Drug-Induced Hepatitis: Treatment Options and Risks

My father developed fulminant hepatitis after taking anti-tuberculosis medication!

Hello Dr.
Hsu, my father does not have hepatitis B, but the doctor is now recommending treatment with Zeffix (at his own expense) because his ALT was previously over 1000.
Is it necessary for him to take Zeffix? Will it help with liver recovery? Will continuing to take it place a greater burden on his liver? This condition seems to be drug-induced liver failure caused by tuberculosis medication, not hepatitis B! Additionally, my father's bilirubin is very high at 16.
The doctor mentioned considering plasmapheresis (at his own expense) to address the jaundice first and prevent hepatic encephalopathy.
However, will plasmapheresis improve the prognosis for acute hepatitis? Furthermore, his PT INR is over 3 (it was 20.8 seconds a few days ago, and now it's 23.4 seconds).
Is this situation very concerning? Are there any methods to improve it? Is liver transplantation the only option? (My father is currently alert and aware.) Thank you!

An, 20~29 year old female. Ask Date: 2005/01/11

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! 1.
Your first question is unclear.
If there is no hepatitis B, why is there a need to take Gan An Neng? Is there some information missing? 2.
Plasma exchange therapy is only a temporary measure to replace the liver's function of clearing bilirubin and other harmful substances from the body; it can only reduce jaundice to a limited extent, but it is not a long-term solution.
3.
An extended PT INR indicates prolonged coagulation time, which suggests severe liver dysfunction.
If your father's liver cannot self-repair, then liver transplantation is the only option.

Reply Date: 2005/01/11

More Info

When considering drug-induced hepatitis and the treatment options available, it's crucial to understand the underlying causes of liver dysfunction and the potential risks associated with various medications. In your father's case, it appears that his liver issues may be related to medication-induced liver injury, specifically from tuberculosis medications, rather than a viral hepatitis infection like B or C. This distinction is important because it influences the treatment approach.

Understanding Drug-Induced Hepatitis:
Drug-induced liver injury (DILI) can occur when medications cause inflammation and damage to liver cells. Common culprits include antibiotics, anti-tuberculosis drugs, and non-steroidal anti-inflammatory drugs (NSAIDs). Symptoms can range from mild liver enzyme elevation to severe liver failure, as seen in your father's case with an ALT level exceeding 1000 and elevated bilirubin levels.

Treatment Options:
1. Zeffix (Lamivudine): This medication is primarily used to treat chronic hepatitis B. If your father does not have hepatitis B, the use of Zeffix may not be appropriate. Instead, the focus should be on managing the underlying cause of his liver injury. If the liver damage is indeed due to tuberculosis medications, discontinuing those drugs (if safe to do so) may be the first step in treatment.
2. Plasmapheresis: This procedure involves filtering the blood to remove harmful substances, including antibodies and toxins. In cases of acute liver failure, plasmapheresis may help reduce bilirubin levels and alleviate symptoms of jaundice. However, its effectiveness in improving long-term outcomes in acute liver failure is still debated. It may provide temporary relief but does not address the root cause of liver damage.

3. Liver Transplantation: If your father's liver function continues to deteriorate, and he develops complications such as hepatic encephalopathy (confusion due to liver failure), transplantation may become necessary. The decision for transplantation is based on several factors, including the severity of liver dysfunction, overall health, and the presence of other medical conditions.

Risks and Considerations:
- Monitoring: Continuous monitoring of liver function tests (LFTs) is essential. Elevated PT/INR levels indicate impaired liver function and a higher risk of bleeding. This situation is concerning and requires close medical supervision.

- Medication Burden: Introducing new medications, such as Zeffix, without a clear indication can further burden the liver. It is crucial to weigh the benefits against the risks, especially in a patient with existing liver dysfunction.

- Consultation with Specialists: Given the complexity of your father's condition, consulting a hepatologist (a liver specialist) is advisable. They can provide a comprehensive evaluation and tailor a treatment plan specific to his needs.

In conclusion, while medications like Zeffix may be beneficial for certain liver conditions, their use must be justified based on the underlying cause of liver dysfunction. In your father's case, addressing the drug-induced liver injury and considering supportive treatments like plasmapheresis may be more appropriate. Close monitoring and possibly consulting with a liver specialist will be critical in managing his condition effectively.

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