Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity.
BACKGROUND
Isoniazid, rifampicin, and pyrazinamide, the first-line antituberculosis (anti-TB) drugs, are associated with hepatotoxicity.


OBJECTIVE
To study the hepatoprotective effect of N-acetylcysteine (NAC) on liver injury induced by anti-TB drugs.


METHODS
A randomized clinical trial was conducted on 60 new TB patients who were aged 60 years or more. Patients were randomized into two groups. In group I (n=32), drug regimen included daily doses of isoniazid, rifampicin, pyrazinamide, and ethambutol. Patients in group II (n=28) were treated with the same regimen and NAC. The patients were followed up for 2 weeks. Liver enzymes and bilirubins were measured at baseline, after 1 and 2 weeks of treatment, and whenever the patients presented with clinical symptoms of hepatotoxicity.


RESULTS
The mean+/-SD values of aspartate aminotransferase and alanine aminotransferase were significantly higher in group I than in group II after 1 and 2 weeks of treatment. Hepatotoxicity occurred in 12 patients with (37.5%) group I and none in group II. The mean duration of treatment before the onset of hepatotoxicity was 4.67+/-4.58 days.


CONCLUSIONS
NAC protects against anti-TB drug-induced hepatotoxicity.
Baniasadi
Shadi
S
Pharmaceutical Care Department, Virology Research Center, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Eftekhari
Parivash
P
Tabarsi
Payam
P
Fahimi
Fanak
F
Raoufy
Mohammad Reza
MR
Masjedi
Mohammad Reza
MR
Velayati
Ali Akbar
AA
D000111:Acetylcysteine / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000517:prevention & control*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000009:adverse effects; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects*; D008099:Liver / Q000187:drug effects; D008297:Male; D011718:Pyrazinamide / Q000009:adverse effects; D012293:Rifampin / Q000009:adverse effects; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000995:Antitubercular Agents; D016166:Free Radical Scavengers; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D000111:Acetylcysteine