What is drug-induced hepatitis? What medications can cause drug-induced hepatitis?

Drug-induced hepatitis is an inflammatory process in the liver provoked by certain medications. If treatment of the disease is not started in a timely manner, then the onset of necrotic processes in the affected organ and cirrhosis is quite possible. In advanced stages, death is no exception. According to statistics, drug-induced hepatitis is diagnosed three times more often in women than in men. This circumstance has no scientific explanation yet.

Etiology

The main reason for the development of drug-induced hepatitis is long-term use and high dosage of hepatotoxic drugs. Their exposure leads to depletion of enzymes that neutralize the active ingredients of medications and damage to organ cells.

Risk factors for the formation of this disease include:

• presence in the anamnesis;
• abuse of alcoholic beverages and surrogates;
• contact with toxic substances;
• pregnancy;
• poor nutrition;
• prolonged nervous tension;
• genetic predisposition.

Medications that can trigger the development of toxic drug-induced hepatitis include:

• antibiotics, especially the tetracycline group;
• anti-tuberculosis;
• cytostatics;
• diuretics;
• non-steroidal anti-inflammatory drugs;
• antimicrobial;
• proton pump inhibitors;
• hormonal;
• antidiabetic;
• drugs for the relief of epileptic attacks and convulsions.

It should also be understood that moderate use of drugs from this list, subject to doctor’s recommendations and a strong immune system, should not be considered as a 100% predisposition to the development of drug-induced hepatitis.

It should be noted that this type of disease does not have a clear incubation period. This disease can develop both over several years of taking medications, and several weeks after the start of treatment with certain medications.

Some patients develop chronic drug-induced hepatitis, which is difficult to treat. As a rule, this form of the disease occurs in people who are forced to take certain medications constantly.

Classification

Based on the nature of the disease, two forms are distinguished:

• acute – characterized by an intense clinical picture, responds relatively well to treatment;
• chronic form - often develops over several years, is difficult to treat, and often leads to...

Regardless of what caused the development of this pathological process, treatment should begin immediately.

Symptoms

Symptoms of drug-induced hepatitis are almost identical to the clinical picture of viral hepatitis. The clinical picture appears as follows:

• pain, feeling of heaviness in the right hypochondrium;
• nausea, often with vomiting. Sometimes vomit may contain bile;
• general weakness, malaise;
• dysfunction of the gastrointestinal tract;
• attacks of diarrhea after eating fatty, heavy foods;
• a feeling of heaviness in the stomach, even with a minimal amount of food consumed;
• yellowness of the skin;
• itching on the body;
• rich dark color of urine;
• stool discoloration;
• enlarged liver and spleen.

It should be noted that chronic drug-induced hepatitis (CHD) can be asymptomatic for a long time. In some cases, the patient may be bothered, especially while taking medications, by periodic abdominal pain, heaviness in the right hypochondrium and short-term disruption of the functioning of the gastrointestinal tract. Symptoms may disappear completely after stopping the use of drugs. That is why the chronic form of the disease is often diagnosed in an advanced stage.

The manifestation of such symptoms does not always indicate drug-induced hepatitis, so you cannot take treatment on your own. Such medical measures can aggravate the development of the pathological process, which can also lead to the formation of concomitant diseases. Death is no exception.

Diagnostics

If you have the above symptoms, you should consult a doctor. After clarifying the complaints, medical history and life history, the doctor prescribes an examination.

The diagnostic program may include the following methods:

• general and biochemical blood test;
• general urine analysis;
• coagulogram;
• coprogram;
• Ultrasound of the abdominal organs;
• liver biopsy.

Since the clinical picture is quite ambiguous and may be a manifestation of other liver diseases, differential diagnostics are carried out to exclude or confirm such diseases:

• oncological process;
• liver tumor;

The treatment program will be prescribed by the attending physician after an accurate diagnosis and identification of the etiology of the disease.

Treatment

Treatment of drug-induced hepatitis is only comprehensive, with adherence to diet therapy.

First of all, hepatotoxic drugs should be discontinued. Then, detoxification therapy is prescribed.

To remove toxic substances from the body, the following is prescribed:

• infusion therapy;
• in more severe cases - plasmapheresis and hemodialysis.

Drug therapy involves replacing a hepatotoxic drug with a safe analogue. If this is not possible, then to prevent the development of chronic drug-induced hepatitis, hepatoprotectors are prescribed.

The duration of medication, dosage and regimen are strictly prescribed by the attending physician. Making unauthorized adjustments to the course of treatment is unacceptable.

The treatment program for both acute and chronic drug-induced hepatitis necessarily includes diet therapy. A diet for toxic drug-induced hepatitis involves excluding the following:

• alcohol;
• fatty meats, fish, offal;
• foods high in cholesterol;
• cocoa, strong tea, coffee;
• chocolate;
• products containing oxalic acid.

The patient's diet should consist of light, but at the same time nutritious foods. The diet implies the following daily protein-energy composition:

• carbohydrates - 350–400 grams;
• fats - no more than 90 grams, of which 30 grams are of vegetable origin;
• proteins – no more than 100 grams, of which 60 grams are of animal origin;
• table salt no more than 4 grams per day.

