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    Drugs and Medications that Cause Liver Disease

    For patients with liver disease, the ingestion of everyday drugs may cause further damage as the liver breaks down these toxic substances from the bloodstream. Because the length of time for liver injury to occur may vary from days to months, frequent blood tests are necessary to monitor possible damage.

    Following is a list of hepatotoxic drugs. Patients who take these medications (regularly or daily) should undergo monthly laboratory testing for the first three months of therapy and then every three to six months because of the association between these medications and liver disease.

    • acetominophen, particularly hazardous when taken with alcohol or anti-seizure medications

    • alpha-methyldopa (Aldomet)

    • amiodarone

    • carbamazapine

    • chlorzoxazone, Parfon-forte

    • dantrolene

    • diclofenac, voltaren

    • fluconazole or ketoconazole

    • flutamide

    • hydralazine

    • ibuprofen

    • imuran/azathioprine/6-MP

    • isoniazid (INH)

    • Ketek

    • long-acting nicotinic acid

    • luekotriene synthase inhibitors (asthma medications) [Zafirlukast Accolate] and zileuton (Zyflo)

    • methotrexate

    • nitrofurantoin (Macrodantin)

    • perihexilene maleate

    • phenylbutazone

    • phenytoin

    • pravastatin, fluvastatin, simavastatin, lovastatin

    • quinidine

    • rifampin

    • sulfa medications (especially Septra or Bactrim)

    • tacrine

    • Tasmar (tolcapone) [Parkinson's Disease]

    • Ticlid

    • troglitzone (Rezulin)

    • vitamin A (in doses greater than 5,000 Units/d; beta carotene is safe at all doses)
    According to the April 1996 New England Journal of Medicine, the most common cause of acute liver failure in the United States is the negative interaction between acetaminophen (Tylenol™) and alcohol. In addition, there are interactions that are less common but equally as serious. Research suggests individual genetic variations in liver enzymes may be the cause.

    For information on cytochrome P450 drug interactions or to order a pocket reference card, visit http://medicine.iupui.edu/flockhart/