Iatrogenic Liver Disease

iatrogenic Jaundice "This is largely synonymous with drug jaundice. Drugs can produce jaundice in two ^ays. Firstly they can produce haemolysis and so overload a normal liver. Secondly they may produce actual liver disease, either by obstructing the intrahepatic biliary Canaliculi or by injuring the liver cells. In the second group obstructive jaundice is Produced by drugs such as methyl testosterone, chlorothiazide, thiouracil, sulphonoj*Udes, arsphenamine, chlorpropamide and chlorpromazine. Chlorpromazine is perhaps the best known of these drugs, because of its recent widespread use, and it causes Jaundice in a small percentage (about 1 per cent) of patients to whom it is administered. is usually stated that chlorpromazine jaundice is due to allergy on the part of the Patient, but not all the drugs in this group act in this way. Although obstructive Jaundice resulting from drugs may be persistent and severe, and may continue on rare ?ccasions for many months long after the drugs have been withdrawn, there is little eyidence suggesting that irreversible damage results to the liver and "primary" biliary Clrrhosis is probably not the end result of this type of reaction. Drugs which may injure liver cells and produce jaundice are far more numerous. fn a recent survey there were thought to be about 150 drugs which can act in this way deluding anti-epileptic, anti-tuberculous and anti-rheumatic agents and others. The ttiost recently recognized are the tranquillizer drugs particularly the amine oxidase ^hibitors such as iproniazid (Marsilid). With regard to Marsilid it has been shown that the clinical picture is practically indistinguishable from acute infective hepatitis, ?^though it is not necessary or indeed possible to remember all the drugs which can Cause jaundice it is necessary to remember that drugs can cause jaundice. An essential Part of the history of any patient with jaundice is to enquire about drugs being taken.