Food should only be warm, steamed or boiled. The preferred consistency of dishes is liquid, grated, puree. The patient should eat frequently (4–5 times a day), in small portions and at intervals of 2.5–3 hours.

Compliance with the drinking regime is also important. The volume of liquid you drink per day should be at least two liters. It is recommended to drink mineral water without gas.

Forecast

If treatment for drug-induced hepatitis is started in a timely manner, complete restoration of liver function is possible. Otherwise, the development of serious pathological processes – liver cirrhosis, etc. – is possible. A fatal outcome cannot be ruled out.

Prevention

Preventive measures for this disease are as follows:

• taking only medications prescribed by a doctor and following their dosage;
• timely and correct treatment of all diseases;
• preventive examination by specialized medical specialists.

If you have the above symptoms, you should seek help from qualified medical specialists and not self-medicate.

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Diseases with similar symptoms:

Jaundice is a pathological process, the formation of which is influenced by a high concentration of bilirubin in the blood. The disease can be diagnosed in both adults and children. Any disease can cause such a pathological condition, and they are all completely different.

Drug-induced hepatitis is caused by the negative effects of certain medications that have increased toxicity.

The increased toxic effect on the liver leads to the fact that it is not completely cleansed during the process of neutralizing toxic compounds. Drug-induced hepatitis provokes the appearance of an inflammatory process. With prolonged use of drugs that have a toxic effect on the gland, cirrhosis develops in the body, which leads to liver failure.

Signs of the development of a pathological condition are the appearance of a feeling of nausea, the urge to vomit, loss of appetite, the appearance of constipation and diarrhea, jaundice, darkening of urine and lightening of stool. To diagnose the pathological condition of the liver, laboratory and instrumental diagnostic methods are used.

Causes of drug-induced hepatitis

The most important function of the liver in the body is to neutralize and neutralize toxic compounds that enter it through the bloodstream; this is what determines the specific anatomy of the organ.

Metabolism and disposal of chemical and biological toxic agents is carried out using a special enzymatic system of liver tissue. The main role in neutralizing toxins is played by specialized cells of the gland parenchyma - hepatocytes.

Currently, more than 1000 types of medications are known that can provoke drug-induced hepatitis. The toxicity of some drugs increases when used in combination. So, when using 6 or more drugs, the probability of toxic damage to hepatocytes increases to 80%. Very often, pathology develops as a result of violations of the dosage and regimen of medication.

The utilization of toxic compounds in liver tissue is carried out in several stages. During the process of disinfection of substances, intermediate components are formed that are more hepatotoxic than the drugs themselves. It is for this reason that long-term use of such drugs or the use of high dosages leads to damage to the cells of the liver parenchyma. An increased amount of toxic substances leads to depletion of the enzymatic system of cells.

The rate of progression of the dosage form of hepatitis can vary while taking medications from several days to several years.

The main risk factors for the appearance of this type of pathology are:

• genetically determined hypersensitivity to any drug;
• the presence of a chronic form of hepatitis, viral or autoimmune hepatitis and ascites in the patient at the time of prescription of a toxic drug;
• drinking alcohol;
• exposure to solvents or toxic gases during drug therapy;
• pregnancy period;
• the presence of a condition in which there is a deficiency of proteins in the body;
• exerting stress on the body during drug therapy;
• renal failure;
• heart failure and some others.

The main groups of medications that can provoke the appearance and progression of a pathological condition are:

1. Drugs for the treatment of tuberculosis - Rifampicin, Isoniazid.
2. Antibiotics of the tetracycline group - Tetracycline, Chlortetracycline, Dixycycline, penicillin group - Benzylpenicillin, Amoxicillin, as well as macrolides - Erythromycin.
3. Sulfonamides - Sulfamethoxazole + Trimethoprim, Sulfadimethoxine and some others.
4. Hormonal drugs - steroid hormones, oral contraceptives based on hormones.
5. NSAIDs – Diclofinac and Ibuprofen.
6. Anticonvulsants and antiepileptic drugs.
7. Antimycotics – Amphotericin B, Ketoconazole and Fluorocytosine.
8. Cytostatics – Methotrescat.
9. Diuretics – Furosemide.
10. Medicines used in the treatment of arrhythmia, diabetes, gastric and duodenal ulcers and other pathologies.

Drug-induced hepatitis can be triggered by the use of almost any medication, this especially often occurs when several drugs are taken in combination during therapeutic measures.

Characteristic symptoms of the pathological condition

The course of drug-induced hepatitis can be acute or chronic. The acute form of this pathology is divided, in accordance with the existing classification in hepatology, into cholestatic, cytolytic and mixed.

The symptoms characteristic of this type of disease are similar to those that appear with other forms of hepatitis.

The dominant clinical picture of the disease is a complex of dyspeptic disorders.

Such disorders manifest themselves:

• loss of appetite;
• the appearance of a feeling of nausea;
• belching with a bitter taste;
• urge to vomit;
• diarrhea or constipation;
• losing weight.

