Tag Archives: Tegretol

5 Common Meds That Can Harm the Liver

Day in and day out, week after week and year after year, as you eat, drink and take medications or supplements, there’s an unsung hero working hard to filter and process all of these substances, store the nutrients and get rid of the waste: your liver. That adds up to lots of chances that something passing through might harm this vital organ. Numerous medications, for example, have been shown to increase the risk of liver damage – that goes for herbal medicines too, as well as dietary supplements.

“There is increasing evidence that complementary and alternative medicines such as supplements and herbs can cause liver damage. These include kava, Comfrey, mistletoe and others,” says Lauren Aleksunes, PharmD, PhD, associate professor of pharmacology and toxicology at the Ernest Mario School of Pharmacy at Rutgers University, and resident scientist at the Environmental and Occupational Health Sciences Institute. “Just because they can be purchased without a prescription does not mean they are safe.”

The following five over-the-counter (OTC) and prescription drugs are some of the most common medications known to cause liver damage, according to Norman P. Tomaka, MS, FAPhA, a consultant pharmacist and healthcare risk manager based in Melbourne, Florida, and media liaison for the American Pharmacists Association, with assistance from Javier Martiney, a current PharmD student from the University of South Florida.

1. Tylenol (acetaminophen)

A common remedy for mild pain and fever, this drug is known to cause liver damage by producing a toxic metabolite in the body that accumulates over time and causes a change in the structure of the liver, which lowers its ability to work normally. Other pain medicines that are commonly associated with liver injury include Advil (ibuprofen), Voltaren (diclofenac), and sulindac. “This is a predictable type of liver damage,” notes Aleksunes. “For other medications, liver damage is rare and not entirely predictable.”

2. Zyloprim (allopurinol)

This medicine is commonly used to treat gout and is sometimes used for the prevention of recurring kidney stones. It most commonly causes liver damage by provoking an allergic response in the body.

3. Amoxicillin/clavulanate

This is a combination of an antibiotic and a drug that prevents bacteria from destroying the antibiotic. It is used to treat bacterial infections including pneumonia, urinary tract infection and sinusitis. It is also believed to cause liver damage by triggering an allergic response in the body, but researchers have not yet figured out the exact process by which this happens. Other antibiotic and antifungal medicines that are commonly associated with liver injury include isoniazid, trimethoprim/sulfamethoxazole, erythromycin, nitrofurantoin, minocycline, and ketoconazole.

4. Lipitor (atorvastatin)

Statins, which are used to reduce cholesterol and triglycerides, can harm the liver. Atorvastatin is thought to cause liver damage by producing a toxic metabolite or provoking an allergic reaction, although the exact mechanism is unknown. Zocor (simvastatin), another statin, has also been associated with liver injury. Aleksunes adds that liver damage from these medications is usually mild and typically reversible after a patient stops taking the drug (with guidance from their health care provider, of course).

5. Depakote (valproate)

This medication is used to prevent some types of seizures in patients who have epilepsy. It is also used in the treatment of bipolar disorder and to prevent migraines. It can directly cause liver damage by depositing fats in liver cells – a condition known as steatosis – which lowers its ability to work normally. Other anti-seizure drugs that have been linked with liver damage include Tegretol (carbamazepine) and Dilantin (phenytoin).

Look for signs and symptoms of liver damage if you are taking one of these medications. These usually appear within six weeks of starting a drug and may include stomach pain, nausea, tiredness, dark urine, loss of appetite, itching, and yellow skin or eyes. Immediately contact your prescriber if you observe these symptoms.

In addition to medicines and supplements, “it is becoming increasingly evident that differences in a person’s genetics can heighten the risk of liver damage,” according to Aleksunes. She offers the following suggestions to help patients avoid these kinds of side effects.

  • Read the ingredients on medication labels. Beware of combination products that contain acetaminophen to make sure you are not taking more than one medicine containing this drug and that you that you do not exceed the daily recommended amount of 3000 mg. These include commonly used cough, cold, and pain medications. Labels may not list the word “acetaminophen” but instead may use abbreviations like APAP, AC, acetaminophen, acetaminoph, acetaminop, acetamin or acetam.
  • Similarly, the drug insert that you receive from the pharmacist will let you know if the prescribed medication can potentially cause liver damage.
  • Avoid acetaminophen if you drink 3 or more alcoholic drinks each day. Check in with your doc about other meds that may require lowering alcohol intake.
  • Talk to your pharmacist and health care providers about herbal and supplement medications, as some over-the-counter supplements can cause liver damage.

Tomaka also emphasizes the importance of taking your medicine as directed on the label or prescription. Never take a double dose at one time, and do not exceed the maximum daily dose noted on the label. If you have signs and symptoms of liver damage, your doctor may choose to stop your medication and prescribe a different one. A steroid might be prescribed to help lower inflammation caused by the injury, and an antihistamine such as Benadryl may be used to help with itching caused by allergy to the medicine.

Quick Hits: Americans Open to Non-Drug Pain Treatments, Psychiatric Drugs’ Impact on Cognition & More

More than three-quarters of Americans — 78% — say they are willing to try non-drug alternatives for pain before turning to prescription painkillers. Results from the Gallup-Palmer College of Chiropractic Annual Study of Americans show that 40% of Americans consider prescription painkillers such as opioids a “crisis” or “very serious problem.” And 55% of those who know about the nation’s opioid epidemic place some of blame on the drug industry’s encouraging physicians to prescribe opioids. Another 53% place a lot of blame on doctors overprescribing painkillers to patients. About 23% of those polled said prescription pain meds such as opioids are not very safe, and 8% said opioids are not safe at all. In 2015, more than two-thirds of the opioid deaths reported involved prescription opioids such as oxycodone, hydrocodone, morphine and fentanyl. Posted Sept. 13, 2017. Via Gallup.

