DRUG INDUCED HEPATITIS

• If patient has drug induced hepatic injury it accounts for approximately 2 to 5 percent of patients requiring hospitalization for jaundice, and 10 percent of cases of hepatitis in all adults and more than 40 percent in patients older than 50 [215]
• If patient has drug induced hepatic injury, it may be divided into two broad groups: Direct chemical reactions (intrinsic hepatotoxins) or idiosyncratic reactions or immune-mediated hypersensitivity [215]
• If patient is using certain medications like aspirin, isoniazid (increased risk in HBV carriers), methyldopa, minocycline, nitrofurantoin, nonsteroidal anti-inflammatory drugs and propylthiouricil may result in acute or chronic hepatitis that is histologically—and in some cases clinically—indistinguishable from autoimmune hepatitis [215]
• If patients taking cocaine, ecstasy, efavirenz, nevirapine (increased risk in HBV and HCV carriers), ritonavir, sulfonamides, troglitazone (withdrawn from the market in the United States), and zafirlukast as well as a variety of alternative remedies (eg, chaparral, germander, jin bu huan, skullcap, kava) , may develop acute or chronic hepatitis [215]
• If patient has drug induced hepatic injury due to direct toxicity, serum aminotransferases are typically 8 to 500 times normal, while serum alkaline phosphatase is only one to two times normal [215]
• If patient has drug induced hepatic injury,liver biopsy reveals eosinophilic or granulomatous inflammation of the liver with hepatocyte necrosis and cholestasis [215]
• If patient has drug induced hepatic injury, mortality is high in severe cases [216]