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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The three ‘golden rules’ for DILI are: Any drug or medicinal compound should be considered as a potential cause of hepatotoxicity.Any type of liver disease can be caused by drugs.The diagnosis is one of exclusion of other causes and a suitable temporal relationship.
Herbal Supplements and Health
Published in Anil K. Sharma, Raj K. Keservani, Surya Prakash Gautam, Herbal Product Development, 2020
Himangini Bansal, Sakshi Bajaj
Kava concentrates are commonly very much tolerated; yet reports of hepatotoxicity required a worldwide reappraisal of its safety. Hepatotoxicity can occur as an acute, severe form or a chronic, mild form. Inflammation seems to be involved in both forms and may end result from the activation of liver macrophages (Kupffer cells), both at once or through kava metabolites (Rowe et al., 2011). In an ongoing randomized, double-blind, placebo-controlled examination done in Germany, the adequacy of kava was surveyed in 58 individuals with anxiety syndrome not brought about by mental issue. Contrasted with the placebo group, the kava gathering showed a critical decrease in uneasiness side effects dependent on a few methods for evaluation. The specialists presumed that the kava concentrate was clinically successful in decrease of conditions of uneasiness, excitedness, and tension. Another ongoing randomized, placebo-controlled, double-blind study examination was directed for 25 weeks on 101 outpatients experiencing uneasiness and tension of nonpsychotic origin. The specialists presumed that the outcome supports the utilization of the kava extract “as a treatment alternative to tricyclic antidepressants and benzodiazepines in anxiety disorders, with proven long-term efficacy.” The overall tolerability of the concentrate was incredible (Rouse 1998).
Effects of treatment on the abdomen and pelvis
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Patients undergoing bone marrow transplant (BMT) who receive myeloablative treatment, with either high-dose chemotherapy or whole-body irradiation, are prone to the specific complication of hepatic veno-occlusive disease (VOD). Hepatic VOD usually occurs in the first month following BMT and presents clinically with tender hepatomegaly, ascites, and jaundice. US can assist in the early diagnosis of hepatic VOD with typical findings including decreased or reversed portal venous flow. CT findings include periportal oedema, ascites, and decreased right hepatic vein diameter (<0.45 cm) (22). Drug-related hepatotoxicity usually occurs within the first 2 months of therapy and is usually reversible, making early reporting of toxicity essential.
Intestinal epithelial damage due to herbal compounds – an in vitro study
Published in Drug and Chemical Toxicology, 2023
Susan M. Britza, Ian F. Musgrave, Rachael Farrington, Roger W. Byard
The knowledge that herbal substances may have direct toxic effects on a wide variety of organ systems is becoming increasingly recognized (Tovar and Petzel 2009). The most commonly reported side effects involve hepatotoxicity with a number of cases described of acute liver injury, liver failure, hepatonecrosis and even death (Gilbert et al.2014, Fernández-Aceñero et al.2019). The two major herbal ingredients causing liver damage are alkaloids and terpenoids (He et al.2019) with a wide range of herbal preparations being implicated including Ge Gen (Pueraria lobate Ohwi), Lu Cha (Camelia sinensis Kuntze), He Shou Wu (Polygoni multiflora Moldenke), Bai Xian Pi (Dictamnus dasycarpus Turcz), Jin Bu Huan (Lycopodium serratum Thunb) and Tu San Qi (Gynura segetum (Lour.) Merr) (Chow et al.2019). In addition, carcinogenic effects on rodent livers have been demonstrated after prolonged exposure to Golden seal, Kava kava and Ginko (Dunnick and Nyska 2013).
Lagerstroemia speciosa (L.) Pers., ethanolic leaves extract attenuates dapsone-induced liver inflammation in rats
Published in Drug and Chemical Toxicology, 2022
Thakur Rohit Singh, Devaraj Ezhilarasan
Drug-induced liver injury (DILI) is a common cause of acute liver failure (ALF) (Licata 2016, Ezhilarasan 2021). DILI is one of the leading causes of drug terminations at the preclinical and clinical levels (Norman 2020). The hepatotoxicity is very common with drugs like acetaminophen, anti-tubercular, anti-epileptics, dapsone, hormones, ferrous sulfate overdose, anti-retroviral, chemotherapeutic agents (Devarbhavi et al.2010, Ezhilarasan et al.2017, Hoofnagle and Björnsson 2019, Ezhilarasan 2021). The prevalence of viral hepatitis escalating worldwide and DILI also emerged as a major cause of acute hepatitis (Asrani et al.2019). Devarbhavi et al (2019) has reported that DILI is one of the common and important cause for acute and chronic liver failure in Asian patients. Despite significant advancements in diagnosis, hazard identification and risk mitigation, DILI remains to be a difficult task for drug development and a major health concern worldwide (Mosedale and Watkins 2017). Clinical studies from India also reported that fourteen percent of drug-induced ALF was mainly associated with dapsone, anti-tubercular, anti-epileptic, and anti-retroviral drugs (Devarbhavi et al.2017, Devarbhavi et al.2018).
Case report: Increasing the frequency of intramuscular naltrexone administration in a high risk patient with opioid use disorder
Published in Substance Abuse, 2021
Melissa Wright, Joao P. De Aquino, Tamara Bystrak
One proposed strategy to enhance the efficacy of XR IM naltrexone is to increase the frequency of its administration (Figure 1D).5,8 The 2020 American Society of Addiction Medicine (ASAM) National Practice Guideline for the Treatment of Opioid Use Disorder states that XR IM naltrexone may be administered every 3 weeks in patients who metabolize naltrexone at a higher rate, although further investigation is needed to determine outcomes of this 3-week dosing strategy.9 The potential concerns regarding this approach include a higher risk of adverse effects, such as nausea, headache, insomnia, precipitated opioid withdrawal, injection site reactions, depression, suicidality, and hepatotoxicity. Although naltrexone-induced hepatotoxicity, in particular, is thought to be dose dependent, most liver enzyme elevations from naltrexone are mild and self-limiting.10 Clinically significant hepatotoxicity remains rare, with elevations in serum liver enzymes over three times the upper limit of normal occurring in only about 1% of patients.11 Hepatotoxicity is most likely to occur in patients with other risk factors for liver injury, such as alcohol use disorder, hepatitis B or C, or other hepatotoxic drugs.12