Drug-induced hepatitis. Hepatitis officinalis

  • 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 cause 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 quickly removes 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 medications for treatment, enzymes cannot cope with big amount metabolites occur that subsequently cannot be restored. Human tolerance to medications plays an important role.

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. An important role is played by the dose of medications, the duration of their use and the amount taken medicines. Among the medications that can provoke drug-induced hepatitis are:

  • medicines for the treatment of tuberculosis;
  • tetracyclines;
  • hormonal agents;
  • drugs for treatment peptic ulcer, 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 area (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 type 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. Increased level enzymes 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.

The main medications for the treatment of drug-induced hepatitis are: Essliver Forte, Phosphonciale, 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.

Herbal medicines contribute well to treatment. Legalon, Karsil, Silimar have one common ground- milk thistle herb, which is one of 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 problems with the liver, take milk thistle in its 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 promote the removal of 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.

Hepatitis comes from the Greek word for “liver.” This common name acute infectious, acute and chronic inflammatory liver diseases.

Drug-induced hepatitis, also known as drug-induced hepatitis, like all other etiologies, primarily inflammatory processes in the liver that occur as a result of taking certain medications. We are in Once again We return to the issues of self-medication, since you cannot take any medications without consulting a doctor! You are looking for ways to treat a disease, buy a drug that should relieve you of the disease, but in fact, you can aggravate the condition of the disease and cause harm by more severe development, the addition of another disease, namely drug-induced hepatitis.

Drug-induced hepatitis is complicated by the fact that its symptoms and occurrence have a reactive inflammatory form. Let us consider in more detail the forms of drug-induced hepatitis, drugs from which the disease can occur.

Forms of drug-induced hepatitis

Hepatitis has several forms, for this reason it is often difficult to determine its etiology.

The first thing that often confuses the patient, as well as the doctor. The very moment of liver damage is caused by medications, which can occur not only in normal clinical form hepatitis A. Hepatitis is a diffuse inflammatory process.

With drug-induced hepatitis, forms of focal (toxic) liver necrosis, steatosis, granulomatous changes and cholestatic are possible.

  1. The diagnosis of drug-induced hepatitis is rather conditional. clinical picture, rather, we can consider it as a drug-induced liver injury. Since hepatitis itself is an infectious viral disease, as a result of which inflammatory processes of the liver occur, here we are talking about the direct causative agent of the disease in dosage form without transmission (infection) from another person.
  2. Hepatitis may be clinically (manifestations, symptoms) identical toxic hepatitis. Repeated studies on drug-induced hepatitis have revealed that it may also include alcoholic hepatitis as the etiology of its manifestation.

All statements regarding the possible addition of symptoms and types of drug-induced hepatitis, namely alcoholic and toxic, can be considered absolutely legitimate, since they have a very similar clinical picture.

Causes of the disease

What happens to the liver when exposed to hepatotoxic medical supplies. Liver tissue (parenchyma) cells are involved in many processes, namely:

  • Cholesterol synthesis;
  • Removal of endogenous elements from the body;
  • Bile formation, excretion of bile;
  • Detoxification of harmful substances, toxins;
  • Synthesizes and stores proteins.

In case of disease, drug-induced hepatitis, inflammatory processes in the liver affect, destabilize the listed processes and lead to serious diseases, such as cirrhosis of the liver, liver failure, hepatic coma.

The reasons for the development of drug-induced hepatitis, as you may have already understood, are medications, which include xenobiotics, which enter the liver. Metabolism of these drugs occurs in the liver with the processes of breaking them down into elements and their product formation.

The liver has three types of drug interactions:

  • Biotransformation (transformations), metabolism of drugs in the liver;
  • The influence is already existing diseases liver on the process of drug metabolism in the liver;
  • The destructive effect of the drugs themselves, which directly act upon contact with the liver.

Modern psychiatry and narcologists take into account the fact that the use ( wide application), often in high doses in patients, are psychotropic drugs. Large doses of psychotropic drugs have strong hepatotoxic properties and place a serious burden on the hepatocytes (cells) of the liver. Metabolic loads on liver cells cause their slowdown. Liver cells simply cannot cope with high doses of hepatotoxins, and this leads to liver dysfunction.

