OTC medications and supplements are most common causes of drug-induced liver failure

http://www.eurekalert.org/pub_releases/2015-03/uops-pso030315.php

Public Release: 3-Mar-2015
University of Pennsylvania School of Medicine

Drug-induced acute liver failure is uncommon, and over-the-counter medications and dietary and herbal supplements -- not prescription drugs -- are its most common causes, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The findings are published in the current issue of Gastroenterology.

One of the most feared complications of drugs and medications is acute liver failure, traditionally associated with a greater than 50 percent chance of dying without a liver transplant. Drug-induced liver injury, known as hepatotoxicity, is the second most common reason drugs are withdrawn from the market, behind cardiac toxicity, according to the U.S. Food and Drug Administration (FDA). The Penn authors, however, say this is based solely on abnormal liver tests, not actual liver damage. The real risk of acute liver failure that the researchers calculated was 1.61 per million people per year.

[Surely there would be more cases of drug-induced liver failure if drugs hadn't been withdrawn based on abnormal liver tests.]

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Among the 5,484,224 patients evaluated, 62 were identified with acute liver failure, nearly half of which were drug-induced. Acetaminophen was implicated in 56 percent of cases, dietary/herbal supplements in 19 percent, antibiotics in 6 percent and miscellaneous medications in 18 percent.

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In addition, the researchers believe these findings could inform more aggressive regulation of the dietary and herbal supplements industry, which has been linked to other toxicities, including kidney toxicity induced by some herbs and heart problems, which have been associated with the herb ephedra, making it no longer available in the U.S..

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