From the Guidelines
Yes, Trimethoprim/Sulfamethoxazole (Bactrim) can cause hepatotoxicity.
Hepatotoxicity Risk
- The British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease list liver parenchymal damage as a contraindication for the use of Trimethoprim/Sulfamethoxazole 1.
- Although the frequency of hepatotoxicity is lower compared to other medications, Trimethoprim/Sulfamethoxazole can still cause severe and prolonged liver injury 1.
- Patients with underlying liver disease should be closely monitored with laboratory and clinical tests if Trimethoprim/Sulfamethoxazole is used 1.
- The risk of hepatotoxicity is a significant concern, and hypersensitivity to sulfonamides is also a contraindication for the use of Trimethoprim/Sulfamethoxazole 1.
From the FDA Drug Label
Adverse Reactions ... Gastrointestinal: Hepatitis (including cholestatic jaundice and hepatic necrosis), elevation of serum transaminase and bilirubin, pseudomembranous enterocolitis, pancreatitis, stomatitis, glossitis, nausea, emesis, abdominal pain, diarrhea, anorexia Fatalities and serious adverse reactions, including ... fulminant hepatic necrosis
Hepatotoxicity is a potential adverse reaction associated with the use of Trimethoprim/Sulfamethoxazole (Bactrim), including hepatitis, cholestatic jaundice, hepatic necrosis, and fulminant hepatic necrosis 2.
From the Research
Hepatotoxicity Associated with Trimethoprim/Sulfamethoxazole
- Trimethoprim/Sulfamethoxazole (Bactrim) has been reported to cause hepatotoxicity in various studies 3, 4, 5, 6, 7
- The mechanism of hepatotoxicity is not fully understood, but it is thought to be related to the sulfamethoxazole component of the drug 5
- Cases of fatal hepatotoxicity have been reported, even with small doses of the drug 3
- Hepatotoxicity can occur in both adults and children, although the risk in pediatrics is not well established 6
- Symptoms of hepatotoxicity can include jaundice, liver failure, and elevated liver enzymes 4, 7
- Diagnosis is typically made through a combination of clinical presentation, laboratory tests, and exclusion of other causes of liver injury 4, 7
- Treatment typically involves withdrawal of the drug and supportive care, with most patients making a full recovery 7
Risk Factors and Incidence
- The incidence of hepatotoxicity associated with Trimethoprim/Sulfamethoxazole is considered rare 5, 7
- Certain populations, such as those with pre-existing liver disease or renal transplantation, may be at increased risk 4
- The risk of hepatotoxicity in children is not well established, but case reports suggest it can occur 6
Clinical Presentation and Diagnosis
- Clinical presentation can vary, but typically includes symptoms such as jaundice, fatigue, and abdominal pain 4, 7
- Laboratory tests, such as liver enzymes and bilirubin, can be used to diagnose hepatotoxicity 4, 7
- A thorough medical history and physical examination are also important in diagnosing hepatotoxicity 4, 7