It is a well-known fact that almostEvery drug has side effects that are harmful to the liver. Since the liver acts as a natural filter for the entire body, poisons can accumulate in it when taking a large number of drugs, thereby causing toxic or drug-induced hepatitis.

Medicinal Hepatitis: the causes of

This is an inflammatory liver disease.character, resulting from taking certain medications. In 1-28% of cases, it significantly complicates the ongoing pharmacotherapy and in 12-25% of cases leads to the development of liver failure and cirrhosis. Drug-induced hepatitis affects women 2-3 times more often than men. Only 2-10% of hospitalized patients develop drug-induced hepatitis of varying severity. In the elderly, susceptibility to the hepatotoxic effect of drugs increases. This is primarily due to a decrease in the intensity of hepatic blood flow and liver volume. The risk of developing drug-induced hepatitis increases with liver damage of various etiologies, as well as in the case of decreased kidney function. A decisive role in the development of drug-induced hepatitis is played by a person's sensitivity to a specific drug, it is determined by a number of factors:

• genetic features of the human body(for example, if one of the parents suffered from hepatitis due to taking the medicine, then the likelihood that the same reaction will be in the child is also quite large);
• the state of the liver at the time of taking the medicine (in patients with chronic hepatitis, especially the toxic effect of drugs);
• combining drugs or medicines andpoisonous substances. In the case of simultaneous use of 2 or more drugs, the toxic effect of drugs is enhanced, or if the patient is exposed to toxic substances (poisonous gases, solvents, alcohol, etc.) against the background of treatment.

What medications can lead to the development of the disease?

Almost any drug cancontribute to the development of drug-induced hepatitis. Its development depends on the individual characteristics of the body, the properties of a particular drug, the dosage of the drug, the duration of its administration, as well as the number of drugs taken simultaneously by a person. The risk of developing drug-induced liver damage is greatest in pregnant women, in people who do not consume enough protein foods (for example, vegetarians or people with limited financial resources), with prolonged stress, as well as with severe diseases of other organs (renal failure, severe heart failure, etc.). There are some groups of drugs that cause the development of the disease more often than others. These include:

• anti-tuberculosis drugs (Rifampicin, Isoniazid);
• antibiotics from the tetracycline group (Doxycycline, Tetracycline, Chlortetracycline, etc.), penicillins (Benzylpenicillin, Amoxicillin, etc.), macrolides (Erythromycin);
• hormonal drugs (sex hormones, oral contraceptives, retabolil, etc.);
• non-steroidal anti-inflammatory drugs (Diclofenac, Aspirin, etc.);
• anticonvulsant, antiepileptic drugs (phenytoin, clonazepam, carbamazepine, etc.);
• antiulcer drugs (omeprazole);
• antidiabetic drugs;
• sulfonamides (Biseptol, Cotrimoxazole, Sulfadimethoxin, etc.);
• diuretics (Hypothiazide, Furosemide, etc.);
• antiarrhythmic drugs (Amiodarone);
• cytostatics (Cyclosporin A and others).

Before using any medication, you must carefully read the instructions for its use and be alert to the occurrence of symptoms of this disease.

How rapidly does drug hepatitis develop?

Currently, all drug-induced hepatitis are divided into 2 groups:

• direct toxic effects, it is known, predictable and taken into account in the drug treatment of patients;
• indirect impact, which is associated with increased sensitivity of patients, and is unpredictable.

Depending on the nature of the disease, it can bechronic and acute. Acute drug-induced hepatitis develops after taking drugs about a week later and is quite rare. It usually occurs with individual intolerance to drugs and direct exposure to drugs. Chronic drug-induced hepatitis, as a rule, develops gradually, and the clinical picture is similar to all existing liver diseases. The development time of this form of the disease is from several months to several years. The danger of chronic drug-induced hepatitis is that it can occur without symptoms, without changing the color of the skin. If the patient stops taking medications, usually even minor symptoms disappear. It is impossible to determine the exact moment of onset of drug-induced hepatitis. In some cases, drug-induced liver damage develops after many years of taking a drug, in other cases the disease can develop several hours or days after the start of therapy. The most complex form of drug-induced liver damage is acute massive necrosis, that is, the death of liver tissue due to exposure to toxic substances. Acute massive necrosis of the liver develops quite quickly and early leads to liver failure and cirrhosis. The most severe disease similar to drug-induced hepatitis is Reye's syndrome, which occurs in children who took aspirin during acute viral infections. As a rule, stopping the drug leads to restoration of liver function and recovery. Chronic drug-induced hepatitis occurs in patients who are forced to take certain drugs for a long time (anti-tuberculosis, anticonvulsants, antidiabetic, anti-inflammatory drugs).

