Possible role for acetylcysteine as a treatment for acute liver failure secondary to antitubercular medication use

Autor:	Marcus Tad Autry, Brooke E Nation, Ashley N Fox, Peter Johnson
Rok vydání:	2020
Předmět:	Adult medicine.medical_specialty Nausea medicine.medical_treatment Antidotes Antitubercular Agents Administration Oral Acetylcysteine 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Tuberculosis Antidote Pharmacology Liver injury business.industry Health Policy Mortality rate Liver Failure Acute medicine.disease Clinical trial Regimen 030220 oncology & carcinogenesis Vomiting Female 030211 gastroenterology & hepatology Chemical and Drug Induced Liver Injury medicine.symptom business medicine.drug
Zdroj:	American Journal of Health-System Pharmacy. 77:1482-1487
ISSN:	1535-2900 1079-2082
DOI:	10.1093/ajhp/zxaa202
Popis:	Purpose Drug-induced liver injury (DILI) that progresses to acute liver failure (ALF) has a high mortality rate, and therapeutic options are limited. Acetylcysteine has a labeled indication for use as an antidote for acetaminophen toxicity and has also been used with limited success in treatment of non–acetaminophen-induced liver injury, with small clinical trials indicating an increase in transplant-free survival. Recommendations for management of non–acetaminophen-induced DILI include withdrawal of the offending agent and supportive care. Treatment guidelines generally discourage a rechallenge with an offending medication, except in cases where there are no other therapeutic options for management of a serious disease, such as active tuberculosis (TB). Summary This case report describes the reversal of ALF due to DILI in a patient receiving antitubercular agents for active TB. After withdrawal of initially prescribed antitubercular agents, the patient was switched to a less hepatotoxic anti-TB regimen and intravenous acetylcysteine pending results of antimicrobial susceptibility testing. After stabilization of the patient’s liver enzyme levels, intravenous acetylcysteine was discontinued and oral acetylcysteine was continued for 5 days without an increase in hepatic enzyme levels or clinical deterioration. After 5 days, oral acetylcysteine was discontinued due to patient-reported nausea and vomiting. Conclusion Given the limited number of therapeutic interventions shown to be beneficial in ALF and data suggesting a protective effect against DILI with initiation of acetylcysteine at the start of treatment with anti-TB medications, acetylcysteine can be considered for patients with anti-TB – associated DILI.
Databáze:	OpenAIRE
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