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Liver & GIT

4 out of 4

Which of the flowing drug lead to liver fibrosis?(DNB JUN 11)

A Methotrexate

C Erythromycin
D Non of the above

Ans. A Methotrexate

Liver and Drug induced hepato toxicity (Ref. H-18thedi, Pg 2562)

Cholestatic Reactions

Non Inflammatory (Bland)


Bland cholestasis is characterized by cholestasis in the absence of inflammation (hepatitis)

This is believed to result from inhibition of various hepatobiliary transport systems.

Important drugs causes bland cholestasis

1. Estrogen and OCP

2. Anabolic steroids

3. Indinavir

4. Mercaptopurine

6. Cyclosporine

Inflammatory cholestasis is characterized by inflammation of portal tracts with bile duct injury often associated with allergic features like eosinophilia

Important drugs causing inflammatory cholestasis

1. Amoxicillin – Clavulanic acid

2. Azathioprine

3. Azithromycin

4. Captopril

5. Cephalosporins

6. Chlorothiazide

7. Chlorpromazine

8. Penicillamine

9. Semisynthetic penicillins

10. Sulpha drug

Examples Of Common Causes Of Drug-Induced Hepatotoxicity

1. Cholestasis Chlorpromazine, High-dose oestrogens

2. Cholestatic hepatitis NSAIDs, Co-amoxicillin, Statins

3. Acute hepatitis Rifampicin, Isoniazid, Pyrazinamide

4. Non- alcoholic steatohepatitis Amiodarone

5. Venous outflow obstruction Busulfan, Azathioprine

6. Fibrosis Methotrexate

7. Granulomatous hepatitis Phenyl Butazone, allopurinol, INH, carbamazepine,