Hepatotoxicity of selected drugs
| Hepatocellular abnormalities Acetaminophen—acute hepatitis Allopurinol—granuloma Azathioprine—veno-occlusive disease, nodular regenerative hyperplasia Chaparral—portal inflammation with bile duct proliferation, lobar necrosis, and collapse Diclofenac, other nonsteroidal anti-inflammatory drugs Hydralazine—granuloma Isoniazid Methotrexate—fibrosis Methyldopa Mistletoe—hepatocellular injury Nitrofurantoin—autoimmune-like disease Quinidine—granuloma Statins Toxic alkaloid—veno-occlusive disease |
| Cholestatic abnormalities Amoxicillin-clavulanate, other penicillin derivatives Anabolic steroids—cholestasis, peliosis hepatis, neoplasm Captopril Carbamazepine Chlorpromazine Erythromycin estolate Estrogens Kava—hepatic necrosis, cholestasis, lobular hepatitis Oral contraceptives Phenytoin—mononucleosis-like syndrome Sulfa drugs |
| Drug-induced fatty liver (with or without hepatocellular abnormalities) Amiodarone —phospholipidosis Anabolic steroids—cholestasis, peliosis hepatis, neoplasm Cocaine—microvesicular steatosis Corticosteroids Jin Bu Huan—focal hepatic necrosis, steatosis, bridging fibrosis Tetracycline Valproic acid |
Adapted from Aragon G, Zounossi ZM. When and how to evaluate mildly elevated liver enzymes in apparently healthy patients. Cleve Clin J Med 2010; 77(3):195–204. doi:10.3949/ccjm.77a.09064.