Quinine-Induced Hepatotoxicity
Abstract: OBJECTIVE: To report a case of quinine-induced hepatotoxicity presenting within 24 hours following the ingestion of the first dose.
DATA SOURCES: Case report information was obtained from the medical record, the patient, and the physicians involved in this patient's case. MEDLINE and Index Medicus were searched to obtain relevant published literature from January 1942 to May 1997 using the terms quinine, muscle cramps, liver disease, and hepatotoxicity.
CASE SUMMARY: A 57-year-old Native American woman presented with symptoms of nausea, vomiting, generalized myalgia, headache, fever, chills, and rigor. The alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase concentrations were dramatically elevated. Quinine was suspected as the cause after several days of hospitalization and continued therapy. With discontinuation of the quinine, the patient's symptoms resolved within 48 hours and the liver enzyme concentrations declined within 72 hours.
CONCLUSIONS: Documented hepatotoxicity has occurred with quinidine, the optical isomer of quinine. Limited awareness of quinine-induced hepatotoxicity may result in an unrecognized adverse effect.
AUTHOR: Farver DK, Lavin MN SOURCE: ANNALS OF PHARMACOTHERAPY 33: (1)
32-34 JAN 1999
TITLE: Ibuprofen-induced hepatotoxicity in patients with chronic hepatitis C: a case series.
Hepatitis C is a common chronic infection. Nonsteroidal anti-inflammatory drugs are commonly ingested both over-the-counter and by prescription. This case report describes three cases where ibuprofen use leads to a marked rise in hepatic transaminases with one case repeating on rechallenge. These cases support the recommendation of acetaminophen over nonsteroidal antiinflammatory drug use in patients with chronic hepatitis C.
AUTHOR: Riley TR 3rd, Smith JP, Penn State Geisinger Health System, The Milton S. Hershey Medical Center, The Pennsylvania State University,
Department of Medicine, Hershey 17033-0850, USA.
SOURCE: Am J Gastroenterol 1998 Sep;93(9):1563-1565
Drugs That May Cause Liver Dysfunction or Damage
The liver is the principal organ that is capable of converting drugs into forms that can be readily eliminated from the body. Given the diversity in use today and the complex burden they impose upon the liver, it is not surprising that a broad spectrum of adverse drugs effects on liver functions and structures has been documented. The reactions range from mild and transient changes in the results of liver function tests to complete liver failure with death of the host. Many drugs may affect the liver adversely in more than one way, as cited below in several listings. The use of the following drugs requires careful monitoring of their effects on the liver during the entire course of treatment.
Drugs that may cause ACUTE DOSE-DEPENDENT LIVER DAMAGE (resembling acute viral hepatitis)
acetaminophen salicylates (doses over 2 grams daily)
Drugs that may cause ACUTE DOSE-INDEPENDENT LIVER DAMAGE (resembling acute viral hepatitis)
acebutolol indomethacin phenylbutazone allopurinol isoniazid phenytoin atenolol ketoconazole piroxicam carbamazepine labetalol probenecid cimetidine maprotiline pyrazinamide dantrolene metoprolol quinidine diclofenac mianserin quinine diltiazem naproxen ranitidine enflurane para-aminosalicylic acid sulfonamides ethambutol penicillins sulindac ethionamide phenelzine tricyclic antidepressants halothane phenindione valproic acid ibuprofen phenobarbital verapamil
Drugs that may cause ACUTE FATTY INFILTRATION OF THE LIVER
adrenocortical steroids phenothiazines sulfonamides antithyroid drugs phenytoin tetracyclines isoniazid salicylates valproic acid methotrexate
Drugs that may cause CHOLESTATIC JAUNDICE
actinomycin D chlorpropamide erythromycin amoxicillin/clavulanate cloxacillin flecainide azathioprine cyclophosphamide flurazepam captopril cyclosporine flutamide carbamazepine danazol glyburide carbimazole diazepam gold cephalosporins disopyramide griseofulvin chlordiazepoxide enalapril haloperidol ketoconazole norethandrolone sulfonamides mercaptopurine oral contraceptives tamoxifen methyltestosterone oxacillin thiabendazole nifedipine penicillamine tolbutamide nitrofurantoin phenothiazines tricyclic antidepressants nonsteroidal phenytoin troleandomycin anti-inflammatory propoxyphene verapamil drugs
Drugs that may cause LIVER GRANULOMAS (chronic inflammatory nodules)
allopurinol gold phenytoin aspirin hydralazine procainamide carbamazepine isoniazid quinidine chlorpromazine nitrofurantoin sulfonamides diltiazem penicillin tolbutamide disopyramide phenylbutazone
Drugs that may cause CHRONIC LIVER DISEASE
Drugs that may cause active chronic hepatitis
acetaminophen (chronic dantrolene methyldopa use, large doses) isoniazid nitrofurantoin
Drugs that may cause liver cirrhosis or fibrosis (scarring)
methotrexate nicotinic acid
Drugs that may cause chronic cholestasis (resembling primary biliary cirrhosis)
chlorpromazine/valproic imipramine thiabendazole acid (combination) phenothiazines tolbutamide chlorpropamide/erythro- phenytoin mycin (combination)
Drugs that may cause LIVER TUMORS (benign and malignant)anabolic steroids oral contraceptives thorotrast danazol testosterone
Drugs that may cause DAMAGE TO LIVER BLOOD VESSELS
adriamycin dacarbazine thioquanine
anabolic steroids mercaptopurine vincristine azathioprine methotrexate vitamin A (excessive doses) carmustine mitomycin cyclophosphamide/cyclo- oral contraceptives sporine (combination)
SOURCE: The Essential Guide to Prescription Drugs, 1994 Edition, by James W.
Long and James J. Rybacki. ISBN 0-06-273211-0