Suggested guidelines for patient monitoring: hepatic and hematologic toxicity attributable to systemic dermatologic drugs.
Hepatic and hematologic toxicity are among the most fearful adverse effects that occasionally occur as a result of systemic drugs in the dermatologist's therapeutic armamentarium. Drugs of greatest interest concerning hepatic toxicity include methotrexate, azathioprine, dapsone, and acitretin. Somewhat overlapping are drugs that have important hematologic toxicities, including methotrexate, azathioprine, dapsone, sulfonamides, cyclophosphamide, and chlorambucil. Laboratory tests most commonly used include (1) hepatic monitoring: transaminases (AST/SGOT and ALT/SGPT) and the ultrasound-guided liver biopsy, and (2) hematologic monitoring: CBC with diff and platelets along with occasional use of the reticulocyte count. Important principles and specific guidelines for monitoring by drug group are highlighted.
Wolverton
Stephen E
SE
Indiana University Medical Center, Department of Dermatology, 550 N. University Boulevard, Suite 3240, Indianapolis, IN 46202, USA. swolvert@iupui.edu <swolvert@iupui.edu>
Remlinger
Kathleen
K
D056486:Chemical and Drug Induced Liver Injury; D003879:Dermatologic Agents / Q000009:adverse effects*; D016903:Drug Monitoring / Q000379:methods*; D006402:Hematologic Diseases / Q000139:chemically induced*; D006801:Humans; D008099:Liver / Q000187:drug effects; D017410:Practice Guidelines as Topic; D012871:Skin Diseases / Q000188:drug therapy*
D003879:Dermatologic Agents