Medikamentös induzierte Leberschädigung

Kernaussagen

Epidemiologie und Pathogenese

• Die Inzidenz der arzneimitteltoxischen Hepatopathie liegt bei etwa 14 – 20 pro 100000 Einwohner.

• Die arzneimitteltoxischen Hepatopathien werden in den idiosynkratischen, nicht vorhersagbaren und den intrinsischen, vorhersagbaren Typ unterteilt.

• Zahlreiche nicht genetische und genetische Risikofaktoren für die Pathogenese des idiosynkratischen Typs sind näher charakterisiert.

Diagnostik und Therapie

• Die arzneimitteltoxische Hepatopathie kann nahezu jede Form einer akuten und chronischen Lebererkrankung – sowohl im klinischen Erscheinungsbild als auch laborchemisch und histologisch – imitieren.

• Der Schlüssel zur Diagnosestellung ist eine ausführliche, akkurate Anamnese. Die am häufigsten mit medikamentös-toxischer Hepatopathie in Verbindung stehenden Substanzgruppen sind Antibiotika, verschiedene Analgetika und nichtsteroidale Antirheumatika.

• Neben den klassischen Medikamenten muss auch der Einnahme pflanzlicher Präparate und naturheilkundlicher Medikamente Beachtung geschenkt werden.

• Im Allgemeinen ist die Prognose der arzneimitteltoxischen Hepatopathie als gut anzusehen. In den meisten Fällen ist eine Restitutio ad integrum zu erwarten und die Gefahr der Entwicklung einer klinisch relevanten chronischen Lebererkrankung als eher gering zu bewerten.

• Die wohl wichtigsten therapeutischen Maßnahmen sind die frühzeitige Identifikation und das alsbaldige Absetzen der auslösenden Substanz.

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