الأدوية التي تؤثر على وظائف الكبد والتي تسبب أمراض الكبد

[سلطان حكمي]

DRUGS INDUCED HEPATOTOXICITY
والتي تتطلب منا عند تعاطيها Liver Screening and monitoring for Liver functions enzymes and liver injury.
فما هذه الأدوية؟
سأبدأ أنا أولا بأدوية السكر:

بسم الله الرحمن الرحيم


Hepatotoxicity in the Diabetic Population

مرض السكري بنوعيه مرتبط بعدة مضاعفات خطيرة مثل:
as cardiopathy, nephropathy, and retinopathy .
,وبالرغم ان HEPATOTOXICITY هي أهم مضاعفات ومشاكل أدوية السكر
أدوية السكر المرتبطة ب hepatotoxicityهي:

include sulfonylureas, alpha-glucosidase inhibitors, biguanides, and thiazolidinediones.
أولا:




Drug induced hepatotoxicity has been reported occasionally :
with second-generation sulfonylureas. Second-generation sulfonylureas include glipizide, glibenclamide and glimepiride.
ثانيا:





For alpha-glucosidase inhibitors, the most well-known of this class is acarbose. It is minimally absorbed in unchanged form after oral administration, therefore, this drug is widely believed to be safe. However, there were cases of severe hepatotoxicity reported for acarbose
ثالثا:





Biguanides (metformin) is widely used for the treatment of type 2 diabetes. A serious but rare side effect,lactic acidosis, is caused because of its interference with mitochondrial oxidative processes. For hepatotoxicity, only one or two cases reported so far.







رابعا:



Thiazolidinediones (TZDs, also known as glitazones) are insulin sensitizers now widely used for the treatment of type 2 diabetes. Three TZDs are being used in clinical practice: troglitazone, pioglitazone, and rosiglitazone.



Troglitazone is a peroxisome proliferators–activated receptor gamma agonist that enhances insulin sensitivity. Within one year after its widespread use, individual cases of liver injury and failure were reported. The mounting evidence for the idiosyncratic hepatotoxicity of troglitazone in the following years led to its withdrawal from the market in 2000.



Well, antidiabetic drugs are to be taken for long term, for life. For this reason, diabetic patients that are taking drug therapies should be monitored regularly. Although till now, antidiabetic drugs are still relatively 'liver-friendly', recent epidemiological studies suggested that patients with diabetes are twice as likely to suffer hepatic failure compared to patients who do not have diabetes. Increased incidences of hepatotoxicity have been observed in patients with diabetes receiving drug therapies.



We are not sure what is the mechanism or the predisposing factors for the hepatotoxicity in diabetic patients with drug therapies.



It is recommended that diabetic patients with drug therapies should have their liver function tests (LFT) regular (perhaps annually, or twice per year).