Drug-induced hepatitis also known as “drug-induced hepatoxicity” or “drug-induced liver disease” or “medication-induced hepatitis” is a medical condition that is characterized by the inflammation of the liver and in this case it is caused by prescription and non-prescription drugs or medications and their byproducts. Hormones, vitamins, illicit drugs and environmental toxins can also cause this type of hepatitis.
It occurs when the liver reacts to certain type of drugs; some of these drugs that cause this reactions are very toxic to the liver and they include all forms of painkillers especially Acetaminophen (paracetamol), birth control pills, amidarone, anabolic steroids, erythromycin, sulfa antibiotics, general anesthetic halothane and methotrexate.
Prescription drugs that can cause serious injury to the liver thereby leading to this condition are statin drugs (used to treat high cholesterol), the combination drug Augmentin (which is a combination of amoxicillin and clavulanate), phenytoin, azathioprine, niacin, ketoconazole and certain antivirals and anabolic steroids.
Other over-the-counter pain relievers (non-prescription drugs) that can cause this condition are Tylenol, aspirin, ibuprofen, naproxen, etc. These drugs can damage the liver especially if they are taken frequently or they are combined with alcohol. The list is long because more than 900 drugs have been known to cause liver injury.
Metabolites formed while the body processes these drugs (also known as by-products) can trigger immune responses that can lead to inflammation of the liver; these responses can occur after the first use (within hours or days of exposure) of these drugs or after repeated exposure to these drugs (like months of regular use).
The liver is the most important and largest organ of the body; it is one and once anything goes wrong with it, it can lead to serious health complications and even death because there is no second liver to replace and do the function of two like the kidneys.
The many important functions of the liver are production of bile which aids in digestion, filtering and excretion of toxins from the body, excretion of bilirubin, cholesterol, hormones and drugs, breakdown of fats, proteins and carbohydrates, activation of enzymes, production of hormones, storage of glycogen, minerals and fat soluble vitamin (A, D, E and K); synthesis of clotting factors and blood proteins like albumin.
How do drugs cause liver disease?
Liver disease can be caused by drugs in many ways; some directly injure the liver, while some are converted into harmful by-products by the liver and these by-products or chemicals end up harming the liver.
There are three ways in which drugs harm the liver; they can also be called three types of liver toxicity. There are:
- Dose-dependent toxicity: These are drugs that can cause liver toxicity if is taken regularly or if enough of the drug is taken. A good example of drugs that can cause this is Acetaminophen also known as Paracetamol, overdose or regular use of this drug can cause this.
- Drug allergy: Although this is not too common, some drugs are attacked by the immune system with antibodies and immune cells; this reaction causes an inflammation that injures the liver.
- Idiosyncratic toxicity: This type of drug-induced hepatitis can only happen in few people; these people have inherited specific genes that control the chemical transformation of a ;specific drug, this leads to accumulation of the drugs and its by-products which will in turn injure the liver. This cause of liver injury is very rare and it depends on the type of drugs.
Risk factors for Drug-induced Hepatitis
These conditions affect all races, sexes and ages that are exposed to harmful drugs or their by-products; the pre-disposing factors (or risk factors) for this condition are:
- Liver disease from the abuse of Alcohol, HIV or viral Hepatitis.
- Consuming alcohol while taking some medications; this can cause reactions that can severely damage the liver.
- Aged individuals have a higher risk especially if they have taken lots of medications during their youth and middle age.
- Use of long-acting medicines can also cause this; medications that are released slowly or that are metabolized slowly can increase the risk of this liver toxicity.
What are the signs and symptoms of drug-induced hepatitis?
The signs and symptoms of this condition often go away when the drug is stopped, and they are just like those of viral hepatitis; some of them are jaundice (yellowing of the eyes and skin), pruritus or a sensation of intense itching all over the body, weight loss, loss of appetite, skin rash, nausea and vomiting, headache, fever, fatigue, dark coloured urine, diarrhea, abdominal pain and white or clay coloured stool and in severe cases coma.
What are the complications of drug induced hepatitis?
This condition if not diagnosed and treated early can lead to severe liver damage and scarring; this can lead to irreversible scarring of the liver (liver cirrhosis) and make it difficult for the liver to function properly. In some cases it can lead to liver failure which is life threatening; this can only be corrected by a liver transplant.
How is drug-induced hepatitis diagnosed?
- Physical examination is conducted and the medical history of the patient is also taken; the doctor will ask questions concerning the nature of your work to know if you have been exposed to harmful chemicals. He will ask if you are non-prescription drugs or any herbal supplements and if you take alcohol.
- Blood tests can be carried out to see the level of enzymes in the liver; this can be used to tell how well the liver is functioning.
- Imaging can be used to create the picture of the liver which is used to know the state of the liver. Imaging tests includes ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI).
- Liver biopsy can be carried out to confirm the diagnosis of drug-induced hepatitis or toxic hepatitis. It involves using a needle to extract a small sample of tissue from the liver; this sample is examined under a microscope.
