Drug-induced hepatitis

– reactive inflammatory lesion liver caused by taking hepatotoxic medications. Signs drug-induced hepatitis may cause nausea, vomiting, decreased appetite, constipation or diarrhea, jaundice, dark urine and lightened stool. Diagnosis of drug-induced hepatitis is made on the basis of anamnesis, determination of the level of liver tests, and ultrasound of the liver. Treatment of drug-induced hepatitis requires discontinuation of the pharmaceutical drug that caused liver damage, detoxification therapy, and the prescription of gapatoprotectors.

General information

Drug-induced (drug-induced) hepatitis is damage to liver tissue as a result of toxic damage to hepatocytes by metabolites medicinal substances, with the development of reactive inflammation and necrosis of liver cells. Drug-induced hepatitis complicates ongoing pharmacotherapy in 1-28% of cases and in 12-25% of cases leads to the development of liver cirrhosis and liver failure. Women suffer from drug-induced hepatitis 2-3 times more often than men. A special branch of gastroenterology – hepatology – deals with the study and treatment of drug-induced hepatitis.

Causes

The most important function of the liver in the body is to neutralize and render harmless toxic substances entering it through the bloodstream. Metabolism and utilization of chemical and biological toxins occurs under the influence of the enzymatic neutralizing system of hepatocytes, with subsequent excretion harmful products from the body. The process of utilization of toxic substances occurs in the liver in several stages, during which metabolites are formed - intermediate products of biotransformation. Metabolites of some drugs are even more hepatotoxic than the pharmaceutical drugs themselves. Long-term use of such medications or their high dosage leads to depletion of neutralizing enzymatic systems and damage to hepatocytes, resulting in the development of drug-induced hepatitis.

Today, more than a thousand types of medications are known that lead to the development of drug-induced hepatitis. The toxicity of drugs increases when 2-3 drugs are taken in combination, and when 6 or more drugs are taken simultaneously, the likelihood of toxic liver damage increases to 80%. The rate of development of drug-induced hepatitis while taking medications varies from several days to several years.

Risk factors for the development of drug-induced hepatitis include genetically determined increased sensitivity to any medicine; the presence at the time of taking the drug of chronic hepatitis, viral hepatitis, autoimmune hepatitis, ascites; drinking alcohol or toxic effects solvents, poisonous gases on the background drug therapy; pregnancy; protein deficiency in the diet; stress; renal failure, heart failure, etc.

The main groups of drugs that cause drug-induced hepatitis include:

• Drugs for the treatment of tuberculosis (rifampicin, isoniazid)
• Antibiotics: tetracyclines (tetracycline, chlortetracycline, dixycycline), penicillins (benzylpenicillin, amoxicillin, etc.), macrolides (erythromycin)
• Sulfonamides (sulfamethoxazole + trimethoprim, sulfadimethoxine, etc.)
• Hormones (steroid hormones, oral contraceptives and etc.)
• NSAIDs (diclofenac, ibuprofen)
• Anticonvulsants and antiepileptic drugs (phenytoin, carbamazepine, clonazepam, etc.)
• Antifungal drugs (amphotericin B, ketoconazole, fluorocytosine)
• Diuretics (hydrochlorothiazide, furosemide, etc.)
• Cytostatics (methotrexate)
• Drugs for the treatment of arrhythmia, diabetes mellitus, peptic ulcer and many more etc.

The list of drugs that have hepatotoxic effects is far from exhausted by the medications mentioned above. Drug-induced hepatitis can be caused by almost any drug and especially by a combination of several drugs.

Symptoms of drug-induced hepatitis

Drug-induced hepatitis can occur in acute or chronic form. Acute drug-induced hepatitis, in turn, is divided into cholestatic, cytolytic (occurring with necrosis and fatty hepatosis) and mixed.

The symptoms of drug-induced hepatitis are similar to those of other types of hepatitis. The dominant ones in the clinical picture are dyspeptic disorders: loss of appetite, nausea, bitter belching, vomiting, diarrhea or constipation, weight loss. Main clinical manifestations may be preceded by a prodromal period occurring with asthenic or allergic syndrome. With drug-induced hepatitis, moderate pain, heaviness, and discomfort in the right hypochondrium are disturbing; Palpation reveals hepatomegaly and liver tenderness. Sometimes jaundice develops against the background of drug-induced hepatitis, itchy skin, fever, lightening of stool and darkening of urine.

In some cases, drug-induced hepatitis can be detected only on the basis of changes in biochemical blood parameters. Acute drug-induced hepatitis, which occurs with the formation of submassive necrosis, quite quickly leads to cirrhosis of the liver. With massive liver necrosis, liver failure develops.