Taking high doses of antipsychotic drugs over an extended period may be associated with poorer cognition in schizophrenia. However, taking low doses of antipsychotics such as benzodiazepines and antidepressants over a long time doesn’t affect cognition, according to a new study published in the journal European Psychiatry. The research also found that schizophrenia patients who took a long break from using antipsychotic drugs tended to see their cognitive function improve. Posted Sept. 5, 2017. Via EurekAlert/European Psychiatry.

Women who take antiepileptic drugs (AEDs) during pregnancy have a higher risk of having premature babies or babies that have a low birth weight for their age in the womb. Women with epilepsy who took AEDs while pregnant had a 9.3% increased risk of having a premature baby, while women without epilepsy who took an AED had a 10.5% increased risk, according to results published in the Annals of Neurology. Women who did not take a medication and didn’t have epilepsy had only a 6.2% increased risk of a premature baby. Compared to women who didn’t take an AED and didn’t have epilepsy, women with epilepsy who took one of the drugs gave birth to a child with a mean lower birth weight of 3.9 ounces. For women who took an AED and didn’t have epilepsy, the figure was 4.8 ounces. Common AEDs include Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamazepine), Keppra (levetiracetam) and Neurontin (gabapentin). Posted Sept. 11, 2017. Via Medical Express/Annals of Neurology.

FDA Approves First Pill to Treat All Types of Hepatitis C

The FDA has approved the first drug to treat all 6 forms of the hepatitis C virus, though it won’t come cheap: A 12-week treatment course has a list price of $74,760.

Epclusa (sofosbuvir/velpatasvir) was approved to treat chronic hepatitis C virus (HCV), both with and without cirrhosis of the liver. Sofosbuvir, better known under its brand name Solvadi, was already approved back in 2013 to treat 4 genotypes of the HCV. Velpatasvir is an entirely new drug.

The approval of the combination pill, taken once a day, is considered a boost for patients because other oral HCV treatments require genetic testing to determine if a particular drug will work on them.

Epclusa was tested in 3 late-stage clinical trials that included more than 1,500 people with mild liver cirrhosis or no cirrhosis at all. Results indicated that between 95% and 99% of patients who received Epclusa had no HCV detected in the blood 12 weeks after finishing treatment, an indication the infection has been cured.

Side Effects

The most common side effects seen in these trials were headache and fatigue. However, Epclusa’s labeling also includes a warning that serious slowing of the heart rate, a condition known as symptomatic bradycardia, has occurred. Additionally, there are cases in which some patients have needed a pacemaker when sofosbuvir was used in combination with Corderone or Pacerone (amiodorone), a medication used to treat abnormal heart beat.

Epclusa’s label carries a warning not to use with certain drugs that may reduce the amount of Epclusa in the blood, which could minimize its efficacy. The other drugs include the anticonvulsant and mood stabilizer Tegretol (carbamazepine); Rifadin (rifampin), an antibiotic used to treat tuberculosis; and the herbal supplement St. John’s wort.

HCV affects between 130 million and 150 million people worldwide, according to the World Health Organization.

Quick Hits: Opioids Tied to Heart Problems, Diabetes Meds Linked to Kidney Injury, & More

People who take an opioid medication for pain are at a higher risk for heart problems. Patients prescribed an opioid painkiller had a 64% higher risk of early death compared to patients given an another type of pain med, researchers reported in JAMA. Much of the increased risk was connected to difficulty breathing during sleep, as well as abnormal heartbeat and other cardiovascular complications. Some of the alternatives meds examined in the study were Neurontin (gabapentin), Lyrica (pregabalin) and Tegretol (carbamazepine), and some low doses of antidepressants. The authors concluded that long-acting opioids should be in favor of other meds, especially in people with existing cardiovascular issues or diabetes. Posted June 14, 2016. Via Healthday.

The FDA is strengthening existing warnings about kidney injury risk for a popular class of type 2 diabetes drugs. The medications, Invokana and Invokamet (canagliflozin), as well as Farxiga and Xigduo XR (dapagliflozin), belong to a relatively new class of drugs called sodium-glucose cotransporter-2 (SGLT2) inhibitors. Between March 2013 and October 2015, the agency said it received word of 101 cases of acute kidney injury associated with the meds. The FDA is advising doctors to monitor a patient’s kidney function prior starting and while on therapy, and avoid prescribing the drugs to patients who may be predisposed to kidney injury. Posted June 14, 2016. Via FDA.

The FDA is calling on drugmakers to conduct long-term bone quality studies for the development of new osteoporosis treatments. The agency says in its guidance that the nonclinical studies are needed to investigate whether long-term use of osteoporosis drugs results in poorer bone quality. Because the studies are not to be conducted in humans, the FDA says companies should conduct studies in 2 animal species. In addition, the FDA is advising drugmakers that are developing anabolic drugs for osteoporosis study whether they have the potential to cause cancer. The agency says previous studies have shown potential for bone tumor growth in mice and rats when given parathyroid hormone (PTH) and parathyroid hormone-related peptide (PTHrP) drugs. Posted June 13, 2016. Via Regulatory Affairs Professionals Society.