Factors causing the causes of drug-induced hepatitis:

  • Genetics – the occurrence of drug-induced hepatitis is possible provided that one of the parents already has this disease, or could have been sick at the time of conception of the child. This factor can be a direct transmission of the gene type from father to child, from mother to child.
  • Disease chronic hepatitis– the toxic effect of the drug at the time of chronic hepatitis disease has an adverse effect on the condition of the liver.
  • Use of two or more drugs and toxic effects at the same time - combined drug regimens and effects toxic substances enhances the clinical picture of liver damage. Taking medications and possible impact solvents, poisonous gases, chemical industry, oil and so on. All these toxic effects can be associated with the patient’s place of work, residence, not excluding alcohol consumption.

Let us give examples of hepatoxic effects on the liver, which scheme works during destabilization.

In some cases, the drug may not have a hepatotoxic effect; this function can be performed by its metabolite, which is formed in the liver itself during the biotransformation of the drug. Such examples include the biotransformation of paracetamol (acetaminophen). Toxic derivatives are formed in drugs whose metabolization involves the cytochrome P450 family. Metabolites also accompany the pharmacological activity of the liver.

Drugs have two stages of metabolism:

  • Non-synthetic reactions

The first stage is a non-synthetic reaction. A reaction that includes the processes of oxidation, reduction, hydrolysis. It is possible to combine all processes into one. The initial amount of the drug may be much lower in pharmacological activity than the metabolite itself formed in the process of all non-synthetic reactions.

  • Synthetic reactions

The second stage is the synthetic reaction. Reaction with intermediate metabolite. The intermediate metabolite combines with the endogenous substrate. Forms a so-called highly polar product. The high-field product interacts (excretes) with urine or bile. Synthetic reactions occur, conjugation with glucuronic acid, conjugation with glutamine and glycine (amino acids), sulfation, methylation and acetylation. The products of synthetic reactions may not exhibit pharmacological activity.

Polarity is a property that determines the ability of a substance to be excreted.

The reaction proceeds through complex circuit oxidation of microsomal enzymes of hemoprotein cytochrome P450.

Medicines and metabolic processes in the body

The maximum metabolic rate of drugs, as well as psychoactive substances, and the kinetic properties of enzymes that participate in the metabolism of xenobiotics must comply with speed standards and not exceed a certain value. If the maximum metabolic rate is violated, this is a direct path to the disease drug-induced hepatitis.

In the event of an increase in the plasma concentration of a substance that takes part in metabolism, the activation of all enzyme centers is aimed at this reaction.

The active intensity of biotransformation ceases to increase in direct proportion to the concentration of the substance, which leads to the maximum achievement of the saturation value limit (value threshold).

Such patterns are often observed in anticonvulsants and ethanol (alcohol).

List of drugs that cause drug-induced hepatitis

Drugs with varying effects:

  • Warfarin;
  • Prednisolone;
  • Hydrocortisone;

Oral contraceptives.

Inducer drugs:

  • Carbamazepine (antiepileptic, anticonvulsant);
  • Rifampicin (anti-tuberculosis).

Drugs with varying effects are drugs that can change the effect in the degree of absorption, changes in motility, if the drug is poorly absorbed, dissolves in the fluid of the gastrointestinal tract.

Inducer drugs are drugs of the interferon group with a combined effect of etiotropic, immunomodulatory effects.

Extended list of known drugs that cause drug-induced hepatitis:

  • Cyclosporine A;
  • Furosemide;
  • Hypothiazide;
  • Diabetol;
  • Amiodarone;
  • Biseptol;
  • Clotrimoxazole;
  • Sulfadimethoxine;
  • Phenytoin;
  • Clonazepam;
  • Carbamazepine;
  • Phenytoin;
  • Diclofenac;
  • Aspirin;
  • Retabolil;
  • Omeprazole;
  • Erythromycin;
  • Amoxicillin;
  • Benzylpenicillin;
  • Doxycycline;
  • Chlortetracycline;
  • Tetracycline,
  • Isoniazid;
  • Rifampicin.

