There are numerous drugs which can have toxic effects on the liver (and other organs), which can alter one or more of the liver enzymes (AST, ALT, ALP, GGT), or may cause cholestasis. Drugs commonly cause only a mild to moderate increase in enzyme activity or bilirubin, which return to normal when therapy is stopped.
It is advisable to change therapy if the patient is on long term treatment, and the drug can be demonstrated to be the cause of the hepatotoxicity by monitoring the enzyme activities during a period of withdrawal. Some drugs can cause significant and permanent liver disease with only minimal effects on the liver enzyme activities.
Idiosyncratic hepatotoxicity is uncommon, but is also unpredictable, not dose related, and may occur either immediately or after a period of exposure to the drug.
Examples of Drug Effects on the Liver (not all inclusive)
("Chemical Pathology in Diagnosis and Treatment", Mayne PD, 6th Edition 1994)
| Necrosis | Hepatitlis-like reaction |
Chronic Hepatitis |
Cholestasis | |
|---|---|---|---|---|
| alpha-methyldopa | + | + | + | + |
| Carbamazepine | + | |||
| Cholorambucil | + | + | ||
| Chlordiazepoxide | + | |||
| Chlorpromazine | + | |||
| Chlorpropamide | + | |||
| Chlortetracycline | + | |||
| Cytotoxic drugs | + | |||
| Erythromycin | + | |||
| ferrous sulphate | + | |||
| Halothane | + | + | + | |
| Indomethacin | + | |||
| Isoniazid | + | + | ||
| MAO inhibitors | + | |||
| Methotrexate | + | |||
| Nitrofurantoin | + | + | + | |
| oral contraceptives | + | |||
| Oxyphenastatin | + | + | ||
| PAS | + | |||
| Paracetamol | + | + | ||
| Phenothiazines | + | |||
| Phenylbutazone | + | |||
| Phenytoin | + | |||
| Salicylate | + | |||
| Tolbutamide | + | |||
| Valproate | + | + |
Emails to chemicalpathologist@adhb.govt.nz will receive priority attention from the on-call chemical pathologist.
If the query concerns a specific patient please include the NHI number in your email.
If email is not a suitable option, please contact the on-call chemical pathologist via Lablink (Auckland City Hospital ext. 22000 or 09-3078995).
Individual chemical pathologists may be contacted but will not be available at all times.
After-hours : contact Lablink (Auckland City Hospital ext. 22000 or 09-3078995) or hospital operator for on duty staff after hours.
Dr Samarina Musaad (Clinical Lead) : SamarinaM@adhb.govt.nz ext. 22402
Dr Cam Kyle: CampbellK@adhb.govt.nz ext 22052
Dr Weldon Chiu: WeldonC@adhb.govt.nz ext. 23427
Dr Campbell Heron: CHeron@adhb.govt.nz ext. 23427
Dr Sakunthala Jayasinghe: Sakunthala@adhb.govt.nz ext. 23427