What drugs and remedies are most often to blame?
The list is quite broad, and it doesn't just include prescription drugs. The best known are antipyretics and pain relievers with paracetamol when the dose is exceeded, some antibiotics, antituberculosis and antifungal drugs, anticonvulsants, cholesterol-lowering drugs, and certain antitumor drugs. A separate and undervalued group is herbal remedies, sports nutrition and dietary supplements, including those for weight loss and muscle growth: their composition is often not controlled. The risk increases with combinations of multiple drugs, alcohol consumption, and pre-existing liver disease.
- Paracetamol if the dose is exceeded
- Selected antibiotics
- Antituberculosis and antifungal drugs
- Anticonvulsants
- Cholesterol-lowering drugs
- Supplements, herbs and sports nutrition
- Combination of multiple drugs and alcohol
How it manifests itself
Most often, a person does not feel anything, and changes are found in a biochemical blood test taken for another reason. With more severe damage, weakness, fatigue, nausea, loss of appetite, heaviness or dull pain in the right hypochondrium appear. The icteric form is accompanied by yellowing of the skin and sclera, dark urine, light-colored feces and itchy skin. Sometimes the reaction resembles an allergic one: rash, fever, joint pain. Particularly dangerous are increasing drowsiness, confusion and bleeding - signs of severe liver failure requiring immediate hospitalization.
- Asymptomatic increases in ALT and AST
- Weakness and fatigue
- Nausea and decreased appetite
- Heaviness in the right hypochondrium
- Jaundice, dark urine, light stool
- Itchy skin
- Rash and fever due to an allergic reaction
How to make a diagnosis
There is no specific analysis, so the diagnosis is made by exclusion. The doctor asks in detail about all medications, supplements and herbs taken over the past three months, including over-the-counter ones, and compares the timing of the start of use with changes in tests. Be sure to rule out viral hepatitis, autoimmune hepatitis, bile outflow disorders and alcohol impairment. A set of indicators is assessed: ALT, AST, bilirubin, GGT, alkaline phosphatase, albumin and coagulation parameters. Ultrasound of the liver and bile ducts helps to exclude stones and tumors. A biopsy is rarely performed if the picture is unclear.
- Detailed collection of a list of medications and supplements
- ALT, AST, bilirubin, GGT, alkaline phosphatase
- Albumin and coagulogram to assess severity
- Exclusion of viral hepatitis
- Ultrasound of the liver and bile ducts
- Rule out autoimmune hepatitis
- Liver biopsy in difficult cases
Treatment
The mainstay of treatment is stopping the drug that caused the damage. This should be done together with a doctor, because abruptly stopping vital medications, such as anticonvulsants or anti-tuberculosis medications, can be more dangerous than the liver damage itself: the doctor selects a replacement. For paracetamol poisoning, there is a specific antidote that is effective in the first hours, so if an overdose is suspected, emergency assistance is needed. The rest of the treatment is supportive: abstinence from alcohol, good nutrition, monitoring of laboratory tests over time. Severe liver failure requires hospitalization.
- Discontinuation or replacement of the causative drug together with a doctor
- Antidote for paracetamol poisoning - in the first hours
- Complete abstinence from alcohol
- Monitoring liver tests over time
- Hospitalization for jaundice and signs of failure
- Avoid taking new supplements until recovery
Prevention
The most effective measure is not to take too much. Do not prescribe antibiotics and painkillers yourself, follow the indicated doses and duration, carefully read the composition of combined cold remedies: several drugs may contain the same antipyretic component, and the total dose will be dangerous. Treat dietary supplements and herbs like medicine: they can also damage the liver. Keep a list of everything you take and show it to your doctor. During long-term therapy with drugs with known effects on the liver, monitor tests at the appointed time.
- Do not take medications unless prescribed
- Check the composition of combination cold remedies
- Observe doses and course duration
- Treat dietary supplements and herbs as medicines
- Do not combine drugs with alcohol
- Maintain a list of accepted funds
- Monitor liver function tests during long-term therapy