Diagnostics

In the process of diagnosing drug-induced hepatitis, it is important to exclude viral hepatitis, cholelithiasis, liver tumors, and pancreatic cancer. When collecting anamnesis, it is important to find out the cause-and-effect relationship of liver damage with taking hepatotoxic drugs.

If drug-induced hepatitis is suspected, biochemical liver tests are examined, in which the activity of transaminases (AST, ALT) and alkaline phosphatase, bilirubin level, globulin fractions. A coagulogram, general urine and blood analysis, and coprogram are examined.

Ultrasound of organs abdominal cavity allows you to detect diffuse enlargement of the liver, but does not allow you to judge the cause of hepatitis.

Treatment of drug-induced hepatitis

The first step in the treatment of drug-induced hepatitis is to stop the drug suspected of causing liver damage and replace it with a more effective one. safe analogue. The patient is strictly prohibited from changing medications on his own. In order to remove toxic metabolites from the body, detoxification is carried out infusion therapy, plasmapheresis, in severe cases- hemodialysis.

Recovery damaged cells the liver is prescribed hepatoprotective drugs (essential phospholipids, ademetionine, methionine). When prescribing medications with known hepatotoxic potential, preventive use of hepatoprotectors is recommended, which helps prevent the development of drug-induced hepatitis.

Prognosis and prevention

In severe cases, with fulminant development of drug-induced hepatitis or massive necrosis of the liver parenchyma, cirrhosis develops, liver failure, sometimes - hepatic coma and death. With timely withdrawal of a hepatotoxic drug in most cases, full recovery.

Prevention of drug-induced hepatitis involves the rational use of medications, monitoring side effects, taking medications only as prescribed by a doctor, excluding additional toxic effects. Against the background of a long drug therapy It is recommended to prescribe hepatoprotectors. Patients who are forced long time taking medications, it is necessary to periodically examine the level of transaminases in order to identify drug-induced hepatitis at an early stage.

Acute hepatitis A is a liver disease that occurs as a result of human infection with the virus of the same name. During the course of this disease, an inflammatory process occurs in the liver of the infected person, which affects the condition of his entire body.

This article will address issues such as:

• Causes of hepatitis A infection.
• Symptoms and treatment of hepatitis A.
• Vaccination for hepatitis A.
• Incubation period of this disease.
• Drug-induced hepatitis (symptoms and treatment).
• Toxic hepatitis.
• treatment).
• Prognosis of hepatitis disease.

Causes of hepatitis A infection

Infection can occur due to violations of basic hygiene rules. Drinking dirty water, unwashed vegetables and fruits can lead to infection with this disease. It is also necessary to be careful when in direct contact with a sick person, since hepatitis A is transmitted through household contact.

The virus can survive on the hands of an infected person for several hours. It also lasts for a long time on leftover food. If there is a person with hepatitis A in your home, the use of shared utensils is prohibited, as this can lead to infection of all family members.

The route of infection for this disease is fecal-oral, therefore, during homosexual (bisexual) contacts in men, such a route of transmission as sexual is possible. Hepatitis A is not transmitted through heterosexual contact.

when infected with hepatitis A

The incubation period of this disease lasts on average for a month. At this time, the virus multiplies in the blood of a sick person, reaching the target organ (liver), as a result of which damage to its cells and tissues begins.

Clinical manifestations of hepatitis A begin only after dysfunction of the body occurs due to insufficient functioning of the affected organ.

Duration incubation period varies from 10 to 50 days and depends on several factors:

• From virulence, as well as from the nature of the causative virus.
• From the amount of virus entering human body.
• On the state of immunity and/or compensatory properties of the patient’s systems.
• Depending on the method of infection (with blood transfusion, the incubation period is shortened).

Symptoms and treatment of hepatitis A

One of the first symptoms of hepatitis A is signs of inflammatory processes in the liver of the sick person. As a result, at first the following are observed:

1. Increased body temperature (period from 4 to 10 days).
2. Weakness and malaise.
3. Muscle pain.
4. Nausea and vomiting.
5. Loss of appetite.

The next stage of the disease, which occurs a few days after the first signs appear, is characterized by the following symptoms:

1. Darkening of urine.
2. Lightening of stool.
3. Yellowness of the skin and sclera of the eye.

In some cases, the disease is asymptomatic, most often in children. Hepatitis A is not a serious disease and often goes away on its own. To alleviate symptoms, the doctor can prescribe the necessary therapy aimed at relieving intoxication and improving the patient’s well-being. Vitamins may also be prescribed to increase the body's resistance to infection.

To cleanse the blood of toxins and are prescribed intravenous drips with glucose or saline. In addition, for this disease, it is recommended to take hepatoprotectors aimed at maintaining liver cells and quickly restoring its vital functions.

The symptoms and treatment of hepatitis A are similar to those of other types of viral hepatitis. However, it should be noted that this variety Among others, the disease is the most “harmless” and can be easily treated.