All of these drugs are medical drugs related to – anti-tuberculosis drugs, antibiotics, hormonal, oral contraceptives, antiulcer drugs, nonsteroidal anti-inflammatory drugs, antiepileptic, anticonvulsant drugs, antiarrhythmic drugs, diuretics, antidiabetic drugs.

Before taking medications, be sure to consult with your doctor to prescribe a treatment regimen. Remember, exceeding the norm, which can be individual for everyone (regardless of the instructions for the drug), the drug can cause deterioration in health and lead to the associated disease drug-induced hepatitis.

Medicines and treatment used for the disease

Medicines in tablet form - Essentiale forte, Heptral, Methionine, Ursosan, Remaxol, Riboxin.

Essentiale forte, Ursosan - hepatoprotectors of the liver.

Remaxol is a metabolic agent;

Riboxin is a drug with a cardiological focus.

Heptral - significantly increases the resistance of liver cells to toxins. Restores damaged cells, normalizes cell function.

Essentiale forte – construction material liver cells. Contains vitamins, elements of liver cells that help the liver for speedy recovery.

Treatment is carried out by hospitalization, since the doctor must constantly monitor the patient’s well-being and monitor the drug effect.

Treatment regimen

Cancellation, identification of the drug that caused drug-induced hepatitis (drug-induced). If it is necessary to take medications that cause drug-induced hepatitis, or if it is discontinued, the doctor will prescribe another drug with a curative effect aimed at treating the disease.

Detoxification of the body is nothing more than removing from the blood the remains of poisons, toxic substances that destabilize and destroy the functioning of the liver. Hemodesis is one of the main blood purification procedures. The procedure is carried out by placing a dropper.

And the mandatory use of medications, which we described above in this article. Only a combination of drugs and medical procedures with a timely diagnosis, yours successful path to recovery.

Symptoms of drug-induced hepatitis

The symptoms of hepatitis are similar to general symptoms all forms of hepatitis and only a doctor can make the correct diagnosis of the form of hepatitis.

General related, including to drug-induced hepatitis:

  • A state of constant fatigue;
  • Unreasonable weight loss;
  • Nausea;
  • Diarrhea;
  • Bitter taste in the mouth;
  • Belching, possibly mixed with bile;
  • Pain in the right hypochondrium at the location of the liver;
  • Heaviness in the right hypochondrium associated with;
  • Sleep disorders;
  • Daytime sleepiness;
  • Insomnia at night;
  • Apathy;
  • Loss of ability to work;
  • Attacks of headache, migraine;
  • Yellow whites of eyes;
  • Yellowed palms;
  • Dark urine;
  • Light cal.

All these symptoms can manifest themselves in drug-induced hepatitis partially, singly, or complexly.

Drug-induced hepatitis is an inflammatory disease of the liver that occurs due to taking certain medications. The main symptoms of the disease include nausea, loss of appetite, bitter belching, dull pain and discomfort in the hypochondrium, jaundice.

Diagnosis of drug-induced hepatitis is based on a biochemical blood test and general reaction body to discontinue a drug that is believed to cause liver damage. Treatment of the disease is carried out under the full supervision of a doctor. The main principles of treatment for drug-induced hepatitis include: withdrawal of the drug that caused the development of the disease, detoxification therapy (removal of the remnants of the drug and other harmful substances from the bloodstream), and the prescription of hepatoprotectors (drugs that will accelerate liver recovery).

Scientists have still not been able to figure out why drug-induced hepatitis most often develops in women. Certain risk factors for drug-induced liver damage primarily include age (vulnerable age: fetus in the last trimester of pregnancy, neonatal period, elderly age), trophological status, pregnancy, as well as background diseases of the liver, kidney function, and concomitant systemic diseases.


For what reason does drug-induced hepatitis develop?

Our liver performs many different functions, the main one of which is the neutralization of toxins and harmful substances that enter the body. Any medicine that enters the bloodstream enters the liver, where it is excreted and neutralized. The liver can convert toxic substances into substances harmless to the body due to a large set of enzyme proteins. As a result chemical reactions Liver enzymes convert toxic substances (including drugs) into metabolites (intermediate substances).

