A hepatotoxin ('' Gr., hepato = liver'') is a

toxic Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a subst ...

chemical substance that damages the

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

. It can be a

side-effect In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually used ...

, but hepatotoxins are also found naturally, such as

microcystin Microcystins—or cyanoginosins—are a class of cyanotoxins, which are toxins produced by cyanobacteria, sometimes known as blue-green algae. Over 250 different microcystins have been discovered so far, of which microcystin-LR is the most commo ...

s and

pyrrolizidine alkaloid Pyrrolizidine alkaloids (PAs), sometimes referred to as necine bases, are a group of naturally occurring alkaloids based on the structure of pyrrolizidine. Their use dates back centuries and is intertwined with the discovery, understanding, and e ...

s, or in laboratory environments, such as

carbon tetrachloride Carbon tetrachloride, also known by many other names (such as carbon tet for short and tetrachloromethane, also IUPAC nomenclature of inorganic chemistry, recognised by the IUPAC), is a chemical compound with the chemical formula CCl4. It is a n ...

, or far more pervasively in the form of ethanol (drinking alcohol). The effects of hepatotoxins depend on the amount, point of entry and distribution speed of the oxin and on the health of the person. Intrinsic hepatotoxins (type A) have a predictable, dose-dependent effect. Idiosyncratic (type B) hepatotoxic reactions are unpredictable, independent of dose, and appear to be determined by the individual exposed. Compounds that preferentially affect bile ducts are referred to as "cholestatic", one example being

chlorpromazine Chlorpromazine (CPZ), marketed under the brand names Thorazine and Largactil among others, is an antipsychotic medication. It is primarily used to treat psychotic disorders such as schizophrenia. Other uses include the treatment of bipolar d ...

. Those that target mostly the hepatocytes themselves are termed "hepatocellular", one example being

paracetamol Paracetamol, or acetaminophen, is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely available over-the-counter drug sold under various brand names, including Tylenol and Panadol. Parac ...

. "Mixed" toxicity, affecting both the bile ducts and hepatocytes, is not uncommon. Hepatocellular injury is clinically marked by a high ratio of

ALT Alt or ALT may refer to: Abbreviations for words * Alt account, an alternative online identity also known as a sock puppet account * Alternate character, in online gaming * Alternate route, type of highway designation * Alternating group, mathem ...

to ALP, and cholestatic injury by a lower ratio.

Hepatotoxic substances

α-amanitin α-Amanitin (''alpha''-Amanitin) is a cyclic peptide of eight amino acids. It is possibly the most deadly of all the amatoxins, toxins found in several species of the mushroom genus ''Amanita'', one being the death cap (''Amanita phalloides'') as ...

, a deadly cellular toxin found in ''

Amanita phalloides ''Amanita phalloides'' ( ), commonly known as the death cap, is a deadly poisonous basidiomycete fungus and mushroom, one of many in the genus ''Amanita''. Originating in Europe but later introduced to other parts of the world since the late ...

'' mushroom (death cap) - intrinsic *

Aflatoxin Aflatoxins are various toxicity, poisonous carcinogens and mutagens that are produced by certain Mold (fungus), molds, especially ''Aspergillus'' species such as ''Aspergillus flavus'' and ''Aspergillus parasiticus''. According to the USDA, "The ...

- intrinsic *

Ethanol Ethanol (also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound with the chemical formula . It is an Alcohol (chemistry), alcohol, with its formula also written as , or EtOH, where Et is the ps ...

- intrinsic *

Halothane Halothane, sold under the brand name Fluothane among others, is a general anaesthetic. It can be used to induce or maintain anaesthesia. One of its benefits is that it does not increase the production of saliva, which can be particularly useful ...

- idiosyncratic *

Paracetamol Paracetamol, or acetaminophen, is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely available over-the-counter drug sold under various brand names, including Tylenol and Panadol. Parac ...

- intrinsic *

Pyrrolizidine alkaloid Pyrrolizidine alkaloids (PAs), sometimes referred to as necine bases, are a group of naturally occurring alkaloids based on the structure of pyrrolizidine. Their use dates back centuries and is intertwined with the discovery, understanding, and e ...

s, found in many plants in the

Boraginaceae Boraginaceae, the Borago, borage or forget-me-not family, includes about 2,000 species of shrubs, trees, and herbs in 146 to 154 genus, genera with a worldwide distribution. The APG IV system from 2016 classifies the Boraginaceae as single famil ...

Compositae Asteraceae () is a large family of flowering plants that consists of over 32,000 known species in over 1,900 genera within the order Asterales. The number of species in Asteraceae is rivaled only by the Orchidaceae, and which is the larger fa ...

, and

Leguminosae Fabaceae () or Leguminosae,International Code of Nomen ...

families - intrinsic *

Luteoskyrin Luteoskyrin is a carcinogenic mycotoxin A mycotoxin (from the Greek μύκης , "fungus" and τοξικός , "poisonous") is a toxic secondary metabolite produced by fungi and is capable of causing disease and death in both humans and other ani ...

Kava Kava or kava kava (''Piper methysticum'': Latin 'pepper' and Latinized Ancient Greek, Greek 'intoxicating') is a plant in the Piperaceae, pepper family, native to the Pacific Islands. The name ''kava'' is from Tongan language, Tongan and Marqu ...

