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  • RESEARCH 4 BUSINESS 2016, Ljubljana, 5 and 6 of May 2016

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    In addition, we have reviewed the English equivalent to viagra over the counter literature using Ovid for Medline searches and identified single or multiple cases reports of DIH associated with antiviral drugs (Table 3). Table 2 Estimated Percentages of Treated Patients with Abnormalities 5 ULN for Serum ALT or AST, 4 ULN for Alkaline Phosphatase (AP), and 2.6 ULN for Bilirubin, Unless Otherwise Noted (21,22,72) Drug Antiherpetic agent Acyclovir Famciclovir Valacyclovir Penciclovir Hydroxyurea Cidofovir Ganciclovir Foscarnet Anti-influenza drug Rimantadine Amantadine Oseltamivir Zanmivir Interferon IFNa3b IFNa1a Alferon Interferon beta Rebetron Antiretroviral Zidovudine Didanosine Stavudine Zalcitabine Lamivudine Abacavir Nelfinavir Indinavir Ritonavir Lopinavir Amprenavir Saquinavir Nevirapine Delavirdine Efavirenz without hepatitis Efavirenz with HBV or HCV ALT 1–5% 2.1% a — — occ occ occ occ — occ — occ 2–11% — — 31.3 — 9% 3–9.7% 5–14% 8% 4–9.7% .4% 3–6.3% d 5.9 e 10.4% f occ 8.8 e 2.7–7.7 6.6–6.8 5% 8–6% AST 1–2% 1.4% a 1–3.1% — occ occ occ occ — occ — occ 3–53% 6–26% 6% 31.3 — 9.4% 3–10.6% 7–12 5–8% 5–11.6% — 2–4.5% d 7.0 8.5% f occ 5.1 e 5–8.7 1.1–5.6 2% 7–6% AP — — — — — occ — — — occ — — — — 8% — — occ occ occ 1.6 e occ — — — occ — 0.4 e — — — — Bilirubin — 1.10% b — — — — — — — occ — — 6–10% Up to 8% 4% — 0.5–2% c Mild 1–5% 1% 1% 1% — — 13.8 c — occ 1.4 c 0.5 0.5–1.0 — — — not available or not reported. In Table 7, elevations in AST, ALT, and AP are reported as percentage of treated patients with documented grade 2 toxicity unless otherwise stated.

    All doses are average adult doses. Obviously, there are problems in interpreting data from case reports (13). Not all cases of liver toxicity are reported in the published literature, first.

    Second, case reports may fail to adequately rule out other causes of hepatitis, and it may be difficult to determine or refute a cause-effect relationship 630 Bonacini et al. Adjustments may be needed in special circumstances.

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    (1999). Consroe, P., Laguna, J., Allender, J., Snider, S., Stern, L., Sandyk, R., Kennedy, K., and Schram, K. (1991).

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    Azathioprine (all four lesions), urethane (peliosis and SOS), heroin (sinusoidal dilatation, sinusoidal and equivalent to viagra over the counter perivenular fibrosis), thorotrast (peliosis, veno-occlusive lesions with hepatocyte atrophy), and oral contraceptives (sinusoidal dilatation and peliosis hepatis) cause an overlap of these injuries. It is not surprising that this group of liver injuries is linked to one drug, such as 5thioguanine. SOS, nodular regenerative hyperplasia, peliosis hepatis, and sinusoidal dilatation often share similar causes and in some cases up to all four have been described within the same liver. There is also a case report of peliosis hepatis associated with 3-thioguanine plus cytarabine.

    Damage to sinusoidal endothelial cells and sometimes to hepatic venular endothelial cells seems to be the common link in these four types of liver injury.