Often, metabolites formed from drugs are more toxic to the body than the original substances. Drug metabolites are also subsequently treated with liver enzymes until they are completely neutralized, after which they are quickly removed. With prolonged use of one of the medications, liver enzyme resources quickly deplete, so toxins begin to damage hepatocytes (liver cells). Inflammation of the liver occurs, which is called drug-induced hepatitis.

The determining role in the development of drug-induced hepatitis is played by the patient’s sensitivity to this medicine, determined by a number of factors:

  • Features of the genetics of the human body (for example, if one of the parents responded to the drug with hepatitis, then the child will probably have a similar reaction);
  • General state liver while taking medication (the toxic effect of drugs is especially strong in patients with chronic hepatitis);
  • Combining a drug or drugs and toxic substances. The toxic effects of drugs will increase if the patient takes two or more drugs at the same time, or if during treatment the patient is exposed to various toxic substances (solvents, alcohol, poisonous gases, etc.).


What medications lead to the development of drug-induced hepatitis?

The development of drug-induced hepatitis can be caused by almost any drug. The development of drug-induced hepatitis will depend on the properties of the drug, the characteristics of the body, the dosage of the drug, the duration of use, as well as the number of drugs that a person takes at the same time. The risks of developing drug-induced liver damage are high in pregnant women, in people who do not consume protein foods in sufficient quantity(vegetarians, people of modest means), in progress long-term stress, and also in case severe course diseases of other organs ( renal failure, heart failure, etc.).

Some groups of drugs may cause drug-induced hepatitis more often than others. These include:

  • Antibiotics-tetracyclines (Doxycycline, Tetracycline, Chlortetracycline, etc.), Penicillins (Benzylpenicillin, Amoxicillin, etc.), Macrolides (Erythromycin);
  • Antituberculosis drugs (Rifampicin, Isoniazid);
  • Hormonal drugs(sex hormones, oral contraceptives, Retabolil, etc.);
  • Antiulcer drugs (for example, Omeprazole);
  • Anti-inflammatory non-steroidal drugs(Diclofenac, Aspirin, etc.);
  • Anticonvulsants, antiepileptic drugs (Phenytoin, Carbamazepine, Clonazepam, etc.);
  • Sulfonamides (Biseptol, Sulfadimethoxine, Cotrimoxazole, etc.);
  • Diuretics (Hypothiazide, Furosemide, etc.);
  • Antiarrhythmic drugs(Amiodarone);
  • Cytostatics (Cyclosporine, etc.);
  • Antidiabetic drugs.

It was already noted above that hepatitis can be caused by almost any medicine, therefore, before you start taking any medicine, you need to carefully read the instructions for its use and with special attention relate to the appearance of symptoms of drug-induced hepatitis.


How quickly can drug-induced hepatitis develop?

It is almost impossible to determine with extreme accuracy the moment when drug-induced hepatitis begins to develop. In some cases, the liver is affected after systematically taking a specific drug; in other cases, drug-induced hepatitis occurs within a few days after the start of treatment.

The most severe form of drug-induced liver damage can be called massive acute necrosis liver - death of liver tissue due to the action of a toxic substance. Massive acute liver necrosis develops quite quickly and can early lead to liver failure and cirrhosis.

A serious disease similar to drug-induced hepatitis is Reye's syndrome, which occurs in children who took aspirin in the event of the development of acute viral infections. Stopping the medication, in most cases, leads to restoration of liver function and recovery of the patient.
Drug-induced chronic hepatitis is observed in patients who are forced to take certain drugs (antituberculosis, anticonvulsants, antidiabetic and anti-inflammatory drugs) for a long time.


Signs and symptoms of drug-induced hepatitis

Drug-induced hepatitis is characterized by symptoms that are characteristic of any type of hepatitis:

  • Nausea, vomiting, loss of appetite, belching with a bitter taste, weight loss, stool upset;
  • Painful sensations, discomfort, heaviness in the right hypochondrium;
  • Yellowing of the skin, oral mucosa, sclera of the eyes;
  • Lightening of stool, darkening of urine.

Due to the fact that all types of hepatitis have similar symptoms, it is impossible to talk about the nature of hepatitis based on them. If the above symptoms appear, you should consult a doctor who can prescribe necessary research and make a diagnosis.


