Chest
Clinical InvestigationsInfectionsHepatotoxicity Associated With Acetaminophen Usage in Patients Receiving Multiple Drug Therapy for Tuberculosis
Section snippets
Case 1
A woman born in 1960, had been receiving treatment for drug-resistant tuberculosis with isoniazid, rifampin, pyrazinamide, and streptomycin since her immigration from the Philippines in December 1990. In May 1991, she was hospitalized 24 h after ingesting 15 to 20 tablets of acetaminophen (300 mg acetaminophen per tablet); an ingestion of 4.5 to 6.0 g of acetaminophen. She complained of abdominal pain.
On physical examination, the liver was palpable 2 cm below the right costal margin. Admission
Comments
In this report, we described three patients being treated for active tuberculosis who experienced hepatotoxicity in temporal association with the ingestion of acetaminophen. The circumstances were disparate. One patient (patient 1) intentionally took a relatively large amount of acetaminophen; another (patient 2) took acetaminophen in combination form for a minor upper respiratory illness; the remaining one (patient 3) took it in order to ameliorate the symptoms of fever and malaise that were
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Rationally designed nanoparticulate delivery approach for silymarin with natural bio-enhancer: In vitro characterization and in vivo evaluations of hepatoprotective effects in a mouse model
2023, Journal of Drug Delivery Science and TechnologyAcetaminophen-related Hepatotoxicity
2013, Clinics in Liver DiseaseCitation Excerpt :Concomitant use of medications that induce the CYP system, such as anticonvulsants (eg, phenobarbital, phenytoin, and carbamazepine) and antituberculosis agents (eg, isoniazid and rifampicin), may predispose to APAP hepatotoxicity by increased production of NAPQI by way of the oxidative pathway.15,36,37 Severe APAP hepatotoxicity associated with the concurrent use of these medications has been anecdotally reported, although there are no compelling data that this occurs at a therapeutic dose.36,37 Phenytoin is primarily metabolized by CYP3A4 and not CYP2E1 and as such there is an insignificant amount of APAP metabolite being produced.
Acetaminophen: Pathology and clinical presentation of hepatotoxicity
2013, Drug-Induced Liver DiseaseHepatotoxicity of antitubercular drugs
2013, Drug-Induced Liver DiseaseEffects and mechanisms of rifampin on hepatotoxicity of acetaminophen in mice
2012, Food and Chemical ToxicologyCitation Excerpt :There are evidences that rifampin elevates the levels of P450 and cytochrome b5 and the activities of cytochrome c reductase and substrate-metabolizing enzymes both in liver and small intestine (Huang et al., 1996). Some patients experienced hepatotoxic reactions after using acetaminophen while underwent treatment for active tuberculosis with rifampin, isoniazid, and other agents (Nolan et al., 1994). Human pregnane X receptor (PXR) is involved in regulation of acetaminophen-induced toxicity through CYP3A4 mediated hepatic metabolism of acetaminophen in the presence of PXR ligands, thus, some PXR activators, such as rifampin may induce acetaminophen’s toxicity (Cheng et al., 2009).
Covalent functionalization of graphene oxide with l-lysine for highly sensitive and selective simultaneous electrochemical detection of rifampicin and acetaminophen
2023, Journal of Applied Electrochemistry
Manuscript received April 16; revision accepted May 27.