Một ống truyền dinh dưỡng có thể là cần thiết ở những bệnh nhân không thể chịu đựng được thuốc đường uống. Oral N-acetylcystein có tác dụng phụ không nghiêm trọng, nhưng việc chuẩn bị IV hiếm khi có thể gây ra một phản ứng phản vệ. | Drug-Induced Liver Disease 693 carbonated soda or antiemetic medication. A feeding tube may be needed in patients who cannot tolerate the medication orally. Oral N-acetylcysteine has no serious side effects but the IV preparation may rarely cause an anaphylactic reaction. Other Therapies Apart from N-acetylcysteine treatment for acetaminophen poisoning therapy for drug-induced liver injury is scant. A short course of high-dose corticosteroid may be used for severe drug-induced liver disease especially in patients with systemic features of a hypersensitivity reaction. However corticosteroids have not been proven to be of value in controlled trials. Nevertheless we recommend a short course of corticosteroids when systemic features of immune hypersensitivity accompany acute hepatitis eg phenytoin skin rash and liver injury . In patients with prolonged drug-induced cholestatic liver disease ursodeoxycholic acid treatment may be of use although the efficacy is unproved. Prevention Because there is little specific therapy for drug-induced liver disease prevention is of great importance. This process starts during drug development. It is important to monitor for ALT abnormality as well as signs and symptoms of liver disease during clinical studies with new drugs. Even after a drug receives approval from the US Food and Drug Administration surveillance and report of suspected cases should continue to identify hepatotoxicity that may not have been apparent during the initial clinical studies. For patients who take drugs that are known to have hepa-totoxic potential monitoring liver enzymes should be considered. Careful follow-up may identify emerging hepatotoxicity and thus prevent severe drug-induced liver disease. However this approach is most rational for delayed-onset idiosyncratic drug-induced liver disease. When starting any drug all patients should be educated about the signs and symptoms of liver disease and urged to report such symptoms to health care professionals
