Which medication should be avoided to prevent hepatotoxic injury in chronic hepatitis?

Which medication should be avoided to prevent hepatotoxic injury in chronic hepatitis?

• A. Ibuprofen
• B. Naproxen
• C. Acetaminophen
• D. Metformin

Answer: (C)

Acetaminophen should be avoided because chronic hepatitis increases the risk of hepatotoxic injury from this drug. A small portion of acetaminophen is metabolized to NAPQI, a highly reactive substance that damages liver cells. In healthy people, NAPQI is quickly detoxified by glutathione, but chronic liver disease depletes glutathione stores and impairs the detox pathways, so NAPQI can accumulate even at usual doses. Alcohol use and malnutrition can further amplify this risk, making acetaminophen more dangerous in liver disease. For this reason, acetaminophen is avoided or used at the smallest possible dose in chronic hepatitis. By contrast, NSAIDs carry bleeding and kidney risks in liver disease, and metformin is not the primary hepatotoxin, though hepatic impairment requires caution.

Acetaminophen should be avoided because chronic hepatitis increases the risk of hepatotoxic injury from this drug. A small portion of acetaminophen is metabolized to NAPQI, a highly reactive substance that damages liver cells. In healthy people, NAPQI is quickly detoxified by glutathione, but chronic liver disease depletes glutathione stores and impairs the detox pathways, so NAPQI can accumulate even at usual doses. Alcohol use and malnutrition can further amplify this risk, making acetaminophen more dangerous in liver disease. For this reason, acetaminophen is avoided or used at the smallest possible dose in chronic hepatitis. By contrast, NSAIDs carry bleeding and kidney risks in liver disease, and metformin is not the primary hepatotoxin, though hepatic impairment requires caution.