Elevated Liver Enzymes and Antibiotics
When the liver is injured or inflamed, it will release higher than normal amounts of enzymes into the bloodstream which can be detected during routine blood exams. Many prescription medications can cause an elevation in liver enzymes, including a variety of antibiotics. These antibiotics include tetracycline, sulfonamides, isoniazid, trimethoprim-sulfamethoxazole, fluconazole, trimethoprim, and nitrofurantoin.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Tetracycline
Tetracycline is commonly prescribed to treat bacterial infections including urinary tract infections, acne, gonorrhea, and chlamydia. Tetracyclines rarely affect the liver, except in cases where high doses are administered. However, patients with preexisting liver disease or biliary obstruction should be closely monitored.
Sulfonamides
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Sulfonamides work by preventing the growth of bacteria. Sulfonamides are linked to rare cases of drug-induced liver injury, which typically occurs 1-3 weeks of starting therapy. Symptoms include:
- fever
- rash
- facial edema
- lymphadenopathy
- arthralgias,
- eosinophilia
- with severity varying widely
Isoniazid
Isoniazid is used to treat tuberculosis. This antibiotic can raise liver enzymes more than 5 times the upper limit of normal ranges, but often return to normal without adjusting the dose administered. However, isoniazid can induce acute liver injury which can be severe and sometimes fatal. Symptoms include:
- nausea
- anorexia
- abdominal discomfort
- fatigue
- dark urine,
- jaundice
- Isoniazid is used to treat tuberculosis.
- However, isoniazid can induce acute liver injury which can be severe and sometimes fatal.
Trimethoprim with Sulfamethoxazole (TMP-SMZ)
Lisinopril & Elevated Liver Enzymes
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Trimethoprim-sulfamethoxazole (TMP-SMZ) is widely used for mild to moderate bacterial infections and as a preventive medication against opportunistic infections. TMP-SMZ can mildly elevate liver enzymes without leading to severe liver injury. However, this antibiotic has been ranked within the top 5 to 10 causes of drug-induced liver failure.
Fluconazole
Fluconazole is used in the treatment of superficial fungal infections. It can cause mild-to-moderate elevations in liver enzymes which are asymptomatic and typically resolve. Although rare, fluconazole can cause liver injury within the first few weeks of therapy. Symptoms include fever, rash, and eosinophilia.
- Fluconazole is used in the treatment of superficial fungal infections.
- Although rare, fluconazole can cause liver injury within the first few weeks of therapy.
Related Articles
References
- Cleveland Clinic. Cirrhosis of the Liver. Reviewed January 11, 2019.
- David S, Hamilton JP. Drug-induced Liver Injury. US Gastroenterol Hepatol Rev. 2010;6:73–80.
- American Liver Foundation. Medications.
- Cleveland Clinic Health Essentials. Is Acetaminophen Safe to Take When You're Drinking? Published December 19, 2017.
- University of Michigan, Michigan Medicine. Methyldopa. Revised September 17, 2018.
- Elsevier Science Direct. Hypervitaminosis A. Published 2015.
- National Center for Biotechnology Information, U.S. National Library of Medicine. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury: Vitamin A. Updated December 3, 2013.
- National Center for Biotechnology Information, U.S. National Library of Medicine. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury: Niacin. Updated February 2, 2014.
- Amathieu R, Levesque E, Merle JC, et al. Insuffisances hépatiques aiguës sévères d'origine toxique : prise en charge étiologique et symptomatique [Severe toxic acute liver failure: etiology and treatment]. Ann Fr Anesth Reanim. 2013;32(6):416–421. doi:10.1016/j.annfar.2013.03.004
- Devarbhavi H. An Update on Drug-induced Liver Injury. J Clin Exp Hepatol. 2012;2(3):247–259. doi:10.1016/j.jceh.2012.05.002
- Johns Hopkins Medicine. Drug-Induced Hepatitis.
Writer Bio
Destiny Simmons has worked as a professional health writer since 2005. She specializes in health and nutrition articles. Her work has appeared in various health Web sites. Destiny holds a Bachelors of Science in nursing from Boston University and a Master of Public Health Nutrition from Tufts University.