Diagnosis of hepatitis A

Early diagnosis of hepatitis A is impossible due to the lack of bright severe symptoms. For staging correct diagnosis It is necessary to clarify the patient’s epidemiological history by interviewing the patient.

During the examination, the doctor identifies signs of the disease and compares them with the results of biochemical and general blood tests. The patient's stool and urine samples are also assessed.

A blood test for hepatitis A contains information about the condition of the liver and the degree of its damage. The final confirmation of the disease is the presence of antibodies to this virus.

Forecasts

As noted earlier, the symptoms and treatment of hepatitis A are similar to other types of viral hepatitis. Despite the fact that this disease is less life-threatening than all others, it is extremely in rare cases Acute liver failure may develop, resulting in coma and death. In addition, damage to the biliary tract may occur, which is a complication of the disease. But such serious A's are extremely rare.

In most cases, the prognosis for this disease is favorable. Subject to medical recommendations the disease rarely causes complications. Liver hepatitis in in this case passes without causing serious consequences for the body. After recovery, the function of the organ is completely restored, even with severe course diseases.

Also, this type of viral hepatitis does not develop into a chronic, sluggish form. When cured, a person who has recovered from the disease receives lifelong immunity to hepatitis A.

What should family members do if they come into contact with a sick person?

Hepatitis A virus is transmitted by the fecal-oral route. All family members, as well as sexual partners of the sick person, should contact their local clinic. In this situation, doctors recommend quarantine for all the patient’s relatives. After recovery, it is necessary to disinfect the sick person’s personal belongings and those items that he used.

For prophylaxis, it is possible to administer an injection of immunoglobulin at a dose of 0.02 ml/kg body weight. If there was only one contact with the patient, drug prophylaxis is not carried out.

To avoid infection with hepatitis A, it is enough to follow the basic rules, using individual cutlery and personal hygiene items. It is necessary to regularly and thoroughly wash your hands with disinfectants.

Vaccination against hepatitis A

The hepatitis A vaccine is given intramuscularly by giving an injection containing the dead virus. In risk groups, mandatory vaccination is required, which guarantees almost 100% protection against this disease for up to 20 years. Vaccination is also effective during outbreaks of a viral disease.

Side effects during vaccination are relatively rare. The most common complaints are painful sensations and redness at the injection site, as well as headache.

Mandatory vaccination against hepatitis A is indicated for the following list of citizens:

• Persons traveling to endemic areas.
• Workers of water supply and sewerage services, as well as sanitation workers.
• Military personnel.
• Injecting drug addicts.
• Staff of any child care institutions.
• Patients with chronic (including viral) liver diseases.
• Homosexuals and/or men with bisexual orientation.
• Patients receiving blood clotting factor medications.
• For employees of enterprises Catering and food stores in endemic areas.

Contraindications for vaccination are:

• Acute ARVI.
• Exacerbation of any chronic diseases.
• Allergy to vaccine components.

Drug-induced hepatitis: symptoms and treatment

This may occur when taking certain medications. common disease, like drug-induced hepatitis. It is diagnosed using a biochemical blood test.

Many drugs, when entering the human body, are eliminated with the help of the liver, which takes on the entire burden of removing toxic substances from medications. At the same time, it is often medicines cause such a devastating blow to the organ that symptoms resembling

Many substances contained in the medicine have contraindications, in which their use is undesirable for persons with any liver dysfunction. If it is necessary to take two or more drugs, the risk of organ damage increases.

Symptoms of drug-induced hepatitis

Drug-induced hepatitis of the liver is accompanied by the same symptoms as any other type of disease: loss of appetite, nausea and vomiting, bitter belching, digestive problems, a feeling of heaviness and pain in the right hypochondrium, jaundice, darkening of urine and lightening of stool. It is impossible to make a diagnosis on your own, so if these signs appear, you should immediately consult a doctor.

Treatment of drug-induced hepatitis

Drug-induced hepatitis in the absence of timely medical care could go like this serious disease like cirrhosis. Treatment should be prescribed by a specialist after laboratory diagnosis. Therapy is based on the following principles:

• Cancellation (replacement) of the drug that caused liver disease.
• - the fastest possible removal from the patient’s blood of residual substances that damage the liver.
• Taking hepatoprotectors - drugs aimed at rapid restoration of liver cells (Essentiale Forte, Heptral, etc.).

Toxic hepatitis

As a result of various toxic substances entering the human body, a serious disease such as toxic hepatitis can develop. The symptoms and treatment of this disease are similar to the signs and therapy of the drug type.

Toxic substances, poisoning human blood, provoke the destruction and death of liver cells, which entails consequences varying degrees gravity. The condition of the liver is affected by industrial poisons such as:

• arsenic;
• pesticides;
• phosphorus;
• phenols;
• aldehydes and others.

