Toxic Hepatitis and Jaundice

Here are some important causes of toxic hepatitis and jaundice (notorious ones are in bold):

• Hepatocellular (elevated ALT and AST only): acarbose, acetaminophen, allopurinol, amiodarone, aspirin (in Reye’s syndrome), baclofen, bupropion, fluoxetine, HAART drugs, isoniazid, ketoconazole, lisinopril, losartan, methotrexate, NSAIDs, omeprazole, paroxetine, pyrazinamide, rifampin, risperidone, sertraline, statins, tetracyclines, trazodone, trovafloxacin, valproic acid, Vitamin A. Herbals and “over the counters” include ETOH, kava kava, germander
• Mixed (elevated alkaline phosphatase and ALT): amitriptyline, azathioprine, captopril, carbamazepine, clindamycin, cyproheptadine, enalapril, flutamide, nitrofurantoin, phenobarbital, phenytoin, sulfonamides, trazodone, trimethoprim–sulfamethoxazole, verapamil
• Cholestatic (elevated alkaline phosphatase and bilirubin): amoxicillin–clavulanic acid, anabolic steroids, ceftriaxone, chlorpromazine, clopidogrel, oral contraceptives, erythromycins, estrogens, irbesartan, mirtazapine, phenothiazines, terbinafine, tricyclics

For a more general approach to abnormal liver chemistry studies please see Internal Medicine Approach to Hepatic Dysfunction, Jaundice, or Abnormal Liver Chemistry Studies or Abnormal Liver Chemistry Studies.

Reference:

• Drug-Related Hepatotoxicity (NEJM 2006;345:731)