The appearance of the main clinical symptoms may be preceded by a prodormal period, which proceeds with the development of asthenic or allergic syndrome.

As the disease develops, the patient begins to worry about:

1. Moderate pain.
2. The appearance of heaviness in the area of ​​the liver.
3. Discomfortable sensations in the area of ​​the right hypochondrium.

During the palpation procedure, moderate gametomegaly and liver tenderness are revealed. In some cases, the patient may develop signs of jaundice, as well as itching, fever, lightening of the stool and darkening of the urine.

Sometimes the course of drug-induced hepatitis in acute form occurs with the formation of submassive necrosis and can quickly lead to such a complication as cirrhosis of the liver. With the formation of massive necrosis, liver failure occurs.

The presence of a pathological condition can be determined using changes in blood composition detected during biochemical analysis.

Methods for diagnosing a pathological condition

The manifestations characteristic of drug-induced hepatitis are quite striking; against the background of the use of hepatotoxic drugs during therapy, they allow an experienced doctor to make a preliminary diagnosis.

The use of additional examination methods is recommended if it is necessary to clarify the diagnosis and for the purpose of differential diagnosis with other types of hepatitis.

If additional research is necessary, laboratory and instrumental methods are used to confirm the diagnosis.

Instrumental methods of examination

The data obtained using instrumental techniques are not specific, but their acquisition is required to create the most complete diagnostic picture.

The most popular methods of instrumental diagnostics are survey fluoroscopy and radiography, ultrasound examination of the abdominal organs, CT, and MRI.

The use of survey fluoroscopy makes it possible to detect the presence of an increase in the size of the gland; it is not used for those types of drug-induced pathologies when the progression of the disease is not accompanied by an increase in the volume of the organ.

Ultrasound examination for this type of disease is the most informative. With its help, the presence of hepatomegaly and diffuse changes in it are revealed. The use of ultrasound does not allow us to determine the causes of such pathological disorders.

Carrying out MRI and CT makes it possible to determine the localization of changes in the tissues of the gland.

Laboratory diagnostic methods

Laboratory tests are the most informative when carrying out diagnostic measures that are aimed at identifying the causes of drug-induced hepatitis.

Biochemical liver tests, a general blood test, a coagulogram, a general blood test and a coprogram are used as diagnostic methods.

Biochemical liver tests reveal increased activity of AST and ALT, alkaline phosphatase, and an increase in the concentration of bilirubin and some globulin fractions.

A general blood test reveals a slight increase in the level of leukocytes, which is due to the non-inflammatory nature of the pathology. Using a coagulogram, the rate of blood clotting is determined, which, in the presence of a pathological condition, is slightly higher than normal.

A general urine test can reveal an increase in the concentration of bile pigments, red blood cells and protein in it.

In some cases, only the use of laboratory methods can determine the presence of a pathological condition.

Treatment regimens for drug-induced hepatitis

When carrying out a treatment course, it is necessary to use an integrated approach, this allows you to accelerate the restoration of the functional capabilities of the gland.

The primary task of the attending physician is to identify the toxic drug and discontinue its use. In cases where complete refusal to take the drug is impossible, the doctor’s task is to select an appropriate treatment option that has a more gentle effect on the liver.

The development of drug-induced hepatitis very quickly leads to the appearance of cirrhosis of the liver, for this reason the doctor must carry out all the required therapeutic measures to prevent the development of pathology.

In medicine, standard schemes for carrying out therapeutic measures have been developed when this type of illness is detected.

After all measures have been taken to reduce the toxic effects on the body, the next step is the implementation of detoxification therapy in a medical hospital.

Carrying out these activities is aimed at cleansing the body of metabolites and toxins. For the procedures, hemodesic droppers and plasmapheresis are used. In particularly severe cases, hemodialysis is used.

After detoxification measures, it is necessary to carry out therapy aimed at restoring the functionality of the gland. For rehabilitation therapy, hepatoprotective drugs are used.

Such medications are:

• essential phospholipids – Essentiale N, Essentiale Forte, Gepagard, Phosphogliv, Rezalut;
• preparations of animal origin - Hepatosan, Hepatamin, Progepar, Sirepar;
• herbal products – Karsil, Karsil Forte, Legalon, Gepabene, Silimar.

Judging by the reviews of most doctors and patients, the use of these funds allows you to almost completely restore the functionality of the gland.

In addition to medications that ensure the restoration of liver cells, special attention should be paid to dietary nutrition; it is recommended to adhere to diet No. 5. Using a diet can reduce the load on the gland, which significantly speeds up the process of restoration of liver tissue.

After consultation with your doctor, you can use traditional medicine as an additional therapy. Most often, doctors advise using milk thistle-based products for this purpose.

The prognosis for the development of pathology in the acute course of the disease is unfavorable. This is due to the fulminant course of the pathology, which leads to the development of cirrhosis, liver failure and death.

With timely withdrawal of the hepatotoxic drug, in most cases the liver is completely restored.