Also a detrimental effect on vital important organ produced by excessive and chronic consumption of alcohol and certain herbal medicines (ragwort, mustard, and poisons of some mushrooms).

Chronic hepatitis

A group of liver diseases resulting from various factors, are called chronic hepatitis. This disease is characterized by a protracted inflammatory process in the liver tissue, lasting at least six months.

Chronic gapetitis in most cases is provoked by pathogen viruses of types B, C, D. The following types of this disease are also common:

• Autoimmune hepatitis.
• Drug-induced hepatitis.
• Alcoholic liver damage.

With a disease such as chronic hepatitis, symptoms and treatment are similar to those already described. The main difference in the treatment of various viral hepatitis is that, in addition to taking hepatoprotectors, expensive and potent drugs are prescribed antiviral drugs(Ribavirin, PegIntron, etc.).

Conclusion

"Hepatitis" means "liver" in Latin. That's what it's called in medicine whole line diseases, causing inflammation and/or damage to liver tissue or cells. The etiology of this disease is different, however, there are a number of similar signs that unite its various types. One of the main signs is symptoms that indicate a violation normal operation liver.

The most common disease nowadays is viral hepatitis. New method Treatment of such a disease consists in the development and use of modern experimental drugs. There are types of viral hepatitis (for example, hepatitis C) that cannot be treated complete cure Therefore, scientists working in medical research institutes are striving to develop innovative means aimed at curing these diseases.

For prevention various types hepatitis, you should not only monitor the state of your own diet, but also pay close attention to personal hygiene. In addition, violations of the integrity of the skin should not be taken lightly, as in some cases this can lead to infection with viruses.

• Drug-induced hepatitis: causes
• Incubation period of drug-induced hepatitis
• How does drug-induced hepatitis manifest?
• Drug-induced hepatitis: symptoms and treatment

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Drug-induced hepatitis is a liver disease that occurs as a result of taking medications. The disease occurs quite often.

Intoxication of the body can occur even after harmless analgesics. There is a group of drugs that, when taken for more than 7 days, can provoke drug-induced hepatitis (non-infectious). The cause of the disease often lies in the people themselves: by conducting self-treatment and when prescribing medications to themselves, they are unaware that the disease is already progressing in the body.

Drug-induced hepatitis: causes

The liver is the best filter created by nature. One of its functions is to filter and neutralize toxins that enter the blood. Many medications contain toxic substances. In small doses they are harmless, because the liver will quickly remove them from the body with the help of enzymes that enter into chemical reactions with toxins and convert them into metabolites. But with long-term uncontrolled use of drugs for treatment, enzymes cannot cope with a large number of metabolites, which subsequently cannot be restored. Important role plays a role in human tolerance to medications.

The causes of drug-induced hepatitis can be divided into several groups:

• hereditary factor;
• liver condition at the time of taking medications;
• taking incorrectly combined medications.

Very often, the cause of the development of drug-induced hepatitis is a hereditary factor. The risk group is people who already had liver disease in their family, in particular hepatitis, and they were treated.

Before taking medications, it is necessary to examine the liver and make sure that the drugs will not be harmful to it, so as not to carry out treatment in the future. Various inflammatory processes and liver enlargement in combination with the medications used can cause hepatitis.

Very often, drug-induced hepatitis occurs in people who limit themselves to protein foods. Protein is one of the main components of the liver, which breaks down and removes toxins. Therefore, people who do not eat meat (vegetarians), raw foodists or girls who are watching their figures should think carefully about whether this will really bring health.

Taking several medications plays an important role: if the combination is incorrect, a disease can occur, which is why doctors always advise that you should never self-medicate.

In principle, any medication can cause illness. It all depends on the individual properties of the body, its condition, tolerance. The dosage of medications, the duration of their use and the number of medications taken play an important role. Among the medications that can provoke drug-induced hepatitis are:

• medicines for the treatment of tuberculosis;
• tetracyclines;
• hormonal agents;
• drugs for the treatment of peptic ulcers, diabetes mellitus;
• medications for the treatment of seizures, epilepsy;
• anticancer agents;
• diuretics.

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Incubation period of drug-induced hepatitis

As such, there is no incubation period for drug-induced hepatitis. Sometimes the disease can occur as a result of many years of long-term medication use, and in some cases it can develop 2-3 hours after taking the medication. The most severe type of drug-induced hepatitis is the development of massive necrosis. Its consequences are liver cirrhosis and liver failure.

Some people develop a chronic form of the disease that is difficult to treat. These are mainly people who are forced to take medications constantly throughout their lives, for example, for diseases such as tuberculosis, epilepsy, and diabetes.

