JAMA Intern Med

Real-world analysis identifies the most hepatatoxic medications

June 27, 2024

This series of cohort studies comprising 7.8 million persons without liver or biliary disease who initiated any of 194 suspected hepatotoxic medications in a VA outpatient setting from 2000 to 2021 found that 17 medications had rates of severe acute liver injury (ALI) at 5.0 or more events per 10,000 person-years, representing the most potentially hepatotoxic medications; 11 of these medications weren't included in the highest hepatotoxicity category as determined by case reports.

• Of 7,899,888 patients across 194 medication cohorts (mean age, 64.4 years; 92.5% male), 55.1% had polypharmacy.
• Incidence rates of severe ALI ranged from 0 events per 10,000 person-years (candesartan, minocycline) to 86.4 events per 10,000 person-years (stavudine).
• Seven medications (stavudine, erlotinib, lenalidomide or thalidomide, chlorpromazine, metronidazole, prochlorperazine, and isoniazid) exhibited rates of 10.0 or more events per 10,000 person-years, and 10 (moxifloxacin, azathioprine, levofloxacin, clarithromycin, ketoconazole, fluconazole, captopril, amoxicillin-clavulanate, sulfamethoxazole-trimethoprim, and ciprofloxacin) had rates between 5.0 and 9.9 events per 10,000 person-years.
• Of these 17 medications with the highest observed rates of severe ALI, 11 (64%) were not included in the highest hepatotoxicity category when based on case reports.

Source:

Torgersen J, et al. (2024, June 24). JAMA Intern Med. Severe Acute Liver Injury After Hepatotoxic Medication Initiation in Real-World Data. https://pubmed.ncbi.nlm.nih.gov/38913369/