Hyperacute liver injury following intravenous fluconazole: A rare case of dose-independent hepatotoxicity

Gayam, Vijay; Khalid, Mazin; Dahal, Sumit; Garlapati, Pavani; Gill, Arshpal

doi:10.4103/jfmpc.jfmpc_330_17

Cited by 16 publications

(11 citation statements)

References 10 publications

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“…The pharmacokinetics, AE profile and potential drug-drug interactions of the three oral antifungal agents, terbinafine, itraconazole and fluconazole are summarized in Table 4. 83,89,90,94,100,101,[169][170][171][172][173][174][175][176][177] . Concentrations of systemic antifungal treatments persist for several months in the nails, which is beneficial as the drug can continue to exert its effects even after treatment has ended.…”

Section: Comparison Between Systemic Drugsmentioning

confidence: 99%

See 1 more Smart Citation

Onychomycosis: a review

Gupta

Stec

Summerbell

et al. 2020

Acad Dermatol Venereol

192

245

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Onychomycosis is a fungal infection of the nail, causing discoloration and thickening of the affected nail plate, and is the most common nail infection worldwide. Onychomycosis was initially thought to be predominantly caused by dermatophytes; however, new research has revealed that mixed infections and those caused by non‐dermatophyte moulds (NDMs) are more prevalent than previously thought, especially in warmer climates. Microscopy and fungal culture are the gold standard techniques for onychomycosis diagnosis, but high false‐negative rates have pushed for more accurate methods, such as histology and PCR. As NDMs are skin and laboratory contaminants, their presence as an infectious agent requires multiple confirmations and repeated sampling. There are several treatment options available, including oral antifungals, topicals and devices. Oral antifungals have higher cure rates and shorter treatment periods than topical treatments, but have adverse side effects such as hepatotoxicity and drug interactions. Terbinafine, itraconazole and fluconazole are most commonly used, with new oral antifungals such as fosravuconazole being evaluated. Topical treatments, such as efinaconazole, tavaborole, ciclopirox and amorolfine have less serious side effects, but also have generally lower cure rates and much longer treatment regimens. New topical formulations are being investigated as faster‐acting alternatives to the currently available topical treatments. Devices such as lasers have shown promise in improving the cosmetic appearance of the nail, but due to a high variation of study methods and definitions of cure, their effectiveness for onychomycosis has yet to be sufficiently proven. Recurrence rates for onychomycosis are high; once infected, patients should seek medical treatment as soon as possible and sanitize their shoes and socks. Prophylactic application of topicals and avoiding walking barefoot in public places may help prevent recurrence.

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Section: Comparison Between Systemic Drugsmentioning

confidence: 99%

“…The pharmacokinetics, AE profile and potential drug–drug interactions of the three oral antifungal agents, terbinafine, itraconazole and fluconazole are summarized in Table 4 83,89,90,94,100,101,169–177 …”

Section: Pharmacokinetics Adverse Effects and Potential Drug–drug Inmentioning

confidence: 99%

Onychomycosis: a review

Gupta

Stec

Summerbell

et al. 2020

Acad Dermatol Venereol

192

245

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“…The most common offending drugs are acetaminophen, nonsteroidal anti-inflammatory drugs, isoniazid, and amoxicillin/clavulanate [28]. However, there are several potential hepatotoxic agents of DILI leading to ALF [29][30][31].…”

Section: Molecular Adsorbent Recirculating System (Mars)mentioning

confidence: 99%

Liver Assist Devices for Liver Failure

Mandal¹,

Garlapati²,

Tiongson³

et al. 2021

Liver Pathology

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Historically, mortality rates for liver failure have been high, regardless of the type. With new advancements in liver transplantation (LTx), 1-year survival rates have improved up to 95% in most recent estimates. While some patients may live past the critical period, the majority of patients do not survive the interval period for awaiting LTx or liver regeneration. The function of the liver to detoxify and correct several biochemical parameters has been achieved to some extent through artificial liver support technology, although constant innovations are still being developed for the most optimal liver support device. The complex function of the liver makes it challenging since it does not only detoxify toxic by-products but also participates in numerous other synthetic and metabolic functions of the body. Liver support systems are divided into an artificial liver assist device (ALD) and a bioartificial liver assist device (BLD). ALDs include molecular adsorbent recirculating system (MARS), Prometheus, single-pass albumin dialysis, and selective plasma filtration therapy. These devices work as a blood purification system of the liver. On the other hand, BLD has hepatic cell lines incorporated in its equipment, which aims to function as a complex biological liver system providing support to its biochemical processes. Several clinical and randomized trials have conflicting results on the survival of the patients with acute liver failure (ALF), and the ideal liver support system still seems a far-off goal.

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“…Only a small proportion of fluconazole is processed by the liver and about 60-80% is eliminated from the body by the renal system [12]. Nevertheless, there are several reports of fluconazole induced hepatic and kidney toxicity [13,14]. According to recent information, the pre-existing liver toxicity is further complicated by the antifungal use of fluconazole [15].…”

Section: Introductionmentioning

confidence: 99%

Biochemical evaluation of Nigella sativa L. seeds on fluconazole toxicity in Wistar rats

Anwar

Nadeem

Alghamdi

et al. 2020

Journal of Taibah University for Science

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Nigella sativa L. seed commonly known as black seed, extensively used as a folk medicine in Middle East and Asian subcontinent. Traditionally it is used as an adjunct therapy along with modern medicine to counter the adverse effects. Pure thymoquinone or isolated compounds are not free from adverse effects. The present study was undertaken to evaluate N. sativa seeds powder impact on the fluconazole (FLZ) induced toxicities in the liver and kidneys. Male Wistar rats were acclimatized, divided into four groups each group with six animals. Experimental animals were subjected to an FLZ dose of 50 mg per kg of body mass. The toxic effects of FLZ treatment were manifested and animals were given 1000 mg of N. sativa seeds powder per kg of body weight to observe any retrieval. Dissected animals were evaluated for biochemical and histopathology alterations. Based on findings, it can be concluded that N. sativa seeds powder restored various altered biochemical parameters induced by fluconazole and can be used along with fluconazole in the treatment of fungal infections.

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Hyperacute liver injury following intravenous fluconazole: A rare case of dose-independent hepatotoxicity

Cited by 16 publications

References 10 publications

Onychomycosis: a review

Onychomycosis: a review

Liver Assist Devices for Liver Failure

Biochemical evaluation of Nigella sativa L. seeds on fluconazole toxicity in Wistar rats

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