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Several Drugs Can Lead To Toxicity of The Liver

Dec 24, 2002 | Contra Costa Times

Q: A couple of years ago you wrote a column on drugs that might be toxic to the liver. Could you do an update on this? My physician is having difficulty finding out why my ALT readings are several times higher than normal, and I'm wondering if this could be due to the medication I take.

A: The liver's job is to break down drugs for elimination by the body. In some cases, the drug or some of its breakdown products can be toxic to this organ.

For more information on prescription drug side effects and your rights, visit

The good news is that drug-induced liver toxicity is relatively uncommon. The bad news is that when liver toxicity does occur, it can be sudden and serious.

In fact, drugs have become the leading cause of liver failure, and serious drug-induced liver injury is the leading reason that drugs are withdrawn from the market.

Post-marketing follow-up usually detects drug-associated liver toxicity in months compared to years of delay in the past. Ideally, however, these problems would be discovered prior to marketing.

To test liver function, blood levels of liver enzymes, such as ALT and bilirubin, are measured.

When liver cells are damaged, ALT leaks into the blood, resulting in higher levels. Bilirubin also can build up in the blood when the liver is not working properly. The yellow discoloration of jaundice is caused by high bilirubin levels.

Minimal elevations of liver enzymes may not be serious. However, extremely high levels, especially when accompanied by high bilirubin levels, is regarded as an alarm bell.

If no other causes for your high ALT values can be identified, your physician might wish to temporarily stop any suspected drugs you take, if feasible, to see if these values return to normal.

Catching a potential problem early can prevent the development of permanent liver damage. Generally, abnormal test values return to normal when the offending agent is stopped or the dosage reduced. It may be possible to restart a stopped medication at a later time.

Drugs taken off the market because of liver toxicity include bromfenac (Duract), ticrynafen (Selecryn), benoxaprofen (Oraflex) and troglitizone (Rezulin).

Individuals on rosiglitazone (Avandia) or pioglitazone (Actos), other diabetes drugs in the same family as troglitazone, should get regular liver function tests as a precaution.

Among the prescription drugs associated with potential liver damage are nefazodone (Serzone), phenytoin (Dilantin), gemfibrozil (Lopid), isoniazid, acarbose (Precose), leflunomide (Arava), pemoline (Cylert), felbamate (Felbatol), diclofenac (Voltaren, Cataflam), sulindac (Clinoril), dantrolene (Dantrium), zileutan (Zyflo), tolcapone (Tasmar), labetalol (Normadyne, Trandate), trovafloxacin (Trovan), valproic acid (Depakene), amiodarone (Cordarone), tacrine (Cognex), quinidine, methotrexate, sulfonamides, statin drugs and phenothiazine antipsychotics.

Over-the-counter products potentially toxic to the liver at high doses are acetaminophen, aspirin, niacin, vitamin A and iron. Herbs associated with liver toxicity include kava, chaparral, comfrey and coltsfoot.

Combining these agents with each other or with alcohol amplifies the risk.

Signs of liver dysfunction may include fatigue, abdominal pain, nausea and vomiting, appetite loss, dark urine and jaundice, and should be reported immediately.

For more information on prescription drug side effects and your rights, visit

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