, such as those with pre-existing liver disease or taking other hepatotoxic medications, may be at increased risk of cefazolin-induced liver injury 3, 5.
Clinical Implications
- Clinicians should be aware of the potential for cefazolin to cause liver injury and monitor patients for signs of hepatotoxicity, particularly those with risk factors or taking other hepatotoxic medications 2, 3, 5.
- Prompt recognition and cessation of the culprit medication are crucial for recovering normal liver function in patients with DILI 5.
- Further research is needed to fully understand the mechanisms and risk factors for cefazolin-induced hepatotoxicity and to develop strategies for preventing and managing this adverse event 4, 3, 5.