- Other newly developed tests that can be used to diagnose this condition are magnetic elastography and transient elastography and they are non-invasive.
How is drug-induced hepatitis treated?
When the cause of the liver damage has been known, doctors can help one stop the medication that is causing the problem; other treatment options are:
- Intensive care: people with severe symptoms of liver damage are hospitalized so that they can be well cared for and monitored. Intravenous fluids and medications are also given to help them overcome the symptoms like nausea and vomiting.
- Medications are given to reverse the damage caused by medications like acetaminophen: they will give the patient acetyl cysteine which will reduce the severity of the damage caused and this depends on how fast it was administered after the overdose on acetaminophen. It is most effective if it is administered 16 hours after the overdose.
- Liver transplant is the last and only option for a severely damaged liver: this procedure involves removing the diseased liver and replacing it with a healthy liver from a donour. Some donours can donate a portion of their livers.
How to prevent drug-induced hepatitis?
- Limit your intake of both prescription and non-prescription drugs: it is not in every situation we reach for drugs or painkillers, most of the times if we listen to our bodies carefully, we will know that either dehydration, stress, malnutrition or lack of quality sleep are behind the pains and symptoms we feel. There are natural remedies that can help in almost every situation (except for organ transplant). Medications should only be the last option when natural remedies don’t work and they must be prescribed by a doctor.
- When a doctor prescribes drugs for you, take them according to the prescription: even if your symptoms don’t seems to improve, do not exceed the recommended amount.
- Don’t mix Alcohol and drugs: this is a very bad combination, it will cause severe harm and damage to your liver. Paracetamol and alcohol is worse, if you take alcohol and you are prescribed drugs, ask your doctor if you can take alcohol or stop until the medication is finished.
- Keep medications and harmful chemicals away from children so that they will not mistakenly take them.
Are they natural remedies for drug-induced hepatitis?
Well, there are a few things that can be done at home to help one recover fast from this condition and aid the liver to heal fast and function properly.
The first thing to do is to stop the medication that is causing this: also stop the indiscriminate use of painkillers. The way the body communicates and tells us something is through pains and these pains most of the time (99% of cases) can be cured by natural means or doing what the body demands.
Normal cause of body pains and headaches are dehydration, stress, inadequate sleep, sedentary lifestyle, not spending time with nature, poor nutrition, bad body posture, long hours of work and no time for relaxation and deep sleep, taking toxins and chemicals through food, water and drugs, negative emotions and thought and even words; when the root cause of a pain is known and handled, the pain will immediately disappear.
But painkillers don’t work; they don’t address the root cause, they only suppress the symptoms and cause drug induced hepatitis as side effects and other dangerous side effects.
Good nutrition can strengthen the immune system and help the body to overcome this condition: your diet should be filled with anti-inflammatory foods like dark green leafy vegetables, citrus fruits and other fruits and vegetables, regular take powerful anti-inflammatory herbs like Ginger, turmeric, garlic and other powerful herbs.
While taking these foods, avoid inflammatory foods like sugary drinks, processed foods, foods made with white refined flour and refined sugar, food containing artificial colourings, hydrogenated oil, preservatives and other sweeteners should be avoided. Also the intake of alcohol should be stopped as this can aggravate the symptoms.
Drink lots of water: this will help the body to overcome this condition, it will aid the ‘immune system’s fight against this inflammation and increase the flow of blood to the liver.
You can do a liver cleanse: this will help the liver and immune system to get rid of accumulated toxins, chemicals, drugs and their by-products from the liver; if you can’t find an experienced herbalist or qualified naturopath to put you through the process, you can ingest lots of fruits, herbs and dark green vegetables.
This will help to detoxify the liver and reverse the damages. Be careful the herbs you used because not every herb is safe in this case, especially aloe vera, so consult with a doctor or naturopath before trying any herb for detoxification.
Avoid stress and rest properly: this is to aid your body fight off this infection properly and undistractedly. All the energy and nutrients the body gets from food is channeled to fight off this infection and this will aid and support fast recovery. Hard exercises, gyming or hard manual labour should be avoided.
You also need to sleep and rest properly; try to get not less than 8 hours sleep at night and also try to catch few hours of good sleep in the afternoon as this will help quick recovery and healing.
In the night, during deep sleep, healing hormones are released which goes through the whole body repairing the damages and renewing the body, this is why insomnia causes lots of health challenges.
You can engage in short distance walk, (not running or jogging) especially during sunrise or sunset; this will improve your immune functions and hasten healing.
This is a serious medical condition, the warnings and advise of your doctor should not be ignored; these remedies are not to replace treatment but to help you recover fast and to make the treatment more effective.
Also if your doctor is not in support of the use any herb or supplement, don’t use it because it could react with the medications and cause another problem or it can aggravate the symptoms.
When immediate treatment commences after diagnosis; the severity and risk of liver damage is reduced. Healthy lifestyle and less dependence on drugs will also foster quick healing and recovery.