Uğur GÖNLÜGÜR, İbrahim AKKURT

RİFAMPİSİN VE HEPATOTOKSİSİTE

Safraya yüksek derecede afinite gösteren bir antibiyotik olan rifampisin antitüberküloz tedavide değerli bir ilaçtır. Toksisitesi esas olarak hepatik ve immünolojiktir. Bununla beraber rifampisin nadiren ciddi toksisiteye neden olmaktadır. Bilirubinin karaciğerce alımını ve atılımını bozduğundan, kullanımının ilk 2-3 haftası esnasında plazma konjuge ve ankonjuge bilirubin düzeylerini yükseltebilir. Tedavi başlandığında karaciğer enzimlerinde ve plazma bilirubininde yükseklik meydana gelebilir ancak bunlar çoğunlukla geçici olup ilacın kesilmesini gerektirmez. Biz bu yazımızda rifampisinin neden olduğu hepatotoksisiteyi inceledik.

Anahtar Kelimeler:

Rifampisin, hepatotoksisite, bilirubin

RIFAMPICIN AND HEPATOTOXICITY

Rifampicin, a highly cholephilic antibiotic, is a valuable drug for antituberculous therapy. Its toxicity is predominantly hepatic and immunologic. However, rifampicin rarely causes serious toxicity. It impairs hepatic uptake and excretion of bilirubin; plasma conjugated and unconjugated bilirubin levels may be elevated during the first 2-3 weeks of dosing. Rises in plasma bilirubin and hepatic enzymes may occur when treatment starts but are often transient and not necessarily an indication for stopping the drug. We reviewed rifampicin-induced hepatotoxicity in this paper.

Keywords:

Rifampicin, hepatotoxicity, bilirubin,

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1. American Thoracic Society/Centers for Disease Control and Prevention: Treatment of tuberculosis infection in adults and children. Am Rev Respir Dis 1994; 149: 1359-74.
2. Kiter G. Tüberküloz tedavisi ve hepatotoksisite. Tüberküloz ve Toraks Dergisi 2000; 48: 259-65.
3. Durand F, Jebrak G, Pessayre D, et al. Hepatotoxicity of antitubercular treatments. Rationale for monitoring liver status. Drug Saf 1996; 15: 394-405.
4. Tahao¤lu K, Atac G, Sevim T, et al. The management of anti-tuberculosis drug-induced hepatotoxicity. Int J Tuberc Lung Dis 2001; 5: 65-9.
5. Kuru U, Senli S, Turel L, et al. Age-specific seroprevalence of hepatitis B virus infection. Turk J Pediatr 1995; 37: 331-8.
6. Turktas H, Unsal M, Tulek N, Oruc O. Hepatotoxicity of antituberculosis therapy (rifampicin, isoniazid and pyrazinamide) or viral hepatitis. Tuber Lung Dis 1994; 75: 58-60.
7. Steel MA, Burk RF, DesPrez RM. Toxic hepatitis with isoniazid and rifampin. Chest 1991; 99: 467-71.
8. Scheuer PJ, Summerfield JA, Lal S, Sherlock S. Rifampicin hepatitis. A clinical and histological study. Lancet 1974; 1: 421-5.
9. Poole G, Stradling P, Worlledge S. Potentially serious side effects of high-dose twice-weekly rifampicin. Br Med J 1971; 3: 343-7.
10. Sors CH, Sarrazin A, Homberg JC. Accidents hémolytiques récidivants d’origine immuno-allérgique au cours d’un traitement intermittent par la rifampicine. Rev Tuberc Pneumol 1972; 36: 405-16.
11. Murthy GD, Byron D, Shoemaker D, et al. The utility of rifampin in diagnosing Gilbert’s syndrome. Am J Gastroenterol 2001; 96: 1150-4.
12. O’Brien RJ. Hepatotoxic reaction to antituberculous drugs: Adjustments to therapeutic regimen. JAMA 1991; 265: 3323.
13. Grosset J, Leventis S. Adverse effects of rifampin. Rev Infect Dis 1983; 5 (Suppl 3): S440-50.
14. Capelle P, Dhumeaux D, Mora M, et al. Effect of rifampicin on liver function in man. Gut 1972; 13: 366-71.
15. Tacquet A, Savinel E, Devulder B, Duthoit A. La rifampicine dans le traitement de la tuberculose pulmonaire. Note préliminaire. Acta Tuberc Pneumol Belg 1969; 60: 529-44.
16. Pieron R, Marien C, Jagueux M. Jaundice et rifampicin. Sem Hop 1971; 47: 1286-95.
17. Hoensch HP, Balzer K, Dylewizc P, et al. Effect of rifampicin treatment on hepatic drug metabolism and serum bile acids in patients with primary biliary cirrhosis. Eur J Clin Pharmacol 1985; 28: 475-7.
18. Steele MA, Burk RF, Des Prez RM. Toxic hepatitis with isoniazid and rifampin. Chest 1991; 99: 465-71.
19. Gregorio GV, Ball CS, Mowat AP, Mieli-Vergani G. Effect of rifampicin in the treatment of pruritus in hepatic cholestasis. Arch Dis Child 1993; 69: 141-3.
20. Prince MI, Burt AD, Jones DE. Hepatitis and liver dysfunction with rifampicin therapy for pruritus in primary biliary cirrhosis. Gut 2002; 50: 436-9
21. Yerushalmi B, Sokol RJ, Narkewicz MR, et al. Use of rifampin for severe pruritus in children with chronic cholestasis. J Pediatr Gastroenterol Nutr 1999; 29: 442-7.
22. Bachs L, Pares A, Elena M, et al. Effects of longterm rifampicin administration in primary biliary cirrhosis. Gastroenterology 1992; 102: 2077-80.
23. Van Steenbergen W, Vermylen J. Reversible hypoprothrombinemia in a patient with primary biliary cirrhosis treated with rifampicin. Am J Gastroenterol 1995; 90: 1525-8.
24. LaPerche Y, Graillot C, Arondel J, Berthelot P. Uptake of rifampicin by isolated rat liver cells. Interaction with sulfobromophtalein uptake and evidence for separate carriers. Biochem Pharmacol 1979; 28: 2065-9.
25. Erlinger S. Drug-induced cholestasis. J Hepatol 1997; 26 (Suppl 1): 1-4.
26. Morere P, Bourreille J, Matray F, et al. Essais cliniques de la rifadine (rifampicine). Rev Tuberc (Paris) 1969; 33: 177-98.
27. Çobanl› B, Ac›can T, Ayas G, Çak›r M, Zeydan E. Akci¤er tüberkülozlu 1026 olgunun klinik, bakteriyolojik, radyolojik ve tedavi yaklafl›mlar› aç›s›ndan de¤erlendirilmesi. Tüberküloz ve Toraks Dergisi 1994; 42: 252-6.
28. Ortaköylü G, Balo¤lu I, Bahad›r A ve ark. Tüberküloz tedavisi s›ras›nda ortaya ç›kan hepatotoksisite. Tüberküloz ve Toraks Dergisi 1999; 47: 68-72.
29. Utkaner G, Y›lmaz U, Yaln›z E ve ark. ‹zoniazid, rifampin ve morfozinamid hepatotoksisitesinin yafl ve cinsiyetle iliflkisi. Tüberküloz ve Toraks Dergisi 1999; 47: 329-35

ISSN: 1300-4115
Yayın Aralığı: 3
Başlangıç: 1986
Yayıncı: Ali Cangül

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