Abstract
Drug-induced liver injury (DILI) accounts for 20–40% of cases of fulminant hepatic failure. Antitubercular therapy (ATT) may cause hepatotoxicity which can range from transient asymptomatic rise in liver enzymes to acute liver failure. The drugs in ATT responsible for hepatotoxicity include isoniazid, rifampicin, and pyrazinamide. Case series was done to present three different cases of ATT-induced hepatotoxicity which came to the Clinical Pharmacology and Therapeutics Department in NIMS for management.
Highlights
Drug-induced liver injury (DILI) is one of the most important reasons for discontinuation of drugs and treatment failures
Among the first-line drugs, isoniazid (H), rifampicin (R), and pyrazinamide (Z) have potential for hepatotoxicity, pyrazinamide being the most hepatotoxic followed by isoniazid and rifampicin
Advice given According to CDC guidelines 2003, isoniazid, rifampicin, and pyrazinamide can all-cause hepatitis that may result in additional liver damage in patients with pre-existing liver disease
Summary
Drug-induced liver injury (DILI) is one of the most important reasons for discontinuation of drugs and treatment failures. Advice given According to CDC guidelines 2003, isoniazid, rifampicin, and pyrazinamide can all-cause hepatitis that may result in additional liver damage in patients with pre-existing liver disease. A 38-year-old female patient is a known case of scleroderma, rheumatoid arthritis, and moderate pulmonary arterial hypertension She was started on tablet terbinafine for cutaneous fungal infection. Advice given Among the drugs prescribed, terbinafine, isoniazid, rifampicin, and pyrazinamide are reported to cause hepatotoxicity In this case, according to CDC guidelines as SGOT/SGPT raised to more than 3 times the ULN with symptoms, isoniazid, rifampicin, and pyrazinamide should be withdrawn. Review opinion was sought regarding modified ATT in view of hepatitis and seizures (as fluoroquinolones reduce seizure threshold) Advice given This is suspected case of central nervous system (CNS) TB with ATT induced hepatitis (SGOT increased to 5 times upper normal limits and increased bilirubin). Liver function tests should be monitored daily and rechallenge be started with rifampicin, once SGOT is
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