Drug-Induced Hepatotoxicity: Pancreas and Liver..... Kava Kava

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Drug-Induced Hepatotoxicity: 2005.

Pancreas and Liver

Journal of Clinical Gastroenterology. State-of-the-Art Lectures Yale

University Digestive Diseases Section: 50th ANNIVERSARY. 39(4) Supplement

2:S83-S89, April 2005.

Maddrey, Willis C MD

Abstract:

The removal from the marketplace of several widely prescribed drugs due to

hepatotoxicity has attracted considerable attention. Now under extensive

review are means by which we can better identify hepatic risk prior to

federal approval. Assessment of risk-to-benefit ratios regarding a novel

agent with hepatotoxicity issues (especially one for a life-threatening

condition) requires considerable judgment and education on the part of

prescribers and patients. The spectrum of drug-induced liver injury is

broad with simulation of almost all unknown liver disorders. Drug-induced

liver injuries often have a somewhat characteristic signature, as regards

type of injury (hepatocellular vs cholestatic) and time of onset. The

diagnosis of drug-induced liver injury is often one of exclusion with

initial suspicion based on circumstantial evidence. Factors affecting

susceptibility to drug-induced injury include age, sex, concomitant use of

other drugs, and genetic polymorphism in metabolic pathways involved in

activation or disposition of therapeutic drugs. Drug-drug interactions

present particular problems in patients, often elderly, who are receiving

several drugs simultaneously. Mechanisms of drug-induced liver injury are

many and varied. With many drugs, intermediary products produced during

metabolism are highly reactive and toxic. In these situations, the balance

between the rate of production of the metabolite and the effectiveness of

the drug may determine whether or not hepatic injury occurs.

© 2005 Lippincott & Wilkins, Inc.

" and the beat goes on....... " Sonny Bono " It's not the years in your life that

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