What medications can cause elevated transaminase levels?

Medications that may cause elevated transaminase levels generally include anti-tuberculosis drugs, antibiotics, antipyretic analgesics, immunosuppressants, and antifungal agents. A detailed analysis is as follows:

1. Anti-tuberculosis drugs: For example, isoniazid and rifampicin. These are highly effective in treating tuberculosis, but their metabolites may cause liver cell damage, leading to increased transaminase levels, typically occurring 2 to 8 weeks after starting treatment.

2. Antibiotics: Such as tetracycline, chloramphenicol, and erythromycin. Long-term use or overdose may increase the metabolic burden on the liver, resulting in hepatocyte injury and elevated transaminase levels.

3. Antipyretic analgesics: For example, acetaminophen (paracetamol). When taken in excess, the toxic intermediate metabolites produced by the liver may exceed the body's detoxification capacity, causing hepatocellular necrosis and subsequent elevation of transaminase levels.

4. Immunosuppressants: Such as methotrexate and azathioprine. Prolonged use may impair normal hepatic metabolism, potentially leading to liver fibrosis or fatty degeneration, thereby causing abnormal transaminase levels.

5. Antifungal drugs: Such as ketoconazole and fluconazole. These may induce liver damage by interfering with hepatocyte membrane stability or metabolic processes, resulting in elevated transaminase levels.

During medication, it is essential to strictly follow medical instructions and avoid adjusting dosages or combining medications without guidance. Liver function should be monitored regularly. If symptoms such as fatigue or decreased appetite occur, prompt medical attention is advised. Elderly patients and those with chronic liver disease should have shorter monitoring intervals.