However, the incidence of drug hepatotoxicity is estimated at 10-15 cases per 10,000-100,000 people who receive drugs.
It is worth noting that only 40% of patients with drug-induced toxic hepatitis report to physicians that they are receiving “alternative therapies”, either alone or in combination with conventional therapy.
What substances can cause liver damage?
To date, more than 1,000 medicines, herbal products and dietary supplements have been found guilty. Typical examples are paracetamol, non-steroidal anti-inflammatory drugs and some antibiotics. It is worth noting, however, that the higher incidence of toxic hepatitis than these drugs is due to their frequent use. People with low body weight, who consume excessive amounts of alcohol and women, are more vulnerable to the appearance of drug hepatotoxicity, while in children the phenomenon is rare.
The mechanisms of drug hepatotoxicity are twofold, immediate and temperamental. The first concerns the direct toxicity of the drug which depends on the dose (eg paracetamol) and the duration of administration and the second is immunological or metabolic and is not related to either the dose or the duration of treatment.
When does it appear?
Usually 2-4 weeks after starting treatment, however it can occur within the first hours or days after the first dose or even weeks after stopping the medication, especially when the substance accumulates in the body and is eliminated slowly.
What are the symptoms?
Many patients have no clinical symptoms and hepatotoxicity is only detected on blood tests. Fatigue, anorexia and heaviness in the right upper abdomen are the most common manifestations, while jaundice, nausea, vomiting rarely occur in severe cases. There are also extremely rare cases of severe toxic hepatitis where the liver damage progresses rapidly, manifests itself with hepatic encephalopathy and requires a liver transplant.
How is hepatitis of medical origin diagnosed?
First, patients report only the use of prescription drugs, but not dietary supplements or herbs, because they consider them safe. Sometimes they even increase their dose, believing that they will help the liver to recover.
A second reason for the difficulty of diagnosis is the absence of specific indicators of drug hepatotoxicity. The doctor must rule out other acute or chronic liver diseases, so that the liver biochemistry disorder is attributed to side effects of the drug.
The third reason is the lack of prospective epidemiological and clinical studies.
Hematological examination and ultrasound are performed to determine the damage to the liver. Purpose of the investigation – to exclude other causes of liver biochemistry disorders such as infectious, autoimmune, hereditary or vascular diseases of the liver and bile ducts. In some cases, a liver biopsy may be needed.
How is toxic hepatitis treated?
For some substances there are antidotes, which prevent absorption from the intestine, deactivate harmful components and protect the liver. In most cases, recovery is complete only by stopping the drug and measures such as avoiding the use of alcohol and other substances with a possible toxic effect on the liver. There is no “hepatoprotective” supplement or herbal product with scientifically proven therapeutic action.
Recovery time is usually a few days to weeks, or even months. In rare cases, drug-induced hepatitis leads to the development of a chronic disease, liver tumor or acute, life-threatening liver failure.
Prevention measures
• Take medication only with the consent or advice of a doctor.
• Never take more than the recommended dose of medication. Pay special attention to supplements, so as to avoid taking many of the same substances at the same time and not to exceed the safe dosage.
• Avoid alcohol abuse.
• If you are taking medicines with a potentially toxic effect on the liver, have regular liver function tests.
Writes:
Elena Vezali Hepatologist Associate of the Hepatology Department HYGEIA
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