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How does drug-induced hepatitis manifest?

The symptoms and signs are very similar to any type of hepatitis: a person’s appetite decreases, he experiences nausea, often accompanied by vomiting, and there is an upset bowel movement, which causes weight loss. Urine becomes dark, feces become light, but some of the main signs of drug-induced hepatitis are a bitter taste in the mouth, pain in the liver ( right hypochondrium), enlargement of the liver, which causes a feeling of heaviness. An important symptom is the appearance of jaundice. Skin, mucous membrane of the eyes and oral cavity acquire a yellowish tint. At severe forms and massive necrosis, the color becomes deep yellow.

It is impossible to independently determine what kind of hepatitis a person has; this can only be done in inpatient conditions, because the symptoms of all types of hepatitis are almost the same.

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Drug-induced hepatitis: symptoms and treatment

If hepatitis is suspected, doctors prescribe general analysis blood and urine, blood clotting tests (coagulogram) and liver ultrasound are performed, and blood biochemistry is also performed, which helps to identify the level of liver enzymes (transaminases) - they will indicate the degree of damage to liver cells. Elevated enzyme levels are early sign disease, and it is not even necessary to have any symptoms. Therefore, doctors recommend that people who are forced to take regular medications undergo liver examinations every 4-5 months so as not to be subject to constant treatment.

The basic principle of treatment for drug-induced hepatitis is the abolition of the drug that provoked the disease. In hospital settings, after discontinuation of the drug, doctors monitor the condition of the liver. If it improves, they may prescribe a second dose of this medication; if the liver reacts negatively, doctors diagnose drug-induced hepatitis.

Considering that the disease is quite dangerous and can eventually lead to cirrhosis of the liver, treatment is carried out only under the supervision of doctors. Treatment involves detoxification therapy and the use of restorative medications. With the help of therapeutic methods, residual toxins are removed from the blood. To do this, droppers with hemodez are placed.

During treatment, doctors prescribe restorative medications to regenerate liver cells. These can be amino acid derivatives, essential phospholipids, bile acids, herbal preparations animal origin, homeopathic remedies, dietary supplements.

Basic medications in the treatment of drug-induced hepatitis these are: Essliver Forte, Fosphonziale, Rezalut, Phosphogliv, Gepagard.

Drugs such as Sirepar, Hepatosan are considered quite strong and very effective for the treatment of drug-induced hepatitis. They are preparations of animal origin and are sold only with a doctor's prescription. They have a hepatoprotective effect, detoxification, antioxidant properties, and stimulate the regeneration of liver parenchyma.

Diet helps treat drug-induced hepatitis. Basically, doctors recommend diet No. 5 according to Pevzner. It includes separate meals, limited fat consumption and saturation of the diet with carbohydrates, proteins, and vitamins.

People with drug-induced hepatitis are strictly prohibited from drinking alcoholic drinks, eat fried, sour, salty, spicy food, they must adhere to a diet.

Amino acids are prescribed for treatment. Of the amino acids, doctors prescribe Heptral, Heptor. The substances contained in the preparations are involved in the process of synthesis of bioactive substances and phospholipids, and have a regenerating and detoxifying effect.

Medicines plant origin contribute well to treatment. Legalon, Karsil, Silimar have one common ground- milk thistle herb, which is one of the the strongest antioxidants. The drugs reduce the rate of death of liver cells, restore cell membranes and stimulate the growth of new cells. Doctors recommend that when taking any medications, in order to avoid liver problems, take milk thistle in pure form. It can be purchased at the pharmacy and added directly to food in small portions.

Treatment is also carried out with dietary supplements. Doctors use Hepatotransit, Milona 10, Ovesol, Dipana, Cynarix, Artichoke Extract. The drugs relieve intoxication and help remove toxins from the liver and blood.

It should be remembered that any drug has a complex biochemical composition and may also contain toxins in small doses; it is for this reason that you should not take medications on your own, even if in a television program the most famous doctors claim that certain drugs are not prohibited and contribute to treatment. After all, it could just be an advertising campaign.

Drug-induced hepatitis is an inflammation of the liver associated with the use of certain medications. Hepatotoxic drugs cause inflammatory processes and necrosis of hepatocytes, which is accompanied painful sensations and deterioration of health. In addition, this symptom reduces the effectiveness of treatment with basic medications. The danger of drug-induced hepatitis is that toxic substances can accumulate in liver cells, and the first symptoms of the disease develop when the liver is significantly damaged. According to statistics, this pathology occurs more often in women.

Causes of hepatitis after taking medications

The liver is the body's natural filter. Her complex structure allows you to cleanse the blood of poisons, toxins and metabolites of certain medications. If they enter the bloodstream on a constant basis, the liver cannot cope with its functions. Toxic substances drug metabolism accumulate in its tissues.

