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Medicinal hepatitis

Medicinal (drug-induced) hepatitis is a liver lesion that occurs as a result of the toxic effect of drugs on liver cells with the development of inflammation and even necrosis in them.

Among the complications of drug therapy, lesions and death of liver cells are quite common, which in about 15-20% of cases can cause a lightning-fast form of acute drug hepatitis and can lead to a fatal outcome. Acute drug-induced hepatitis is one of the indications for liver transplantation. Drug-induced hepatitis is somewhat more common in women than in men.


  • more than 1000 drugs that can lead to the development of drug-induced hepatitis

  • the combined use of 2-3 drugs increases the toxicity of the drugs

  • simultaneous use of 6 or more drugs increases the likelihood of toxic liver damage by up to 80%

  • the rate of development of drug-induced hepatitis varies from several days to several months

  • it may be asymptomatic (including without jaundice)

  • even minor symptoms disappear when the drugs are discontinued

  • do not self-medicate!

  • the prognosis is favorable, but with the timely withdrawal of the drug that caused liver damage.

Some groups of drugs cause the development of medicinal hepatitis more often than others. These include:    

  • Nonsteroidal anti-inflammatory drugs (Aspirin, Diclofenac, Paracetamol, etc.)

  • Anti-tuberculosis drugs (Isoniazid, Rifampicin)

  • Antibiotics from the group of tetracyclines (Tetracycline, Doxycycline, Chlortetracycline, etc.), penicillins (Amoxicillin, Benzylpenicillin, etc.), macrolides (Erythromycin), sulfonamides (Sulfadimethoxine, Biseptol, Cotrimoxazole, etc.) 

  • Hormonal drugs (oral contraceptives, sex hormones, Retabolil, etc.)

  • Anti-ulcer drugs (Omeprazole)

  • Antiepileptic, anticonvulsant drugs (Carbamazepine, Phenytoin, Clonazepam, etc.)

  • Antiarrhythmic drugs (Amiodarone).                  

Inter-drug interactions

As a rule, with age, in the presence of several concomitant diseases, patients are forced to take several medications at the same time, which can negatively affect both the effectiveness of treatment and lead to the development of side effects.

The conversion of drugs (detoxification) is carried out in the liver with the participation of cytochrome P450 — a group of enzymes responsible for the metabolism of foreign organic compounds and drugs.

Cytochrome P450 is involved in the metabolism of many drugs, for example:

  • drugs that reduce the acidity of gastric juice (proton pump inhibitors)

  • anti-allergic (antihistamines) drugs

  • drugs that lower blood pressure (calcium antagonists)

  • sedatives and tranquilizers (benzodiazepines)

  • antiviral drugs (protease inhibitors)

  • hypolipidemic drugs (statins).

Important! 17-23% of drug combinations are potentially dangerous.                                                      

This may alert you:

  • Nausea, sometimes vomiting
  • Stool disorder
  • General malaise and weakness
  • Pain or heaviness in the right hypochondrium
  • Jaundice - yellowing of the skin and mucous membranes (e.g., sclera)
  • Skin itching with subsequent scratching
  • An increase in the size of the liver and spleen.

How to confirm medicinal hepatitis:

  • Biochemical blood analysis (AST, ALT, ALP, GGTP, bilirubin level, globulin fractions)

  • Coagulogram (INR, prothrombin)

  • General blood test

  • General urinalysis

  • Coprogram

  • Ultrasound of the abdominal cavity; 

  • Puncture biopsy

  • Thorough collection of a medical history!

Important to exclude: 


  • Viral nature:

       * Hepatitis A (reference to Viral Hepatitis A) 

       * Hepatitis B (reference to Viral hepatitis B) 

       * Hepatitis C (reference to Viral hepatitis C) 

       * Hepatitis D (reference to Viral Hepatitis D) 

       * Hepatitis E (reference to Viral hepatitis E)

  • Wilson-Konovalov disease
  • Cholelithiasis
  • Liver tumors
  • Pancreatic cancer

Basic principles of treatment of medicinal hepatitis:

Withdrawal of the drug that caused hepatitis

  • Selection of the appropriate replacement

  • Pathogenetic therapy (restoration of the liver with the help of drugs that improve the metabolism in liver cells and promote their recovery)

  • Symptomatic therapy

  • Diet-table No. 5 according to Pevsner (fractional nutrition, fat restriction, but sufficient content of carbohydrates, proteins, vitamins in food; fatty, fried and spicy food, alcohol are prohibited) 

  • Liver transplantation is performed in patients with acute liver failure.


What should a patient know before taking any medication?

  • Indications for the appointment of a particular drug.

  • How and when to take the drug.

  • Does skipping a dose of the drug matter and what should be done in this case.

  • How long it is supposed to take the drug.

  • How to recognize adverse side effects.

  • Risk of drug interaction with alcohol and smoking

  • The risk of drug interaction with other drugs.

Do not delay-seek qualified medical help!

Rememberthat a correct and timely diagnosis guarantees the effectiveness of treatment!

We will choose a treatment for everyone!

The scope of research is determined by the doctor after an in-person consultation.

Our Center uses proven in clinical practice innovative diagnostic methods and proven treatment regimens for liver diseases.

The effectiveness of our work is associated with the development and implementation of modern methods of examination and treatment.

GBUZ Moscow Clinical Scientific Center named after Loginov MHD