Developments in jaundice.

Abstract

Potential hepatic toxicity of oral contraceptive agents (OCAs) and the possible use of hepatic enzyme induction in therapy are reviewed for their role in jaundice. Toxicity with jaundice occurred in less than 1 in 10000 women taking OCAs with 1 to 4 mg of a progestagen and .05 to .15 mg of an estrogen. The liver lesion is usually a mixed hepatocellular and cholesterol one and the lesion disappears rapidly when the pill is withdrawn. Minor abnormalities of liver function and histology probably occur in a much higher percentage of women taking the pillW Synthetic estrogens impair liver function more than natural steroids and the metabolism of 19-norprogestagens to the very active ethinyl estradiol may explain the hepatic toxicity of progesterones especially when given in combination with estrogens. Contraceptive pills with a progesterone-derived progestagen may be safer than the testosterone-derived 19-norprogestagens. Oral contraceptives are not recommended for woman with a history of jaundice or pruitis of pregnancy or for women with heriditary hepatic excretory defects or with any of the different varieties of intrahepatic cholestasis. Recent episodes of hepatitis or other liver disease are also contraindications for OCA therapy. A review of enzyme induction therapy follows this OCA discussion.