If you do not stop taking medications in time, the disease can develop in several stages:

• hepatitis - inflammation of the liver parenchyma;
• fatty hepatosis is a condition in which drops and inclusions of fat appear along with healthy hepatocytes;
• cirrhosis of the liver - terminal stage all liver pathologies with Not timely treatment, consists in the death of functional tissues and their replacement with connective tissue.

Drug-induced hepatitis manifests itself as a complex characteristic symptoms. If there are complaints of pain in the right hypochondrium, the doctor collects medical history data and always clarifies whether the patient is taking any medications. At timely diagnosis, eliminating the hepatotoxic drug and treatment, it is possible to stop the disease at the stage of inflammation and prevent the development of liver hepatosis.

In some cases, the development of the disease depends not on the group of the drug, but on the reaction of the human body to its use. Even a medicine with a minimal degree of toxicity can provoke the development of drug-induced hepatitis.

The following categories of people are at risk:

• convinced vegetarians and others who, for whatever reason, consume insufficient amounts of protein foods;
• children and elderly people;
• prolonged sleep disturbances or stressful situations;
• pathology internal organs– chronic liver, kidney, heart failure.

How many days will pass from the onset of action of the medicine until the first symptoms of intoxication appear, it also depends on the condition of the liver. Patients who have a history of viral, alcoholic and other types of hepatitis at the time of action of the drugs, in most cases it will worsen. Inflammation will have a combined etiology - viruses or toxins act as the main cause of hepatitis, and medications will become a prerequisite for its manifestation.

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Even safe medicines may cause drug-induced hepatitis if consumed in increased dosage or combine with incompatible products

Drugs that can cause drug-induced hepatitis

The causes of drug-induced hepatitis are certain groups of drugs that have Negative influence to the liver. In some cases, their processed products are even more toxic than the medications themselves. Before prescribing them, be sure to check the condition of the liver or simply ask whether the patient is experiencing pain or discomfort in the right hypochondrium.

Doctors identify several main groups of medications that can trigger the appearance of drug-induced hepatitis:

• drugs prescribed for the treatment of tuberculosis (isoniazid);
• antibacterial agents - tetracyclines, penicillins, macrolides;
• sulfonamides (Sulfadimethoxine);
• hormonal drugs (including steroidal anti-inflammatory drugs and contraceptives);
• non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac and their analogues);
• agents that affect nervous system and are prescribed for seizures, epilepsy and other symptoms;
• antifungal medications, especially in tablet form;
• diuretics;
• cytostatics – drugs that suppress tumor growth;
• means for normalization heart rate and others.

The risk of drug-induced hepatitis increases if you take several medications at the same time. The combined effect of medications increases, and the liver cannot cope with the load. This effect can occur even if the drugs individually are not considered toxic.

Symptoms of the disease

Drug-induced hepatitis can occur in acute or chronic forms. develops within a few days after taking the medication. The chronic form is associated with the accumulation of toxins in the liver parenchyma. They may begin to act several weeks after taking the medication, and the symptoms will be less pronounced.

Symptoms of drug-induced hepatitis appear in the same way as liver inflammation of any other etiology. Patients complain of characteristic signs:

• acute or moderate pain in the right hypochondrium;
• nausea, vomiting, digestive disorders;
• alternating constipation and diarrhea;
• a sharp decrease in body weight;
• Symptoms of jaundice may occur: yellow discoloration of the skin and mucous membranes, lightening of the stool and darkening of the urine;
• intense skin itching, a rash may appear;
• by palpation it can be determined that the liver is enlarged in size and protrudes beyond the edges of the costal wall.

Intensity of manifestation clinical picture depends on the stage of drug-induced hepatitis and on concomitant diseases. In many cases, the disease is limited to a feeling of discomfort and heaviness in the side, as well as nausea after eating. In acute hepatitis, the overall body temperature may increase, and in advanced cases, nervous phenomena develop due to brain intoxication. Distinctive feature This type of hepatitis is that its symptoms begin to gradually fade after its cause is eliminated, that is, the drug is stopped.

Diagnostics

The main goal of diagnosis is to find out the cause of inflammation and its stage. It is important to collect medical history and establish that pain in the liver area appeared precisely after taking medications. During the initial examination, the doctor feels the liver area and determines its increase in inflammation. To begin treatment, it is necessary to collect more accurate information about the disease.

Next, the examination is carried out in compliance with all safety rules, since at the first stage it is impossible to exclude the possibility of a viral origin of hepatitis. More full picture can be obtained based on a number of studies:

• Ultrasound of the liver and biliary tract;
• CT or MRI, if indicated - with the addition of a contrast agent;
• general blood test (increased number of lymphocytes, decreased level of total protein);
• biochemical analysis blood (increased activity of liver enzymes - ALT, AST);
• serological tests with blood serum to detect antibodies to the causative agent of viral hepatitis.