Diagnosis of drug-induced hepatitis

Of particular importance is early diagnosis drug-induced liver damage due to the high risk of disease progression without further discontinuation of the drug. Probability of defeats this kind taken into account when liver function is impaired in patients who receive certain medications, as well as drugs alternative medicine and herbal medicine. Due to the fact that intracellular organelles, primarily mitochondria, are often affected by drugs, in terms of differential diagnosis with viral hepatitis, recording an increase in the level of ASAT, lactate dehydrogenase and gamma-glutomyl transpeptidase can help, although these signs are not pathognomonic.

A carefully collected anamnesis also helps in diagnosis. Exclusion of alcoholic, viral, ischemic, autoimmune hepatitis and other forms of pathology requires a number of instrumental and laboratory methods diagnostics There is a set of principles quick diagnostics diseases. The doctor should take into account the slightest complaints and symptoms that may indicate liver damage: anorexia, nausea, weakness, malaise, pain in the right upper quadrant of the abdomen, jaundice, itchy skin.

If drug-induced hepatitis is suspected, liver test results should be checked. functional tests. In addition, it is necessary to analyze the likelihood of hepatotoxicity of the over-the-counter and prescription drugs. Stopping the drug, in most cases, will contribute to the rapid normalization of liver function, but in some cases, negative dynamics are allowed for several days or weeks after discontinuation of the drug. If the drug is taken repeatedly, the liver will be affected more quickly and severely. However, sometimes adaptive tolerance develops, so when readmission liver damage may not be observed.

For differential diagnosis and diagnosis of drug-induced hepatitis, it is often necessary to needle biopsy. Characteristic morphological signs of drug-induced hepatitis include: a significant admixture of eosinophils in the inflammatory infiltrate, granulomas, a clear area of ​​demarcation between the unaffected parenchyma and the area of ​​necrosis. Histological specific changes in drug-induced liver damage are not observed.

An extremely important stage in diagnosing the disease is differential diagnosis with other liver diseases. In order to exclude viral hepatitis, PCR diagnostics is required and serological studies. It is also necessary to carry out differential diagnosis with primary biliary cirrhosis, sclerosing primary cholangitis and other biliary pathology, fatty non-alcoholic infiltration of the liver. It is necessary to exclude alcoholic damage, genetic and metabolic etiology, ischemic (hemodynamic) causes of liver damage (heart failure, vascular occlusion, shock, hypotension, etc.).

The prognosis of the disease varies in different situations, but in the case of jaundice the mortality rate reaches 10% or more.


Treatment of drug-induced hepatitis

Drug-induced hepatitis – enough dangerous disease, which without adequate treatment progresses to liver cirrhosis and leads to liver failure. Treatment of the disease should be carried out under the supervision of a doctor.

Treatment of drug-induced hepatitis is based on the basic principles:

  • Complete withdrawal of the medication that caused the development of drug-induced hepatitis. It cannot be said that the discontinuation of a drug must be agreed upon with the attending physician, who must assess the level of risk when discontinuing a particular drug and, if necessary, prescribe another drug;
  • Detoxification therapy is the removal of toxic elements from the blood that damage the liver. Therapy, in most cases, consists of prescribing droppers with drugs that cleanse the blood;
  • Taking hepatoprotectors - medications that promote the restoration of liver cells (hepatocytes). Hepatoprotectors include the following drugs: Methionine, Essentiale Forte, Heptral, etc. Heptral can increase the resistance of hepatocytes to toxic substances, accelerate the recovery of damaged cells, and also help cells carry out their functions. It is recommended to take the drug 2-3 times a day for several weeks. Essential Forte contains building elements of liver cells, as well as vitamins necessary for liver restoration. It is recommended to take the drug two capsules three times a day for 2-3 weeks.

When using drugs that have a pronounced hepatotoxic potential, hepatoprotectors are prescribed simultaneously with the toxic drug and until the end of use of this drug. Such a treatment regimen will prevent the occurrence of drug-induced hepatitis and make it possible to carry out adequate treatment.


Prevention of drug-induced hepatitis

Disease prevention is based on rational use medications and monitoring of probable side effects, limiting additional hepatotoxic effects. Many researchers recommend the use of hepatoprotectors against the background of long-term massive drug therapy.

