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Hepatotoxicity of Commonly Used Drugs: Nonsteroidal Anti-Inflammatory Drugs, Antihypertensives, Antidiabetic Agents, Anticonvulsants, Lipid-Lowering Agents, Psychotropic Drugs
Abstract
Hepatotoxic adverse drug reactions have contributed to the decline of many promising therapies, even among mainstream medication classes (bromfenac and troglitazone are recent examples). The spectrum of nonsteroidal anti-inflammatory drug-related liver toxicity continues to expand, with reports in children, interactive toxicity in persons with hepatitis C, and recognition of the toxicity of both the preferential and selective cyclooxygenase-2 inhibitors. Of the antihypertensive agents, methyldopa is now rarely prescribed and adverse effects are reported infrequently, whereas cases of liver injury associated with the angiotensin receptor and converting enzyme inhibitors are increasingly reported. Of the antidiabetic agents, acarbose, gliclazide, metformin, and human insulin have been implicated in causing liver injury. To date, the newer thiazolidinediones do not appear to share the hepatotoxic potential of troglitazone, although a few reports of acute hepatitis have accrued. Although liver injury has been associated with the "statins," the frequency of such toxicity is lower than that of the background population and the value of biochemical monitoring remains unproved. Newer concepts in anticonvulsant hepatotoxicity have been the recognition of the reactive metabolite syndrome, delineation of the risk factors for valproic acid toxicity, the potential role of carnitine in preventing valproic acid hepatotoxicity, and the toxicity of second-line antiepileptic drugs. Liver injury associated with newer psychotropic agents, particularly the selective serotonin reuptake inhibitors, is also discussed. The focus of the review is the hepatotoxicity of commonly used drugs with particular reference to recent and novel reports of toxicity. Well-known causes of liver injury such as chlorpromazine, phenytoin, and methyldopa are not discussed.
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“Gliclazide has signi fi cant hepatic metabolism.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [467]
In the citing paper
“Hepatotoxicity has also been reported for glibenclamide and is rarely seen with gliclazide.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [467]
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Schlatter, C., Egger, S. S., Tchambaz, L., & Krähenbühl, S. (2009) · Drug Safety · doi:10.2165/00002018-200932070-00003 · Cited by 38
Martín-Castillo, A. M., Castells, M. T., Adánez, G., et al. (2009) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2009.06.003 · Cited by 37
Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities
McLaren, K., & Marangell, L. B. (2004) · Annals of General Hospital Psychiatry · doi:10.1186/1475-2832-3-7 · Cited by 36
Gura, K. M., Strijbosch, R., Arnold, S., McPherson, C. C., & Puder, M. (2007) · Nutrition in Clinical Practice · doi:10.1177/0115426507022006664 · Cited by 32
A Case of Drug-induced Hepatic Injury Associated with Sitagliptin
Toyoda-Akui, M., Yokomori, H., Kaneko, F., Shimizu, Y., Takeuchi, H., Tahara, K., Motoori, T., Ohbu, M., Oda, M., & Hibi∥, T. (2011) · Internal Medicine · doi:10.2169/internalmedicine.50.5057 · Cited by 32
“Patients with type II diabetes mellitus have a high incidence of nonalcoholic fatty liver disease, and several antidiabetic agents such as acarbose, gliclazide, and metformin have been associated with drug-induced liver injury (12).”
BackgroundSaadi, T., Baruch, Waterman, & Yassin, H. (2013) · International Journal of General Medicine · doi:10.2147/ijgm.s49657 · Cited by 32
Ritschel, T., Hermans, S. M. A., Schreurs, M., van den Heuvel, J. J. M. W., Koenderink, J. B., Greupink, R., & Rüssel, F. G. M. (2014) · Chemical Research in Toxicology · doi:10.1021/tx5000393 · Cited by 31
Die PRISCUS-Liste im klinischen Test
Siebert, S., Elkeles, B., Hempel, G., Kruse, J., & Smollich, M. (2012) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-012-0324-4 · Cited by 32
“Dies erscheint zweifelhaft, da die bei geriatrischen Patienten häufige Nieren- oder Leberinsuffizienz eine Kontraindikation für sämtliche NSAR darstellt [5, 11].”
Background
Metadata
- Authors
- Chitturi, S., & George, J.
- Affiliations
- The University of Sydney (AU)
- Venue
- Seminars in Liver Disease
- Publisher
- Georg Thieme Verlag KG
- Published
- 2002-05-16
- Volume
- 22
- Issue
- 02
- Pages
- 169-184
- ISSN
- 0272-8087 (ISSN-L)
- 1098-8971
- OpenAlex
- W1996604226
- Cited by
- 216
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 4 · 2016: 9 · 2015: 14 · 2014: 8 · 2013: 10 · 2012: 10
- FWCI
- 10.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Seminars in Liver Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Keywords
- drug-induced liver injury, hepatotoxicity, adverse drug reactions, nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, antihypertensive drugs, angiotensin receptor blockers, ACE inhibitors, methyldopa, antidiabetic drugs, thiazolidinediones, troglitazone, statins, antiepileptic drugs, L-carnitine, selective serotonin reuptake inhibitors, psychotropic drugs, hepatitis C
- MeSH terms
- Adult, Anti-Inflammatory Agents, Non-Steroidal, Anticonvulsants, Antihypertensive Agents, Hypolipidemic Agents, Child, Cholestasis, Humans, Hypoglycemic Agents, Liver, Psychotropic Drugs, Liver Failure
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