First of all, it is necessary to carry out differential diagnosis drug-induced hepatitis from viral. This disease is not related to taking medications, but also manifests itself as inflammation of the liver. Unlike drug-induced hepatitis, it is contagious and can be transmitted through manipulation of blood.

General and biochemical blood tests will indicate the development inflammatory process in the liver

Methods of treating the disease

Treatment of drug-induced hepatitis should begin with eliminating its cause, that is, stopping the course of taking toxic medications. Then therapy is aimed at restoring hepatocytes and normalizing organ function. If it is not possible to stop taking specific hepatotoxic drugs, emphasis is placed on proper nutrition and constant monitoring of liver condition.

The algorithm of actions when drug-induced hepatitis is detected in a patient will consist of several stages:

1. taking means to remove toxins from the body (sorbents, intravenous administration Gemodez or its analogues);
2. restoration of liver parenchyma with hepatoprotectors;
3. additional symptomatic treatment- according to indications.

One of the main conditions quick recovery liver is a diet. Nutrition during this period is aimed at relieving the load on the liver, so it is recommended to eat only simple, low-fat foods. About proper nutrition Doctors have their own recommendations:

• completely eliminate fried, fatty, spicy foods, baked goods, sweets, carbonated drinks and alcohol;
• eat food at least 4–5 times a day in small portions;
• meat and vegetables are better digested boiled or steamed;
• natural fruit and vegetable juices are healthy;
• the main diet should be soups and other first courses, preferably vegetable or dairy;
• All food should be reheated until warm.

There are several treatment options folk remedies, which can cleanse the liver of toxins and relieve the symptoms of its inflammation. Some patients drink fresh beetroot or apple juices- because of great content acids, they provoke the outflow of bile and cleanse the liver. Sprouted oat grains are also useful.

Prevention and prognosis

If you stop taking toxic drugs in a timely manner, the disease can be cured completely. The liver parenchyma is quickly restored, and instead of one healthy hepatocyte, two new cells appear. However, if you do not pay due attention to treatment and measures to restore the liver, hepatitis can progress even after you stop taking harmful medications.

To minimize the risk of developing this disease, you should follow several rules of prevention:

• adhere to the principles of healthy eating;
• carry the lungs physical exercise to maintain normal weight;
• before starting to take new or already known drugs check the condition of the liver;
• Do not combine medications without being sure of their compatibility.

Drug-induced hepatitis may manifest as separate disease or develop in combination with other pathologies. Liver inflammation is painful condition, which affects the functioning of all internal organ systems. In some cases, it is impossible to stop taking toxic medications, as well as to replace them with analogues. Such patients are prescribed restorative therapy after completion of the main course of treatment, and to reduce harmful effects medications for the liver are recommended: diet and hepatoprotectors.

Video on the topic

Drug-induced hepatitis is toxic liver damage caused by taking certain medications. Active substances Many drugs are highly toxic, their effect is detrimental to hepatocytes - liver cells that cease to perform their functions and die. Another name for the disease is drug-induced hepatitis.

Often, drug-induced hepatitis is a serious obstacle to complete drug therapy for serious illnesses. For example, it occurs in 5-10% of hospitalized patients requiring potent medications. In approximately 15-20% of cases, drug-induced hepatitis leads to liver failure or cirrhosis.

Medical statistics say that this disease occurs 2-3 times more often in women than in men. With age, the risk increases, which is associated with a decrease in the volume of the liver, as well as the intensity of blood flow in it. Various diseases liver or kidneys also contribute to the occurrence of drug-induced hepatitis.

Symptoms

• Nausea, vomiting.
• Belching with a bitter taste.
• Loss of appetite.
• Weight loss.
• Diarrhea or constipation.
• Jaundice – the skin, sclera of the eyes and mucous membrane of the mouth acquire a yellow tint.
• The urine becomes dark and the stool becomes light.
• Aching pain in the right hypochondrium.

Causes

As you know, the liver is responsible for fighting harmful toxins that enter the blood. This is why the liver is the first to suffer in alcohol and medicinal poisonings. Well, if with alcohol poisoning everything is clear - you just need to drink less, but stopping taking some medications is problematic, since it is necessary to treat some other disease in the body. In this case, it is often necessary to be treated with potent, highly toxic drugs, long-term use of which leads to the fact that hepatocytes cannot cope with the incoming level of toxins and begin to die - drug-induced hepatitis occurs.

It also happens that drugs with little toxicity seem to be prescribed, but in combination with each other their toxicity increases significantly, and simultaneous administration 5-6 medications increases the risk of liver damage by 75%.