The potential of various antioxidants in limiting drug-induced liver damage, incl. herbal preparations. Funds from spotted milk thistle(siliverin, silymarin), kholmovy solyanka, etc. It would be advisable to use drugs from the category of essential phospholipids, which will most likely reduce the possibility of lipid peroxidation and protect hepatocyte membranes from damage. In patients with tuberculosis, piracetam and riboxin are used in the treatment of liver damage, which exhibit a clinical effect due to their antihypoxic effect. In turn, piracetam greatly reduces the incidence of hepatopathy when rifampicin and isoniazid are prescribed.

If in complex therapy EPL will be turned on, this will reduce the damaging effect of anti-tuberculosis drugs on the liver. There is a positive effect of prescribing EPL to patients with tuberculosis who did not previously have liver disease and were previously treated with rifampicin (increased transaminases are absent in 210 patients out of 238), while after a month of anti-tuberculosis therapy, hypertransaminasemia was noted in 150 patients who did not take EPL > 50 IU/l.

It turns out that the frequency of drug-induced hepatopathies is increasing, but proper use of medications, patient monitoring and early diagnosis of hepatotoxicity, prompt drug withdrawal and treatment of liver damage together make it possible to minimize the frequency of severe organ damage.

Metabolism takes place in the human liver. There are three main types of mutual influence between drugs and the liver:

  • metabolic transformations and transformations (biotransformation) of drugs in the liver;
  • the effect of liver disease on the process of metabolism and utilization of medicinal substances;
  • damaging effects of dosage forms on the liver.

These interactions must be taken into account when prescribing medications.

Important function The liver is responsible for neutralizing poisons and toxic substances that enter the body. Any medicine that enters the human blood passes through the liver cavity. In this organ, due to complex transformations and chemical reactions, it is neutralized and subsequently eliminated from the body.

The liver is capable of converting toxic substances into harmless compounds. This happens thanks to wide range enzymes produced in it, which, acting on toxins, convert them into metabolites (intermediate products of biotransformation).

If it is not the drug itself that has a hepatotoxic property, but its metabolite, the drug becomes a poison for the body. Subsequently, the liver continues to process the metabolites, trying to neutralize them and remove them from the body.

Long-term use of medications gradually depletes the protective resources of the liver, resulting in toxic and harmful substances, released by drugs, begin the process of liver damage. An inflammatory process occurs - drug-induced hepatitis.

Provoking factors

Drug intolerance can be increased by:

  • Genetic predisposition.
  • Physical state liver after a long course of taking medications.
  • Combination of incompatible medications or other toxic substances. The toxic properties of drugs are enhanced by the influence of alcohol, solvents, poisonous gases, and toxic fumes.

Risk group

The likelihood of developing the disease depends on:

  • individual susceptibility of the body;
  • duration of treatment;
  • volume of dose used;
  • other types of medications that are used in parallel.

The following are more at risk of liver damage from drug-induced hepatitis:

  • Pregnant women.
  • People who do not eat an adequate amount of protein (vegetarians, people who exercise intensive methods weight loss, people with limited financial resources).
  • People who are constantly in stressful situation.
  • Persons with severe or chronic forms of diseases of other organs, damage to the functional systems of the body (with heart failure, severe injuries endocrine system, with renal failure).

This type of hepatitis is not contagious to other people.

What medications can provoke the disease?

These drugs include antibiotics:

  • tetracycline group (Tetracycline, Chlortetracycline, Doxycycline);
  • penicillins (Benzylpenicillin, Amoxycycline);
  • macrolides (Erythromycin).

Also inflammatory disease may cause:

  • anti-tuberculosis drugs (Rifampicin and Isoniazid);
  • non-steroidal anti-inflammatory drugs (Diclofenac, Aspirin);
  • sulfonamides (Biseptol, Sulfadimethoxine, Co-trimoxazole);
  • hormonal drugs (sex hormones, oral contraceptives, steroid hormones, Retabolil);
  • anticonvulsants or antiepileptic drugs (Phenytoin, Carbamazepine, Clonazepam);
  • antiarrhythmic drugs (Amiodarone);
  • antifungal agents (Amphotericin B, Fluorocytosine, Ketoconazole,)
  • diuretics (hypothiazide, Furosemide);
  • cytostatic drugs (Cyclosporin A, Methotrexate);
  • antidiabetic medicines;
  • remedies against peptic ulcers.

