This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 4. Hepatic And Biliary Disorders Chapter 43. Caused By Drugs Drugs are an important cause of liver damage. The mechanisms are variable, complex, and, in most instances, poorly understood. No classification of liver damage caused by drugs is completely satisfactory.
Some drugs can produce chronic damage, including tumors.
Mild jaundice can occur from drug-induced hemolysis with unconjugated hyperbilirubinemia, but no true hepatic damage occurs and liver function tests are normal. Liver damage is often not apparent until 2 to 5 days after ingestion of acetaminophen, when clinical and biochemical evidence of acute hepatocellular necrosis develops. Evidence also incriminates acetaminophen in chronic liver damage. Offending agents are numerous and include isoniazid, methyldopa, monoamine oxidase inhibitors, indomethacin, propylthiouracil, phenytoin, diclofenac, and the anesthetic halothane. Of these, isoniazid and halothane have been most thoroughly studied.