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Drugs That May Cause Liver Dysfunction or Damage

The liver is the principal organ that is capable of converting drugs into forms that can be readily eliminated from the body. Given the diversity in use today and the complex burden they impose upon the liver, it is not surprising that a broad spectrum of adverse drugs effects on liver functions and structures has been documented. The reactions range from mild and transient changes in the results of liver function tests to complete liver failure with death of the host. Many drugs may affect the liver adversely in more than one way, as cited below in several listings. The use of the following drugs requires careful monitoring of their effects on the liver during the entire course of treatment.

Drugs that may cause ACUTE DOSE-DEPENDENT LIVER DAMAGE (resembling acute
viral hepatitis)

 acetaminophen               salicylates (doses over 2 grams daily)

Drugs that may cause ACUTE DOSE-INDEPENDENT LIVER DAMAGE (resembling acute
viral hepatitis)

 acebutolol                  indomethacin                  phenylbutazone
 allopurinol                  isoniazid                        phenytoin
 atenolol                      ketoconazole                  piroxicam
 carbamazepine          labetalol                          probenecid
 cimetidine                  maprotiline                      pyrazinamide
 dantrolene                 metoprolol                       quinidine
 diclofenac                  mianserin                        quinine
 diltiazem                    naproxen                         ranitidine
 enflurane                    para-aminosalicylic acid      sulfonamides
 ethambutol                 penicillins                       sulindac
 ethionamide               phenelzine                    tricyclic antidepressants
 halothane                   phenindione                   valproic acid
 ibuprofen                   phenobarbital                 verapamil


 adrenocortical steroids     phenothiazines                sulfonamides
 antithyroid drugs               phenytoin                         tetracyclines
 isoniazid                           salicylates                        valproic acid

Drugs that may cause CHOLESTATIC JAUNDICE

 actinomycin D                   chlorpropamide                erythromycin
 amoxicillin/clavulanate     cloxacillin                         flecainide
 azathioprine                      cyclophosphamide           flurazepam
 captopril                             cyclosporine                    flutamide
 carbamazepine                  danazol                           glyburide
 carbimazole                       diazepam                        gold
 cephalosporins                  disopyramide                  griseofulvin
 chlordiazepoxide               enalapril                          haloperidol
 ketoconazole                      norethandrolone             sulfonamides
 mercaptopurine                  oral contraceptives         tamoxifen
 methyltestosterone            oxacillin                          thiabendazole
 nifedipine                           penicillamine                  tolbutamide
 nitrofurantoin                      phenothiazines              tricyclic antidepressants
 nonsteroidal                       phenytoin                       troleandomycin
 anti-inflammatory drugs     propoxyphene                verapamil

Drugs that may cause LIVER GRANULOMAS (chronic inflammatory nodules)

 allopurinol                 gold                          phenytoin
 aspirin                       hydralazine              procainamide
 carbamazepine         isoniazid                  quinidine
 chlorpromazine         nitrofurantoin           sulfonamides
 diltiazem                   penicillin                   tolbutamide
 disopyramide            phenylbutazone

Drugs that may cause CHRONIC LIVER DISEASE

 Drugs that may cause active chronic hepatitis

 acetaminophen (chronic use, large doses)
 dantrolene                   methyldopa
 isoniazid                     nitrofurantoin

 Drugs that may cause liver cirrhosis or fibrosis (scarring)

 methotrexate                nicotinic acid

 Drugs that may cause chronic cholestasis (resembling primary biliary

 chlorpromazine/valproic acid (combination
imipramine                    thiabendazole
phenothiazines              tolbutamide
chlorpropamide/erythro-mycin (combination)

Drugs that may cause LIVER TUMORS (benign and malignant)

 anabolic steroids           oral contraceptives           thorotrast
 danazol                          testosterone


 adriamycin                  dacarbazine                  thioquanine
 anabolic steroids        mercaptopurine             vincristine
 azathioprine                methotrexate                 vitamin A (excessive doses)
 carmustine                  mitomycin
 cyclophosphamide/cyclo-sporine (combination)
  oral contraceptives

SOURCE: The Essential Guide to Prescription Drugs, 1994 Edition, by James W. Long and James J. Rybacki. ISBN 0-06-273211-0

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