* First-line antituberculous drugs include isoniazid, rifampin, pyrazinamide, and ethambutol. Isoniazid, rifampin, and pyrazinamide are potentially hepatotoxic; ethambutol is not hepatotoxic.
¶ Liver function tests include measurement of serum bilirubin, alkaline phosphatase, and hepatocellular enzymes (alanine aminotransferase and aspartate aminotransferase).
Δ Alternative causes of elevated liver function tests include alcohol, acetaminophen, viral hepatitis, gallstones, biliary obstruction, and others.
◊ Signs and symptoms of hepatotoxicity include nausea, vomiting, malaise, low-grade fever, and anorexia. Refer to the UpToDate topic on drug-induced liver injury for further discussion.
§ The approach to subsequent monitoring depends on clinical circumstances; some favor checking liver function tests weekly until on a stable regimen, then every two to four weeks thereafter.
¥ There is overlap in the pattern of liver injury caused by rifampin, isoniazid, and pyrazinamide; all individually or in combination may contribute to hepatotoxicity.
‡ Intervals of treatment interruption warranting resumption of therapy from the beginning vary between initiation and continuation phases; refer to UpToDate text for further discussion.
† Refer to UpToDate content on treatment of tuberculosis for further discussion.Do you want to add Medilib to your home screen?