Drug-induced hepatitis is an inflammation of the liver associated with the use of certain medications. Hepatotoxic drugs cause inflammation and necrosis of hepatocytes, which is accompanied by pain and deterioration of health. In addition, this symptom reduces the effectiveness of treatment with basic medications. The danger of drug-induced hepatitis is that toxic substances can accumulate in liver cells, and the first symptoms of the disease develop when the liver is significantly damaged. According to statistics, this pathology occurs more often in women.

Causes of hepatitis after taking medications

The liver is the body's natural filter. Its complex structure allows it to cleanse the blood of poisons, toxins and metabolites of certain medications. If they enter the bloodstream on a constant basis, the liver cannot cope with its functions. Toxic substances from drug metabolism accumulate in its tissues.

If you do not stop taking medications in time, the disease can develop in several stages:

• hepatitis - inflammation of the liver parenchyma;
• fatty hepatosis is a condition in which drops and inclusions of fat appear along with healthy hepatocytes;
• Liver cirrhosis is the terminal stage of all liver pathologies if not treated in a timely manner, and consists of the death of functional tissues and their replacement by connective tissue.

Drug-induced hepatitis is manifested by a complex of characteristic symptoms. If there are complaints of pain in the right hypochondrium, the doctor collects medical history data and always clarifies whether the patient is taking any medications. With timely diagnosis, exclusion of hepatotoxic drugs and treatment, it is possible to stop the disease at the stage of inflammation and prevent the development of liver hepatosis.

In some cases, the development of the disease depends not on the group of the drug, but on the reaction of the human body to its use. Even a medicine with a minimal degree of toxicity can provoke the development of drug-induced hepatitis.

The following categories of people are at risk:

• convinced vegetarians and others who, for whatever reason, consume insufficient amounts of protein foods;
• children and elderly people;
• prolonged sleep disturbances or stressful situations;
• pathologies of internal organs - chronic liver, kidney, heart failure.

How many days will pass from the onset of the medicine to the appearance of the first symptoms of intoxication depends on the condition of the liver. Patients who have a history of viral, alcoholic and other types of hepatitis at the time of action of the drugs, in most cases it will worsen. Inflammation will have a combined etiology - viruses or toxins act as the main cause of hepatitis, and medications will become a prerequisite for its manifestation.

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Even safe medications can cause drug-induced hepatitis if taken in high dosages or combined with incompatible drugs

Drugs that can cause drug-induced hepatitis

The causes of drug-induced hepatitis are certain groups of drugs that have a negative effect on the liver. In some cases, their processed products are even more toxic than the medications themselves. Before prescribing them, be sure to check the condition of the liver or simply ask whether the patient is experiencing pain or discomfort in the right hypochondrium.

Doctors identify several main groups of drugs that can trigger the appearance of drug-induced hepatitis:

• drugs prescribed for the treatment of tuberculosis (isoniazid);
• antibacterial agents - tetracyclines, penicillins, macrolides;
• sulfonamides (Sulfadimethoxine);
• hormonal drugs (including steroidal anti-inflammatory drugs and contraceptives);
• non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac and their analogues);
• drugs that affect the nervous system and are prescribed for seizures, epilepsy and other symptoms;
• antifungal medications, especially in tablet form;
• diuretics;
• cytostatics – drugs that suppress tumor growth;
• means for normalizing heart rhythm and others.

The risk of drug-induced hepatitis increases if you take several medications at the same time. The combined effect of medications increases, and the liver cannot cope with the load. This effect can occur even if the drugs individually are not considered toxic.

Symptoms of the disease

Drug-induced hepatitis can occur in acute or chronic forms. develops within a few days after taking the medication. The chronic form is associated with the accumulation of toxins in the liver parenchyma. They may begin to act several weeks after taking the medication, and the symptoms will be less pronounced.

Symptoms of drug-induced hepatitis appear in the same way as liver inflammation of any other etiology. Patients complain of characteristic signs:

• acute or moderate pain in the right hypochondrium;
• nausea, vomiting, digestive disorders;
• alternating constipation and diarrhea;
• a sharp decrease in body weight;
• Symptoms of jaundice may occur: yellow discoloration of the skin and mucous membranes, lightening of the stool and darkening of the urine;
• intense skin itching, a rash may appear;
• by palpation it can be determined that the liver is enlarged in size and protrudes beyond the edges of the costal wall.

The intensity of the clinical picture depends on the stage of drug-induced hepatitis and on concomitant diseases. In many cases, the disease is limited to a feeling of discomfort and heaviness in the side, as well as nausea after eating. In acute hepatitis, the overall body temperature may increase, and in advanced cases, nervous phenomena develop due to brain intoxication. A distinctive feature of this type of hepatitis is that its symptoms begin to gradually fade after its cause is eliminated, that is, the drug is stopped.

Diagnostics

The main goal of diagnosis is to find out the cause of inflammation and its stage. It is important to collect medical history and establish that pain in the liver area appeared precisely after taking medications. During the initial examination, the doctor feels the liver area and determines its increase in inflammation. To begin treatment, it is necessary to collect more accurate information about the disease.