Drug-induced hepatitis can occur within a few days or grow over several years. The disease manifests itself in acute or chronic form. Acute drug-induced hepatitis is divided into cholestatic, cytolytic and mixed.

What drugs cause drug-induced hepatitis? Let's look at the drugs that are most dangerous to liver cells:

• Antibiotics from the group of macrolides (Erythromycin), penicillin (Amoxicillin, Benzylpenicillin), tetracycline (Tetracycline, Doxycycline).
• Anti-tuberculosis drugs – Isoniazid, Rifampicin.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) – Sulindac, Diclofenac, Ibuprofen, Phenylbutazone, Piroxicam, etc.
• Cytostatics – Methotrexate, Cyclosporine A, etc.
• Hormonal drugs – Retabolil, steroids, oral contraceptives, etc.
• Antiulcer drugs – Omeprazole.
• Diuretics – Furosemide, Ethacrynic acid, Hypothiazide, etc.
• Anticonvulsants – Clonazepam, Phenytoin, etc.
• Sulfonamides – Sulfadimethoxine, Cotrimoxazole, Biseptol, etc.
• Antifungal drugs – Ketoconazole, Amphotericin B, etc.
• Antiarrhythmic drugs – Amiodarone, etc.
• Antidiabetic drugs.

This list can be continued for a long time, since most modern drugs are highly toxic. Therefore, strong antibiotics should be taken only as prescribed by a doctor and only in combination with drugs to support the liver.

And yet, the individual sensitivity of the body to a specific drug plays a decisive role in the occurrence of drug-induced hepatitis. This sensitivity may be based on genetic factors (many people inherit drug sensitivity from their parents) as well as the condition of the liver, which is usually weakened by chronic alcoholism, viral hepatitis, ascites, renal or heart failure, protein deficiency, and also during pregnancy.

Chronic drug-induced hepatitis usually occurs when long-term use antidiabetic, antituberculosis, antiepileptic drugs that cannot be canceled due to the urgent need to treat the underlying disease. In these cases, it is necessary to prescribe drugs to support liver cells.

Diagnostics

To identify the disease, a biochemical blood test is performed, which shows increased level liver enzymes - transaminases (AlAT, AST), which indicates liver damage. The level of bilirubin, alkaline phosphatase activity, and globulin fractions also increase. People who are constantly forced to take medications need to regularly perform a biochemical blood test to determine ALT and AST.

Also, to diagnose drug-induced hepatitis, a general blood and urine test, stool analysis for coprogram, ultrasound of the abdominal cavity, etc. are performed.

Differential diagnosis is carried out with cholelithiasis, viral hepatitis, tumors, pancreatic cancer.

Treatment

Drug-induced hepatitis quickly leads to liver cirrhosis and liver failure, so it is necessary to take measures to support the liver as quickly as possible. Treatment of drug-induced hepatitis begins with discontinuation of the drug that caused liver damage. If you cannot completely stop taking the drug (for example, with tuberculosis, diabetes mellitus), then a safer analogue is selected, which is used to treat the underlying disease, but is less toxic. Replacement of medication should only be done under the supervision of a doctor!

An important stage of treatment is detoxification infusion therapy - removing toxins that are dangerous to the liver from the body. Usually, droppers with hemodesis are prescribed, which purify the blood, as well as plasmapheresis. If the patient's condition is severe, hemodialysis is performed.

To restore damaged cells, hepatoprotective drugs are used - drugs to protect the liver from toxic substances. As a rule, when treating with antibiotics and other potent drugs, hepatoprotectors are prescribed from the first day of such treatment; Heptral, Essentiale, and Gepabene are usually prescribed.

Heptral is a drug for restoring liver cells, increasing resistance to toxins, 1 tablet is prescribed 2-4 times a day, the course of treatment is 15-20 days.

Essentiale forte – contains vitamins for accelerated recovery liver cells, prescribed 2 capsules 3 times a day, course of treatment is 15-20 days.

Other hepatoprotectors may also be prescribed: Karsil, Silybor, Silymarin, Allohol, Essliver, Phosphogliv, Legalon, etc.

After diagnosing and starting treatment for drug-induced hepatitis, patients need to exclude fatty and spicy foods from their diet, saturate their diet with vitamins, and completely give up alcohol and smoking.

At early detection pathology and timely treatment, the prognosis is favorable - complete recovery is possible. If the disease is not treated, liver cirrhosis and liver failure develop, and further hepatic coma and even the death of the patient.

Prevention of drug-induced hepatitis consists of strict adherence to the dosages and timing of taking prescribed medications. During drug therapy with potent drugs, it is recommended to take hepatoprotectors in parallel. At long-term treatment patients need to undergo a biochemical blood test to determine the level of transaminases (ALAT, AST) to monitor liver function and early diagnosis diseases.