Symptoms and signs of drug-induced hepatitis

The disease has symptoms typical of almost any type of hepatitis:

• vomiting, nausea, belching with bitter aftertaste, decreased appetite, stool disorders (diarrhea, constipation), weight loss;
• an increase in the size of the spleen and liver;
• jaundice - yellowing of the skin of the body, mucous membrane of the mouth, sclera of the eyes;
• feeling of heaviness, pain, discomfort in the right hypochondrium;
• darkening of urine, clarification of feces;
• itching with subsequent brushes.

Since the symptoms of all types of hepatitissimilar, relying only on them, it is impossible to clarify the nature of hepatitis. If similar symptoms occur, you should consult a doctor who, having prescribed the necessary studies, will make an accurate diagnosis. Diagnostics and studies for drug-induced hepatitis

• general analysis of urine and blood;
• biochemical analysis of blood with determination of protein fractions, bilirubin and its fractions, AST and ALT;
• coagulogram - study of the blood coagulation system;
• Ultrasound of the abdominal cavity organs.

If you suspect this disease, it is necessarydo a biochemical blood test, which determines the increase in the level of transaminases (AST, ALT) - liver enzymes indicating its damage. An increase in the level of transaminases, as a rule, is the earliest sign of liver damage and precedes the onset of symptoms. Thus, patients who are forced to take medications for a long time should regularly check the level of transaminases in the blood to detect drug-induced hepatitis at an early stage. It can be difficult to determine the real cause of hepatitis when characteristic symptoms occur. However, stopping therapy with the drug that caused hepatitis and further improvement in the patient's condition clarify the situation. If the condition improves, the drug is prescribed again and the condition of the liver is monitored. If after repeated prescription of the drug the condition worsens, we can confidently talk about drug-induced hepatitis.

Treatment of medical hepatitis

This disease is quite dangerous,which without proper treatment can quite quickly develop into liver cirrhosis and cause liver failure. Treatment of drug-induced hepatitis should be carried out under the supervision of the attending physician. Treatment consists of several stages:

• cancellation of the medicine that causedmedicamentous liver disease. The withdrawal of the medicine that caused the development of the disease must necessarily be agreed with the attending physician. He will assess the degree of risk with the cancellation of this medication and, if necessary, prescribe another drug;
• conducting detoxification therapy -removal of toxic substances from the blood that damage the liver. As a rule, detoxification therapy includes IV drips with blood-cleansing drugs (for example, hemodez);
• after that it is necessary to carry out a restoringtherapy. This is done with the help of hepatoprotectors, which improve metabolism in the liver cells. These include drugs such as Essentiale forte, Heptral, Methionine, etc .;
• the conduct of symptomatic therapy (according to indications).

When taking medications with pronouncedhepatotoxic action hepatoprotectors are prescribed from the first days of therapy with a toxic drug and until the end of the use of this drug. This principle of treatment helps to prevent the occurrence of the disease and makes it possible to carry out the necessary treatment (for example, with tuberculosis). With this disease, treatment should be carried out while following a strict diet. For drug-induced hepatitis, diet "Table No. 5" is recommended, which is prescribed to all liver patients. It includes:

• limiting intake of spicy, fried and fatty foods;
• fractional food;
• complete exclusion from the diet of alcohol;
• eating foods high in carbohydrates;
• additional cellular nutrition (vitamins, amino acids, minerals).

In the prevention of drug-induced hepatitis it is veryIt is important to monitor the liver condition during the therapy. For this purpose, liver enzyme levels are monitored weekly. After discharge, enzyme monitoring should be performed monthly.

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