Next, the examination is carried out in compliance with all safety rules, since at the first stage it is impossible to exclude the possibility of a viral origin of hepatitis. A more complete picture can be obtained based on a number of studies:

• Ultrasound of the liver and biliary tract;
• CT or MRI, if indicated - with the addition of a contrast agent;
• general blood test (increased number of lymphocytes, decreased level of total protein);
• biochemical blood test (increased activity of liver enzymes - ALT, AST);
• serological tests with blood serum to detect antibodies to the causative agent of viral hepatitis.

First of all, it is necessary to carry out a differential diagnosis of drug-induced hepatitis from viral hepatitis. This disease is not related to taking medications, but also manifests itself as inflammation of the liver. Unlike drug-induced hepatitis, it is contagious and can be transmitted through manipulation of blood.

General and biochemical blood tests will indicate the development of an inflammatory process in the liver

Methods of treating the disease

Treatment of drug-induced hepatitis should begin with eliminating its cause, that is, stopping the course of taking toxic medications. Then therapy is aimed at restoring hepatocytes and normalizing organ function. If it is not possible to stop taking specific hepatotoxic drugs, emphasis is placed on proper nutrition and constant monitoring of liver condition.

The algorithm of actions when drug-induced hepatitis is detected in a patient will consist of several stages:

1. taking medications to remove toxins from the body (sorbents, intravenous administration of Hemodez or its analogues);
2. restoration of liver parenchyma with hepatoprotectors;
3. additional symptomatic treatment - as indicated.

One of the main conditions for rapid liver recovery is diet. Nutrition during this period is aimed at relieving the load on the liver, so it is recommended to eat only simple, low-fat foods. Doctors have their own recommendations regarding proper nutrition:

• completely eliminate fried, fatty, spicy foods, baked goods, sweets, carbonated drinks and alcohol;
• eat food at least 4–5 times a day in small portions;
• meat and vegetables are better digested boiled or steamed;
• natural fruit and vegetable juices are healthy;
• the main diet should be soups and other first courses, preferably vegetable or dairy;
• All food should be reheated until warm.

There are several methods of treatment with folk remedies that can cleanse the liver of toxins and relieve the symptoms of its inflammation. Some patients drink fresh beet or apple juices - due to their high acid content, they provoke the outflow of bile and cleanse the liver. Sprouted oat grains are also useful.

Prevention and prognosis

If you stop taking toxic drugs in a timely manner, the disease can be cured completely. The liver parenchyma is quickly restored, and instead of one healthy hepatocyte, two new cells appear. However, if you do not pay due attention to treatment and measures to restore the liver, hepatitis can progress even after you stop taking harmful medications.

To minimize the risk of developing this disease, you should follow several rules of prevention:

• adhere to the principles of healthy eating;
• carry out light physical activity to maintain normal weight;
• before starting to take new or already known medications, check the condition of the liver;
• Do not combine medications without being sure of their compatibility.

Drug-induced hepatitis can manifest itself as a separate disease or develop in combination with other pathologies. Liver inflammation is a painful condition that affects the functioning of all internal organ systems. In some cases, it is impossible to stop taking toxic medications, as well as to replace them with analogues. Such patients are prescribed restorative therapy after completion of the main course of treatment, and diet and hepatoprotectors are recommended to reduce the harmful effects of drugs on the liver.

Video on the topic

• Drug-induced hepatitis: causes
• Incubation period of drug-induced hepatitis
• How does drug-induced hepatitis manifest?
• Drug-induced hepatitis: symptoms and treatment

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Drug-induced hepatitis is a liver disease that occurs as a result of taking medications. The disease occurs quite often.

Intoxication of the body can occur even after harmless analgesics. There is a group of drugs that, when taken for more than 7 days, can provoke drug-induced hepatitis (non-infectious). The cause of the disease often lies in the people themselves: when conducting self-treatment and prescribing medications to themselves, they are not aware that the disease is already progressing in the body.

Drug-induced hepatitis: causes

The liver is the best filter created by nature. One of its functions is to filter and neutralize toxins that enter the blood. Many medications contain toxic substances. In small doses they are harmless because the liver quickly removes them from the body with the help of enzymes that enter into chemical reactions with toxins and convert them into metabolites. But with long-term uncontrolled use of drugs for treatment, enzymes cannot cope with a large number of metabolites, which subsequently cannot be restored. Human tolerance to medications plays an important role.

The causes of drug-induced hepatitis can be divided into several groups:

• hereditary factor;
• liver condition at the time of taking medications;
• taking incorrectly combined medications.

Very often, the cause of the development of drug-induced hepatitis is a hereditary factor. The risk group is people who already had liver disease in their family, in particular hepatitis, and they were treated.

Before taking medications, it is necessary to examine the liver and make sure that the drugs will not be harmful to it, so as not to carry out treatment in the future. Various inflammatory processes, liver enlargement in combination with medications used can cause hepatitis.

Very often, drug-induced hepatitis occurs in people who limit themselves to protein foods. Protein is one of the main components of the liver, which breaks down and removes toxins. Therefore, people who do not eat meat (vegetarians), raw foodists or girls who are watching their figures should think carefully about whether this will really bring health.

