Systematic Review of Antifungal-Induced Acute Liver Failure.

Eyad Gadour,Ahmed Kotb

doi:10.7759/cureus.18940

Abstract

Antifungals are effective antimicrobial agents broadly used in medical practice. Severe acute liver failure from oral or IV administration of antifungals is a rare but long-standing clinical challenge. We aimed to approximate the risk of clinical acute liver injury among users of oral antifungals in the general population. This review was completed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Six articles were included, comprising case reports and cohort studies, after eliminating duplicate publications. No randomized control studies were found. In all studies, the duration of antifungal use was associated with significantly increased liver enzyme levels.Although it is not very common for patients on antifungals to develop acute liver failure, the prognosis is often good with swift discontinuation of the drug and proper treatment. Liver function evaluation before treatment and periodic monitoring every three to six weeks after commencement of treatment is suggested.

Highlights

BackgroundOral antifungals have been implicated in many case reports of hepatotoxicity and serious liver injuries in the last few decades [1]
The liver is a major component of drug metabolism, and hepatic disease can dramatically alter the pharmacokinetics of antifungal drugs [5] due to impaired clearance, liver blood flow, biliary excretion, and plasma protein binding
We aimed to summarize the current data on the pharmacokinetics of antifungals for these individuals and to increase clinical awareness of the proper use of various antifungal compounds in the case of liver injury

Summary

Introduction

BackgroundOral antifungals have been implicated in many case reports of hepatotoxicity and serious liver injuries in the last few decades [1]. Serious hepatic side effects of oral antifungal agents are considered rare, but reported incidence rates vary widely and depend on the agent [2]. The liver is a major component of drug metabolism, and hepatic disease can dramatically alter the pharmacokinetics of antifungal drugs [5] due to impaired clearance, liver blood flow, biliary excretion, and plasma protein binding. Such patients are less likely to tolerate drug-induced liver injury (DILI) than healthy people [6]. A hepatic function can influence drug-drug interactions (DDI) due to reduced drug uptake and inhibition of metabolizing enzymes [8]

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