Experts remind: liver damage caused by Chinese medicine can not be ignored

[ China Pharmaceutical Network Health Health ] Unreasonable drug use and drug abuse are the most serious situation facing China at present. As the saying goes, "it is a three-point drug." If you use the wrong medicine or hurt your body, you will not get twice the result with half the effort.

(Expert reminder: liver damage caused by Chinese medicine can not be ignored. Source: Baidu pictures)

Professor Mao Yimin, chief physician of the Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, said: "Even if it is a common disease like a cold, I definitely do not recommend that the patient diagnose his own medication." He specializes in the diagnosis and treatment of drug-induced liver damage. I have seen tens of thousands of patients with liver damage caused by medication. They are light and heavy, old and young, and even lost their lives. Therefore, he reminded that drug-induced liver damage is a problem that needs to be widely concerned. Medical staff and ordinary people need to acquire relevant knowledge and avoid the physical harm caused by drugs as much as possible.

Drugs can prevent liver damage? Not preventable?

Speaking of liver damage, the people will think of the increase in transaminase, but Professor Mao informed that elevated transaminase is only a manifestation of drug-induced liver damage. In fact, drugs can cause all types of liver damage, such as acute hepatitis caused by medication. Acute liver failure, cholestasis, fatty liver, chronic hepatitis, liver fibrosis, cirrhosis, liver vascular disease, liver tumors, etc. Therefore, drug-induced liver damage is a very serious problem and must be prevented. So can you prevent it?

Professor Mao pointed out that in order to prevent drug-induced liver damage, it is first necessary to understand how drug-induced liver damage occurs. Under normal circumstances, drug-induced liver damage is mainly divided into the following two cases:

(1) The drug itself or the metabolite of the drug has a direct toxic effect on the liver. The greater the dose, the greater the risk of damage to the liver. This is an intrinsic drug-induced liver damage, the occurrence of liver damage and this pair The liver has a "toxic" that is directly toxic. The most typical of these is the "acetaminophen" component of cold medicine, which has a direct toxic effect on the liver.

Because it has been shown that drugs or metabolites have direct hepatotoxic effects, such liver damage is relatively easy to prevent, try to avoid, or reduce the dose of drugs, can reduce the risk of liver damage.

(2) More clinically encountered drug-induced liver damage. Such liver damage may not be related to the drug itself, because these drugs or metabolites are not directly toxic to the liver, and most people do not have liver damage. However, in some specific populations, liver damage occurs. The liver damage that occurs at this time is more related to the "human" of the drug, because these people have different metabolism of drugs and other people, or they Some ingredients of the drug are allergic. This type of liver damage is more difficult, and there is no way to prevent it in advance.

Therefore, Professor Mao said that it is best to avoid the use of drugs known to have hepatotoxicity, and to avoid the use of drugs that have previously caused liver damage, so as to prevent the occurrence of drug-induced liver damage to the greatest extent. In addition, it is often difficult to predict whether an individual will have liver damage for the first time. From the patient's point of view, it is necessary to follow the doctor's advice, rather than self-medication; at the same time, should tell the doctor whether the previous medication has a history of liver damage and history of allergies.

In addition, Professor Mao reminded older people and young children to be more alert to drug-induced liver damage. The metabolic function of the liver of the elderly will decline, and elderly patients are often accompanied by a variety of chronic diseases. The variety of drugs used and the dose is large, so the risk of liver damage increases. The liver development of infants and young children is not yet mature, so if the drug is used, it may lead to insufficient drug metabolism, and the liver is prone to damage. Therefore, these two groups of people should be more cautious in medication, and should not use drugs.

How to prevent drug-induced liver damage in patients with chronic diseases?

There are more and more patients with chronic diseases, such as diabetes, high blood pressure, hyperlipidemia, and coronary heart disease. There seem to be a few patients around. These patients need long-term medication, so how can they prevent liver damage?

Professor Mao said that from the perspective of prevention and treatment of chronic diseases, it is obvious that patients with chronic diseases can delay the progress of the disease, control the disease and prevent complications. But in theory, all drugs can cause liver damage, and naturally the drugs used in these chronic diseases may also cause liver damage. But in most cases, the liver damage caused by the drugs used in these diseases can be adapted by the body. For example, liver damage caused by statins, these drugs are the main treatment for reducing cardiovascular and cerebrovascular risk, but some patients will have elevated transaminase after use, but most of them tend to adapt. The reaction, that is to say the liver damage caused by statins, is usually only mild to moderate elevation of transaminase. Studies in Europe and the United States have shown that the proportion of people with acute liver failure who are actually taking statins is extremely low. Therefore, although statins can cause elevated transaminase, compared with clinical benefits, its overall benefits outweigh the disadvantages, and can significantly reduce the risk of cardiovascular and cerebrovascular diseases, so it is still widely used in clinical practice.

Professor Mao pointed out that since patients with chronic diseases inevitably use drugs, in order to avoid serious damage to the liver, the most important thing for patients to do is to monitor liver function while applying drugs. The frequency of monitoring liver function is also subject to availability, and doctors will give patients different monitoring strategies for different situations. For example, for drugs that are more likely to cause liver damage, the frequency of monitoring can be higher; when adjusting the drug, it can also be monitored after using new drugs; for drugs that cause lower risk of liver damage, the frequency of monitoring can be It takes a little longer. In short, patients should pay attention to liver function monitoring and take the initiative to monitor, but do not have to take it as a burden and monitor it too frequently. When the patient is unsure, the most important thing to do is to communicate with the attending doctor and follow the doctor's advice.