Taking several medications plays an important role: if the combination is incorrect, a disease can occur, which is why doctors always advise that you should never self-medicate.

In principle, any medication can cause illness. It all depends on the individual properties of the body, its condition, tolerance. The dosage of medications, the duration of their use and the number of medications taken play an important role. Among the medications that can provoke drug-induced hepatitis are:

• medicines for the treatment of tuberculosis;
• tetracyclines;
• hormonal agents;
• drugs for the treatment of peptic ulcers, diabetes mellitus;
• medications for the treatment of seizures, epilepsy;
• anticancer agents;
• diuretics.

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Incubation period of drug-induced hepatitis

As such, there is no incubation period for drug-induced hepatitis. Sometimes the disease can occur as a result of many years of long-term medication use, and in some cases it can develop 2-3 hours after taking the medication. The most severe type of drug-induced hepatitis is the development of massive necrosis. Its consequences are liver cirrhosis and liver failure.

Some people develop a chronic form of the disease that is difficult to treat. These are mainly people who are forced to take medications constantly throughout their lives, for example, for diseases such as tuberculosis, epilepsy, and diabetes.

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How does drug-induced hepatitis manifest?

The symptoms and signs are very similar to any type of hepatitis: a person’s appetite decreases, he experiences nausea, often accompanied by vomiting, and there is an upset bowel movement, which causes weight loss. Urine becomes dark, feces become light, but some of the main signs of drug-induced hepatitis are a bitter taste in the mouth, pain in the liver area (right hypochondrium), enlargement of the liver, which causes a feeling of heaviness. An important symptom is the appearance of jaundice. The skin, mucous membrane of the eyes and mouth acquire a yellowish tint. In severe forms and massive necrosis, the color becomes deep yellow.

It is impossible to independently determine what kind of hepatitis a person has; This can only be done in a hospital setting, because the symptoms of all types of hepatitis are almost the same.

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Drug-induced hepatitis: symptoms and treatment

If there is a suspicion of hepatitis, doctors prescribe a general blood and urine test, conduct blood clotting tests (coagulogram) and liver ultrasound, and also perform blood biochemistry, which helps to identify the level of liver enzymes (transaminases) - they will indicate the degree of damage to liver cells. Elevated enzyme levels are an early sign of the disease, without necessarily having any symptoms. Therefore, doctors recommend that people who are forced to take regular medications undergo liver examinations every 4-5 months so as not to be subject to constant treatment.

The basic principle of treatment for drug-induced hepatitis is the abolition of the drug that provoked the disease. In hospital settings, after discontinuation of the drug, doctors monitor the condition of the liver. If it improves, they may prescribe a second dose of this medication; if the liver reacts negatively, doctors diagnose drug-induced hepatitis.

Considering that the disease is quite dangerous and can eventually lead to cirrhosis of the liver, treatment is carried out only under the supervision of doctors. Treatment involves detoxification therapy and the use of restorative medications. With the help of therapeutic methods, residual toxins are removed from the blood. To do this, droppers with hemodez are placed.

During treatment, doctors prescribe restorative medications to regenerate liver cells. These can be amino acid derivatives, essential phospholipids, bile acids, herbal preparations of animal origin, homeopathic remedies, dietary supplements.

The main medications for the treatment of drug-induced hepatitis are: Essliver Forte, Phosphonciale, Rezalut, Phosphogliv, Gepagard.

Drugs such as Sirepar, Hepatosan are considered quite strong and very effective for the treatment of drug-induced hepatitis. They are preparations of animal origin and are sold only with a doctor's prescription. They have a hepatoprotective effect, detoxification, antioxidant properties, and stimulate the regeneration of liver parenchyma.

Diet helps treat drug-induced hepatitis. Basically, doctors recommend diet No. 5 according to Pevzner. It includes separate meals, limited fat consumption and saturation of the diet with carbohydrates, proteins, and vitamins.

People with drug-induced hepatitis are strictly prohibited from drinking alcoholic beverages, eating fried, sour, salty, spicy foods; they must adhere to a diet.

Amino acids are prescribed for treatment. Of the amino acids, doctors prescribe Heptral, Heptor. The substances contained in the preparations are involved in the process of synthesis of bioactive substances and phospholipids, and have a regenerating and detoxifying effect.

Herbal medicines contribute well to treatment. Legalon, Karsil, Silimar have one common basis - milk thistle herb, which is one of the strongest antioxidants. The drugs reduce the rate of death of liver cells, restore cell membranes and stimulate the growth of new cells. Doctors recommend that when taking any medications, in order to avoid problems with the liver, take milk thistle in its pure form. It can be purchased at the pharmacy and added directly to food in small portions.

Treatment is also carried out with dietary supplements. Doctors use Hepatotransit, Milona 10, Ovesol, Dipana, Cynarix, Artichoke Extract. The drugs relieve intoxication and promote the removal of toxins from the liver and blood.

