Table 1. Main pharmacological agents used by hepatobiliary surgeons, hepatotoxic potential (according to Livertox®) and specific damage patterns and phenotypes associated to these drugs.
| Agents | Hepatotoxic potential | Pattern of damage | Specific phenotype |
|---|---|---|---|
| Anticoagulants | |||
| Low molecular weight heparins | E | Hepatocellular | Asymptomatic hypertransaminasemia |
| Fondaparinux | E | Hepatocellular | Asymptomatic hypertransaminasemia |
| NSAIDs | |||
| Ibuprofen | A | Hepatocellular/Cholestatic | Immunoallergic-like syndrome |
| Acute liver failure | |||
| Vanishing bile duct syndrome | |||
| Flurbiprofen | C | Cholestatic/Hepatocellular | Asymptomatic hypertransaminasemia |
| Acute liver failure | |||
| Naproxen | B | Hepatocellular/Cholestatic | Asymptomatic hypertransaminasemia |
| Acute liver failure | |||
| Diclofenac | A | Hepatocellular/Cholestatic | Asymptomatic hypertransaminasemia |
| Acute liver failure | |||
| Immunoallergic-like syndrome | |||
| Autoimmune-like hepatitis | |||
| Chronic hepatitis | |||
| Piroxicam | B | Cholestatic | Asymptomatic hypertransaminasemia |
| Acute liver failure | |||
| Vanishing bile duct syndrome | |||
| Pyrazolone derivatives | |||
| Metamizole | NA | Hepatocellular | Acute hepatitis |
| Autoimmune-like hepatitis | |||
| Antibiotics | |||
| Amoxicillin-clavulanate | A | Cholestatic (older people)/Hepatocellular (young people) | Acute hepatitis |
| Autoimmune-like hepatitis | |||
| Immunoallergic-like syndrome | |||
| Vanishing bile duct syndrome | |||
| Cephalosporins | B | Cholestatic/mixed | Acute hepatitis |
| Immunoallergic-like syndrome | |||
| Penicillins (2nd generation) | B/C | Cholestatic/Hepatocellular | Asymptomatic hypertransaminasemia |
| Immunoallergic-like syndrome | |||
| Piperacillin-Tazobactam | B | Cholestatic/mixed | Prolonged cholestasis |
| Immunoallergic-like syndrome | |||
| Ciprofloxacin | B | Hepatocellular/Cholestatic | Acute hepatitis |
| Chronic cholestasis | |||
| Vanishing bile duct syndrome | |||
| Meropenem | D | Cholestatic | Asymptomatic hypertransaminasemia |
| Acute hepatitis | |||
| Vanishing bile duct syndrome | |||
| Metronidazole | C | Hepatocellular | Asymptomatic hypertransaminasemia |
| Acute hepatitis | |||
| Vancomycin | B | Hepatocellular | Asymptomatic hypertransaminasemia |
| Immunoallergic-like syndrome | |||
| Acute liver failure | |||
| Tigecycline | E | NA | Asymptomatic hypertransaminasemia |
| Antifungal | |||
| Amphotericin B | C | Hepatocellular/mixed | Asymptomatic hypertransaminasemia |
| Acute cholestasis | |||
| Azoles | B | Hepatocellular | Asymptomatic hypertransaminasemia |
| Immunoallergic-like syndrome | |||
| Echinocandins | D | NA | Asymptomatic hypertransaminasemia |
| Acute hepatitis | |||
Likelihood score: A (well known cause of clinically apparent liver injury), B (highly likely cause of clinically apparent liver injury), C (probable rare cause clinically apparent liver injury), D (possible rare cause of clinically apparent liver injury), E (unproven but suspected cause of clinically apparent liver injury, largely due to bleeding episodes). NSAIDs, nonsteroidal anti-inflammatory drug; NA, no available.