Before taking any medications, you need to carefully study the instructions, consult with specialists, and monitor discomfort in the body.

How quickly can the disease develop?

Precisely determine the moment of occurrence dosage form hepatitis is impossible. In some patients, such liver damage is detected after many years of taking the drug. For other people, liver damage begins within a few hours of starting medication.

The most severe and serious liver injury is massive acute necrosis. As a result of this process, complete death and death of liver tissue occurs. Necrosis develops rapidly and provokes the development of liver failure and cirrhosis.

A particularly severe type of disease, similar in symptoms to the drug form of hepatitis, is Reye's syndrome, which occurs in children. It can be triggered by regular Aspirin, which was given to children to treat an acute viral infection.

Timely detection of the disease helps to stop taking the irritating drug and restore liver function.

Variants of the course of the disease

The disease can be acute or chronic.

Acute drug-induced hepatitis develops a week after starting medication. This form is rare and occurs only in cases of individual intolerance to the components of the drug.

Chronic form Drug-induced hepatitis develops gradually over several months or years, and the clinical picture may initially be almost invisible.

The most common chronic form of drug-induced hepatitis is observed in people who are forced to long time take antituberculosis, anticonvulsant, antidiabetic drugs.

Signs of drug-induced hepatitis

Drug-induced hepatitis is characterized by:

  • icteric manifestations - yellowing of the sclera of the eyes, mucous membranes in the mouth, yellowness of the skin.
  • belching with a bitter taste;
  • nausea or vomiting;
  • various disorders stool (diarrhea or constipation);
  • lightening of stool;
  • decreased appetite and weight loss;
  • discomfort in the right side;
  • feeling of heaviness and pain under the ribs with right side;
  • darkening of urine.

Main clinical manifestations dosage form of hepatitis is the prodromal period (which occurs between incubation period and disease) with manifestations allergic reactions in the form of a rash or itching, asthenic syndrome(increased fatigue and weakness).

Symptoms different types hepatitis are similar, so for staging accurate diagnosis You should consult a doctor immediately.

A biochemical blood test can reveal an increase in the level of transaminases (type AST and ALT) - special liver enzymes that indicate damage to this organ. This test makes it possible to detect the disease before other symptoms appear.

People who regularly take the drug should undergo periodic tests to determine the level of transaminases in the blood to detect drug-induced hepatitis on early stages and prevent its development.

Sometimes the real reason The occurrence of hepatitis is difficult to detect. Then it is recommended to discontinue one of the medications taken. If the patient shows improvement, the drug is prescribed again and the condition of the liver is closely monitored. If the condition worsens again, then the factor provoking the development of hepatitis can be determined with confidence.

Treatment strategy for hepatitis dosage form

Drug-induced hepatitis without appropriate treatment can quickly transform into cirrhosis and cause liver failure.

Treatment of this form of the disease is carried out under the strict supervision of a specialist and is based on:

  • Cancel medicinal substance, which provoked hepatitis. This action is carried out only after consultation with the specialist who prescribed it.
  • Detoxification therapy. It helps remove toxic or toxic residues from the blood. toxic substances, which will help damage the liver or provoke inflammatory processes. This therapy is carried out using droppers (Hemodez).
  • Course of hepatoprotectors. Such medications help restore damaged liver tissue.
  • A gentle diet that will reduce the effect of irritating (hot, spicy, too fatty) foods on the inflamed organ.

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. Its complex structure allows it 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 from 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 untimely 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. With timely diagnosis, exclusion of hepatotoxic drugs 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 medications can cause drug-induced hepatitis if taken in high dosages or combined with incompatible drugs

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 drugs 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. Combined action medication 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.

The intensity of the 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. At acute hepatitis The general 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. On initial examination the doctor feels the area of ​​the liver 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 regulations, since at the first stage it is impossible to exclude the possibility viral origin hepatitis A. A more complete 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 blood test (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 tests blood will indicate 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 medications to remove toxins from the body (sorbents, intravenous administration of Hemodez 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 medications, 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 a painful condition that 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.

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