It should be remembered that any drug has a complex biochemical composition and may also contain toxins in small doses; it is for this reason that you should not take medications on your own, even if in a television program the most famous doctors claim that certain drugs are not prohibited and contribute to treatment. After all, it could just be an advertising campaign.

Hepatitis comes from the Greek word for “liver.” This is the general name for acute infectious, acute and chronic inflammatory liver diseases.

Drug-induced hepatitis, also known as drug-induced hepatitis, like all other etiologies, primarily inflammatory processes in the liver that occur as a result of taking certain medications. We are once again returning to the issues of self-medication, since you cannot take any medications without consulting a doctor! You are looking for ways to treat a disease, buy a drug that should relieve you of the disease, but in fact, you can aggravate the condition of the disease and cause harm by more severe development, the addition of another disease, namely drug-induced hepatitis.

Drug-induced hepatitis is complicated by the fact that its symptoms and occurrence have a reactive inflammatory form. Let us consider in more detail the forms of drug-induced hepatitis, drugs from which the disease can occur.

Forms of drug-induced hepatitis

Hepatitis has several forms, for this reason it is often difficult to determine its etiology.

The first thing that often confuses the patient, as well as the doctor. The very moment of liver damage is caused by drugs, which can occur not only in the usual clinical form of hepatitis. Hepatitis is a diffuse inflammatory process.

With drug-induced hepatitis, forms of focal (toxic) liver necrosis, steatosis, granulomatous changes and cholestatic are possible.

1. The diagnosis of drug-induced hepatitis is rather conditional in nature of the clinical picture; rather, it can be considered as drug-induced liver damage. Since hepatitis itself is an infectious viral disease, as a result of which inflammatory processes of the liver occur, here we are talking about the direct causative agent of the disease in dosage form without transmission (infection) from another person.
2. Hepatitis can be clinically (manifestations, symptoms) identical to toxic hepatitis. Repeated studies on drug-induced hepatitis have revealed that it may also include alcoholic hepatitis as the etiology of its manifestation.

All statements regarding the possible addition of symptoms and types of drug-induced hepatitis, namely alcoholic and toxic, can be considered absolutely legitimate, since they have a very similar clinical picture.

Causes of the disease

What happens to the liver when exposed to hepatotoxic medications. Liver tissue (parenchyma) cells are involved in many processes, namely:

• Cholesterol synthesis;
• Removal of endogenous elements from the body;
• Bile formation, excretion of bile;
• Detoxification of harmful substances, toxins;
• Synthesizes and stores proteins.

In case of disease, drug-induced hepatitis, inflammatory processes in the liver affect, destabilize the listed processes and lead to serious diseases, such as cirrhosis of the liver, liver failure, hepatic coma.

The reasons for the development of drug-induced hepatitis, as you may have already understood, are medications, which include xenobiotics, which enter the liver. Metabolism of these drugs occurs in the liver with the processes of breaking them down into elements and their product formation.

The liver has three types of drug interactions:

• Biotransformation (transformations), metabolism of drugs in the liver;
• The influence of pre-existing liver diseases on the process of drug metabolism in the liver;
• The destructive effect of the drugs themselves, which directly act upon contact with the liver.

Modern psychiatry and narcologists take into account the fact that the use (widespread use), often in high doses in patients, are psychotropic drugs. Large doses of psychotropic drugs have strong hepatotoxic properties and place a serious burden on the hepatocytes (cells) of the liver. Metabolic loads on liver cells cause their slowdown. Liver cells simply cannot cope with high doses of hepatotoxins, and this leads to liver dysfunction.

Factors causing the causes of drug-induced hepatitis:

• Genetics – the occurrence of drug-induced hepatitis is possible provided that one of the parents already has this disease, or could have been sick at the time of conception of the child. This factor can be a direct transmission of the gene type from father to child, from mother to child.
• Chronic hepatitis disease - the toxic effect of the drug at the time of chronic hepatitis disease has an adverse effect on the condition of the liver.
• The use of two or more drugs and toxic effects at the same time - combined drug regimens and exposure to toxic substances enhances the clinical picture of liver damage. Taking medications and the possible influence of solvents, toxic gases, chemical industry, oil and so on. All these toxic effects can be associated with the patient’s place of work, residence, not excluding alcohol consumption.

Let us give examples of hepatoxic effects on the liver, which scheme works during destabilization.

In some cases, the drug may not have a hepatotoxic effect; this function can be performed by its metabolite, which is formed in the liver itself during the biotransformation of the drug. Such examples include the biotransformation of paracetamol (acetaminophen). Toxic derivatives are formed in drugs whose metabolization involves the cytochrome P450 family. Metabolites also accompany the pharmacological activity of the liver.

Drugs have two stages of metabolism:

• Non-synthetic reactions

The first stage is a non-synthetic reaction. A reaction that includes the processes of oxidation, reduction, hydrolysis. It is possible to combine all processes into one. The initial amount of the drug may be much lower in pharmacological activity than the metabolite itself formed in the process of all non-synthetic reactions.