(disputed) - idiosyncratic *

Allyl alcohol Allyl alcohol (IUPAC name: prop-2-en-1-ol) is an organic compound with the structural formula . Like many alcohols, it is a water-soluble, colourless liquid. It is more toxic than typical small alcohols. Allyl alcohol is used as a precursor to ...

- intrinsic *

Allopurinol Allopurinol is a medication used to decrease hyperuricemia, high blood uric acid levels. It is specifically used to prevent gout, prevent specific types of kidney stones and for the high uric acid levels that can occur with chemotherapy. It i ...

- idiosyncratic *

Amiodarone Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of cardiac dysrhythmias. This includes ventricular tachycardia, ventricular fibrillation, and wide complex tachycardia, atrial fibrillation, and paroxys ...

- idiosyncratic * Aroclor 1254 *

Arsenic Arsenic is a chemical element; it has Symbol (chemistry), symbol As and atomic number 33. It is a metalloid and one of the pnictogens, and therefore shares many properties with its group 15 neighbors phosphorus and antimony. Arsenic is not ...

- intrinsic *

Carbamazepine Carbamazepine, sold under the brand name Tegretol among others, is an anticonvulsant medication used in the treatment of epilepsy and neuropathic pain. It is used as an adjunctive treatment in schizophrenia along with other medications and as ...

- idiosyncratic *

Carbon tetrachloride Carbon tetrachloride, also known by many other names (such as carbon tet for short and tetrachloromethane, also IUPAC nomenclature of inorganic chemistry, recognised by the IUPAC), is a chemical compound with the chemical formula CCl4. It is a n ...

- intrinsic *

Chlorpromazine Chlorpromazine (CPZ), marketed under the brand names Thorazine and Largactil among others, is an antipsychotic medication. It is primarily used to treat psychotic disorders such as schizophrenia. Other uses include the treatment of bipolar d ...

- idiosyncratic *

Cocaethylene Cocaethylene (ethylbenzoylecgonine) is the ethyl ester of benzoylecgonine. It is structurally similar to cocaine, which is the methyl ester of benzoylecgonine. Cocaethylene is formed by the liver in small amounts when cocaine and ethanol coexi ...

Diclofenac Diclofenac, sold under the brand name Voltaren among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammatory diseases such as gout. It can be taken orally (swallowed by mouth), inserted rectally as a ...

- idiosyncratic *

Diethylnitrosamine ''N''-Nitrosodiethylamine (NDEA) is an organic compound with the formula Et2NNO (Et = C2H5). A member of the nitrosamines, it is a light-sensitive, volatile, clear yellow oil that is soluble in water, lipids, and other organic solvents. It has ...

Dimethylformamide Dimethylformamide, DMF is an organic compound with the chemical formula . Its structure is . Commonly abbreviated as DMF (although this initialism is sometimes used for 2,5-dimethylfuran, dimethylfuran, or dimethyl fumarate), this colourless liqui ...

Diquat Diquat is the International Organization for Standardization, ISO trivial name, common name for an Ion#Anions and cations, organic dication that, as a Salt (chemistry), salt with counterions such as bromide or chloride is used as a contact herbicid ...

Etoposide Etoposide, sold under the brand name Vepesid among others, is a chemotherapy medication used for the treatments of a number of types of cancer including testicular cancer, lung cancer, lymphoma, leukemia, neuroblastoma, and ovarian cancer. It is ...

Indomethacin Indometacin, also known as indomethacin, is a nonsteroidal anti-inflammatory drug (NSAID) commonly used as a prescription medication to reduce fever, pain, stiffness, and swelling from inflammation. It works by inhibiting the production of pr ...

- idiosyncratic *

Inhalants Inhalants are a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication, in a manner not intended by the manufacturer. They ...

Iproniazid Iproniazid (Marsilid, Rivivol, Euphozid, Iprazid, Ipronid, Ipronin) is a non-selective, irreversible inhibition, irreversible monoamine oxidase inhibitor (MAOI) of the hydrazine (antidepressant), hydrazine class. It is a xenobiotic that was origi ...

(withdrawn) - idiosyncratic *

Methapyrilene Methapyrilene is an antihistamine and anticholinergic of the pyridine chemical class which was developed in the early 1950s. It was sold under the trade names Co-Pyronil and Histadyl EC in the UK. It has relatively strong sedative effects, to the ...

Methotrexate Methotrexate, formerly known as amethopterin, is a chemotherapy agent and immunosuppressive drug, immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancy, ectopic pregnancies. Types of cancers it is u ...

* 3-methylcholanthrene. * All

penicillins Penicillins (P, PCN or PEN) are a group of β-lactam antibiotics originally obtained from ''Penicillium'' moulds, principally '' P. chrysogenum'' and '' P. rubens''. Most penicillins in clinical use are synthesised by '' P. chrysogenum'' ...

- idiosyncratic *

Sulfonamide antibiotics Sulfonamide is a functional group (a part of a molecule) that is the basis of several groups of medication, drugs, which are called sulphonamides, sulfa drugs or sulpha drugs. The original antibacterial sulfonamides are synthetic antimicrobi ...

- idiosyncratic *

Tricyclic antidepressants Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants. TCAs were discovered in the early 1950s and were marketed later in the decade. They are named after their chemical structure, which contains ...

- idiosyncratic

References

Toxins by organ system affected Hepatology Hepatotoxins {{med-toxic-stub

Hepatotoxic substances

See also

References