Liver damage caused by traditional Chinese medicine cannot be ignored

Professor Mao specifically reminded that Chinese medicine causes liver damage is a very important issue. Because the clinical discovery that the people have a lot of misunderstandings about traditional Chinese medicine, most people think that Chinese medicine is natural, non-toxic and harmless, and has no side effects. This is a completely wrong understanding. In fact, there is a considerable proportion of clinically caused liver damage in Chinese medicine. Professor Mao said that he had encountered many patients with liver injury caused by taking Chinese medicine in the clinic. He had liver damage only one month after taking the cream, and he also encountered cirrhosis caused by long-term use of traditional Chinese medicine.

In 2015, in 303 hospitals across the country, inpatients were investigated for the epidemiology of drug-induced liver injury. The investigation found that liver damage caused by herbs and proprietary Chinese medicines accounted for about 30%. Moreover, the problems caused by herbs and proprietary Chinese medicines, especially those caused by herbs, are often more complicated. Because the chemical structure of western medicine is clear, but there are many ingredients in the herbs, what kind of ingredients cause liver damage? It is difficult to identify. Or the herbs themselves have no problems, but are contaminated by heavy metals during the planting process? It is also difficult to identify.

Because the onset time of Chinese medicine is relatively slow, it often takes several months to take effect. The patient takes a long time. In this long process, liver damage may have occurred. Therefore, patients who are taking Chinese medicine need to check their liver function regularly. In order to avoid major problems in the liver without knowing it.

How to treat drug-induced liver damage?

"The diagnosis of drug-induced liver injury is very challenging," said Professor Mao. Any other cause should be ruled out before the diagnosis of drug-induced liver damage. Especially for patients with underlying liver disease, it is necessary to carefully identify the drug-induced liver damage before diagnosis.

For example, the patient has fatty liver and hepatitis B. Then, at this time, is the patient's liver damage caused by fatty liver? Or is it caused by hepatitis B? Or is it caused by drugs? In the case of such a patient, it is first necessary to see whether the liver injury can be explained by fatty liver or by hepatitis B. If it is finally considered that it cannot be explained by fatty liver or hepatitis B, and the patient has a clear history of drug application. Then, it may be inclined to consider that the patient's liver damage is caused by drugs. The diagnosis of drug-induced liver damage is also closely related to the doctor's experience. However, it is quite difficult to differentiate the diagnosis in the clinic. After regular follow-up, it is often necessary to judge the liver damage caused by the evolution of the basic liver disease and the evolution of liver injury.

Once the diagnosis is a drug-induced liver damage, the first step in treatment is to discontinue the suspected drug. At the same time as the diagnosis of drug-induced liver damage, it is necessary to determine which kind of drug is caused. It is very important to find the culprit. In this case, the patient should be told to avoid using the same drug again. Otherwise, it may cause liver damage after re-use. Even more severe liver damage.

However, Professor Mao informed that in some cases, clinical withdrawal may lead to the progress of the primary disease, such as tuberculosis patients, anti-tuberculosis drugs are also easy to cause liver damage, but at this time without anti-tuberculosis drugs, tuberculosis will progress; or some cancer patients Without the anti-tumor drugs, the tumor will progress. So what should I do? Professor Mao informed that when suspicious drugs cannot be stopped, the benefits of the drug to treat the primary disease and the risk of liver damage may be fully weighed. If there is no way to stop the drug, there are still many liver-protecting drugs in China, and some liver-protecting drugs can be used to protect the liver. The most important are glycyrrhizic acid drugs, among which magnesium isoglycyrrhizinate is the only drug in the specification for the treatment of acute drug-induced liver injury, which can treat acute drug-induced liver damage. If acute liver failure occurs, then N-acetylcysteine ​​should be used as soon as possible, which is recommended in both US guidelines and Chinese guidelines. If it is a more serious situation, you may need to have a liver transplant if necessary.

Patients cannot diagnose their own medication

Now that you can buy a lot of over-the-counter drugs at pharmacies, how do you use over-the-counter drugs? Professor Mao said that even a common disease like a cold is not very recommended for patients to diagnose their own medication. Although many drugs in pharmacies are over-the-counter drugs, patients can easily buy them, but the patients themselves are not professional doctors, nor professional pharmacists. It is difficult to use drugs, and they do not understand the drug properties. I don't know. Drug contraindications and usage, do not know which drugs can not be used at the same time, so it is easy to have serious problems. It has been mentioned that acetaminophen contained in cold medicine has occurred in nearly half of patients with acute liver failure in Europe and the United States after using a drug containing this ingredient. Therefore, the risk of liver damage is caused by using a cold medicine. Very big. Therefore, Professor Mao suggested that if you are sick, you should not use drugs indiscriminately. Instead, you should go to the hospital in time to see a doctor and use the medicine under the guidance of a doctor.

At the same time, Professor Mao suggested that you read the drug instructions carefully before using any drugs. The instructions provided are supported by experimental evidence. There are contraindications on the above, and there will be adverse reactions. There are doses and treatments, and there are precautions. All of this needs to be understood before taking the medicine. If you don't understand, you should consult a professional doctor or pharmacist.

Finally, Professor Mao reminded that drugs should never be used together with alcohol or tea.

Drugs and wine are very easy to cause serious liver damage, especially for people who drink for a long time. Once liver damage occurs, the situation is often very heavy, even fatal. Therefore, people who like to drink alcohol are advised to take care of their mouths while taking drugs and not to drink alcohol. Drugs can't be used with tea because they contain theophylline, which has an effect on certain drugs.

Health care products should not be eaten indiscriminately, and may also cause liver damage, which is common in clinical practice.

In addition, the drug is actually a chemical, and there are many chemicals in life, so it is also necessary to pay attention to the chemicals in contact with life can also cause liver damage. For example, hair dyes, most people have no problem after dyeing hair, but there will still be a small number of people with liver damage. So try to avoid contact with chemicals and avoid liver damage.