Efectos de los fármacos sobre el hígado
Por Steven K. Herrine, MD, Thomas Jefferson University;Sidney Kimmel Medical College
Muchos medicamentos pueden afectar la funcionalidad del hígado, producir lesiones en él, o ambas cosas.
Algunos medicamentos, como las estatinas (utilizadas para tratar la concentración elevada de colesterol) pueden aumentar los niveles de enzimas hepáticas y causar daños en el hígado (generalmente menores) pero sin síntomas.
Muy pocos fármacos dañan el hígado lo suficiente para causar síntomas como ictericia, dolor abdominal, prurito y tendencia a sangrar y hacerse moretones.
Los médicos utilizan el término lesión hepática inducida por fármacos (DILI según sus siglas en inglés) para referirse al daño hepático causado por los medicamentos, tanto si se traduce en síntomas como si no. El término también incluye los daños causados por las plantas medicinales y los complementos nutritivos.
PLANTAS MEDICINALES E HÍGADO
Algunas plantas medicinales (las partes de las plantas que se utilizan por sus beneficios para la salud) contienen sustancias que pueden dañar al hígado. El hígado es el primer órgano en sufrir lesiones, ya que transforma todo lo que entra por la boca y se traga.
Alcaloides de la pirrolizidina: Centenares de plantas contienen estos alcaloides, que pueden dañar el hígado. Estas plantas son, entre otras, la borraja (Borago officinalis), la consuelda (Symphytum officinale L.), y ciertas plantas de origen chino, como zi cao (Lithospermum), kuan dong hua (uña de caballo; Tussilago farfara), Qian Guang li (Senecio aureus L.) y pei lan (Eupatorium). Algunas plantas usadas para preparar té contienen estos alcaloides. A veces, la leche, la miel y los cereales están contaminados con dichos alcaloides, con lo que estos se consumen sin saberlo.
Los alcaloides de la pirrolizidina pueden dañar al hígado de forma gradual si se consumen pequeñas cantidades durante mucho tiempo; si se consume una gran cantidad, la lesión aparece de forma más rápida. Las venas hepáticas pueden obstruirse y bloquear el flujo de sangre desde el hígado.
Las personas afectadas tienen dolor abdominal y pueden vomitar. Se acumula líquido en abdomen y piernas. Con el tiempo, se puede producir tejido cicatrizal en el hígado (cirrosis), insuficiencia hepática e incluso la muerte.
Otras plantas: Otras plantas que pueden producir lesiones hepáticas son Atractylis gummifera, Camellia sinensis (usada para preparar té verde y negro), la celidonia mayor o hierba golondrinera (Chelidonium majus), chaparral (Larrea divaricata), olivilla (Teucrium fruticans), huan jin bu (Huperzia serrata), kava-kava (de la familia de la pimienta), ma huang (Ephedra sinica), muérdago (Viscum album), aceite de poleo (utilizado para hacer tés) y syo-saiko-to (una mezcla de plantas).
Para algunos fármacos puede predecirse el daño hepático, que tiene lugar poco después de tomar el medicamento y está relacionado con la dosis tomada. En Estados Unidos, este daño (a menudo provocado por el paracetamol (acetaminofeno)) es una de las causas más frecuentes de aparición repentina de ictericia, de insuficiencia hepática o de ambas. Para otros medicamentos, el daño es impredecible, se detecta algún tiempo después de tomar el medicamento y no está relacionado con la dosis. En raras ocasiones, este daño deriva en un trastorno grave del hígado.
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