Liver Damage and Common Drugs: Diabetes and Hepatotoxicity

Did you know that diabetes is the 6th most common cause of death in the United States according to the CDC? Yeah, diabetes is a serious problem! But, if you think being diagnosed with type I or type II diabetes was worse enough, several drugs associated with diabetes can cause hepatotoxicity. Lets take a closer look!

Of the many drugs on the market today, the following 4 groups of drugs have been known to cause liver toxicity.

As you can see, Troglitazone was pulled off the market in 2000. This particular medication caused many deaths. “When considered as a whole, the pre-marketing clinical data and post-marketing safety data from Rezulin as compared to similar, alternative diabetes drugs indicate that continued use of Rezulin now poses an unacceptable risk to patients," said Dr. Janet Woodcock, Director of FDA's Center for Drug Evaluation and Research. But not only does troglitazone cause severe liver damage, any TZD does! Look at this tid bit of info, http://www.med.umich.edu/diabetes/profs/Page%206%20-%20Oral%20Medications-TZD.pdf. They help insulin work better in muscle and fat; they lower insulin resistance and have a small effect on slowing the release of sugar from the liver. Here are some side effects that might be helpful to you.

Headache
Muscle aches
Swelling or fluid retention

Looking back at the chart, a large class of liver damaging drugs is the sulfonylureas. They work by stimulating the beta cell in the pancreas to release more insulin.This class of drug is dangerous because they are extensively metabolized in the liver. In fact, Glimepiride (Amaryl), has an extremely high protein binding percentage of 99.5%! You can see how this might affect a patient, especially is they are taking other medications too. A common side effect of sulfonylurea drugs are low blood sugar, so one must need a lot of carbohydrates in their diet. Look at some of these other side effect as well.

skin reactions
stomach upset
increased sensitivity to the sun
brownish urine

Now let’s look at alpha-glucose inhibitors. These are more commonly known as starch blockers. The actions of these drugs are to slow or block the breakdown of starches and certain sugars in the intestines. This slows the rise in blood sugar levels following a meal, so this medication should be taken with food. "Although acarbose-induced hepatotoxicity appears to be uncommon, diabetic patients receiving long-term acarbose therapy should be closely monitored for this adverse effect." “patients and clinicians should recognize that dietary management is the principal consideration in the management of diabetes mellitus and that antidiabetic therapy is used only as an adjunct to, and not as a substitute for or a convenient means to avoid, proper dietary management.” So no matter what, proper nutrition is the key to this drug! If one does not begin to properly take care of themselves, or if a nurse doesn’t realize what the patient is eating, they may witness these signs and symptoms.