• Synthetic reactions

The second stage is the synthetic reaction. Reaction with intermediate metabolite. The intermediate metabolite combines with the endogenous substrate. Forms a so-called highly polar product. The high-field product interacts (excretes) with urine or bile. Synthetic reactions occur, conjugation with glucuronic acid, conjugation with glutamine and glycine (amino acids), sulfation, methylation and acetylation. The products of synthetic reactions may not exhibit pharmacological activity.

Polarity is a property that determines the ability of a substance to be excreted.

The reaction occurs through a complex oxidation scheme of microsomal enzymes of hemoprotein cytochrome P450.

Medicines and metabolic processes in the body

The maximum metabolic rate of drugs, as well as psychoactive substances, and the kinetic properties of enzymes that participate in the metabolism of xenobiotics must comply with speed standards and not exceed a certain value. If the maximum metabolic rate is violated, this is a direct path to the disease drug-induced hepatitis.

In the event of an increase in the plasma concentration of a substance that takes part in metabolism, the activation of all enzyme centers is aimed at this reaction.

The active intensity of biotransformation ceases to increase in direct proportion to the concentration of the substance, which leads to the maximum achievement of the saturation value limit (value threshold).

Such patterns are often observed in anticonvulsants and ethanol (alcohol).

List of drugs that cause drug-induced hepatitis

Drugs with varying effects:

• Warfarin;
• Prednisolone;
• Hydrocortisone;

Oral contraceptives.

Inducer drugs:

• Carbamazepine (antiepileptic, anticonvulsant);
• Rifampicin (anti-tuberculosis).

Drugs with varying effects are drugs that can change the effect in the degree of absorption, changes in motility, if the drug is poorly absorbed, dissolves in the fluid of the gastrointestinal tract.

Inducer drugs are drugs of the interferon group with a combined effect of etiotropic, immunomodulatory effects.

Extended list of known drugs that cause drug-induced hepatitis:

• Cyclosporine A;
• Furosemide;
• Hypothiazide;
• Diabetol;
• Amiodarone;
• Biseptol;
• Clotrimoxazole;
• Sulfadimethoxine;
• Phenytoin;
• Clonazepam;
• Carbamazepine;
• Phenytoin;
• Diclofenac;
• Aspirin;
• Retabolil;
• Omeprazole;
• Erythromycin;
• Amoxicillin;
• Benzylpenicillin;
• Doxycycline;
• Chlortetracycline;
• Tetracycline,
• Isoniazid;
• Rifampicin.

All these drugs belong to medical drugs related to – anti-tuberculosis drugs, antibiotics, hormonal, oral contraceptives, anti-ulcer drugs, non-steroidal anti-inflammatory drugs, anti-epileptic, anti-convulsant drugs, anti-arrhythmic drugs, diuretics, anti-diabetic drugs.

Before taking medications, be sure to consult with your doctor to prescribe a treatment regimen. Remember, exceeding the norm, which can be individual for everyone (regardless of the instructions for the drug), the drug can cause deterioration in health and lead to the associated disease drug-induced hepatitis.

Medicines and treatment used for the disease

Medicines in tablet form - Essentiale forte, Heptral, Methionine, Ursosan, Remaxol, Riboxin.

Essentiale forte, Ursosan - hepatoprotectors of the liver.

Remaxol is a metabolic agent;

Riboxin is a drug with a cardiological focus.

Heptral - significantly increases the resistance of liver cells to toxins. Restores damaged cells, normalizes cell function.

Essentiale forte is a building material for liver cells. Contains vitamins, elements of liver cells that help the liver for speedy recovery.

Treatment is carried out by hospitalization, since the doctor must constantly monitor the patient’s well-being and monitor the drug effect.

Treatment regimen

Cancellation, identification of the drug that caused drug-induced hepatitis (drug-induced). If it is necessary to take medications that cause drug-induced hepatitis, or if it is discontinued, the doctor will prescribe another drug with a curative effect aimed at treating the disease.

Detoxification of the body is nothing more than removing from the blood the remains of poisons, toxic substances that destabilize and destroy the functioning of the liver. Hemodesis is one of the main blood purification procedures. The procedure is carried out by placing a dropper.

And the mandatory use of medications, which we described above in this article. Only a combination of medications and medical procedures with a timely diagnosis is your successful path to recovery.

Symptoms of drug-induced hepatitis

The symptoms of hepatitis are similar to the general symptoms of all forms of hepatitis, and only a doctor can make the correct diagnosis of the form of hepatitis.

General related, including to drug-induced hepatitis:

• A state of constant fatigue;
• Unreasonable weight loss;
• Nausea;
• Diarrhea;
• Bitter taste in the mouth;
• Belching, possibly mixed with bile;
• Pain in the right hypochondrium at the location of the liver;
• Heaviness in the right hypochondrium associated with;
• Sleep disorders;
• Daytime sleepiness;
• Insomnia at night;
• Apathy;
• Loss of ability to work;
• Attacks of headache, migraine;
• Yellow whites of eyes;
• Yellowed palms;
• Dark urine;
• Light cal.

All these symptoms can manifest themselves in drug-induced hepatitis partially, singly, or complexly.