Widely used as a dry cleaning solvent, as a refrigerant, in lava lamps, and as fire extinguishers in

1
Carbon tetrachloride

• Widely used as a dry cleaning solvent, as a
  refrigerant, in lava lamps, and as fire
  extinguishers in the early 20th century.
• Acute high concentrations exposure of CCl4 can
  affect the central nervous system, degenerate the
  liver, and kidneys, and may result in coma or
  even death. Chronic exposure can cause liver and
  kidney damage and could result in cancer.
• After safer alternatives such as
  tetrachloroethylene were found, its usage
  declined from 1940 and banned in 1970 in the
  United States
• Conclusion
• Good prove-of-principle chemical for liver
  toxicity studies
• with little practical value.

2
Drugs that induce liver diseases (classified by
type of liver injuries)
Hepatocellular necrosis Acetaminophen Isoniazid
trazodone diclofenac venlafaxine lovastatin sulfon
amides ketoconazole rifampin phenytoin valproic
acid carbamazepine labetalol Cholestasis
Chlorpromazine estrogen erythromycin amoxicillin/
clavulanate carbamazepine anabolic
steroids tetracycline trimethoprim/sulfamethoxazol
e haloperidol
Mixed hepatocellular/ cholestatic
injury Tricyclic antidepressants NSAIDs macrolides
nitrofurantoin sulfonamides amoxicillin/clavulana
te cyclosporine Methimazole Immunoallergic
hepatitis Phenytoin Sulfamethoxazole Granulomatou
s hepatitis Diltiazem sulfonamides quinidine Acut
e steatosis Didanosine tetracycline valproic
acid
Chronic steatosis Glucocorticoids methotrexate am
iodarone tamoxifen valproic acid Chronic
hepatitis Nitrofurantoin methyldopa lisinopril mi
nocycline dantrolene sulfonamides isoniazid Hepat
ic adenocarcinoma Oral contraceptives anabolic
steroids Phospholipidosis Amiodarone Chloroquine
Veno-occlusive disease Etoposide vincristine vinbl
astine cyclophosphamide mitomycin azathioprine ora
l contraceptives NSAIDs nonsteroidal
anti-inflammatory drugs.
Kim JW et al., 2009 Journal of Pharmacy Practice,
22(3), 278-289
3
Drugs associated with acute hepatitis pattern of
injury (classified by drug categories)
Non-steroidal anti-inflammatory
drugs Diclofenac, indomethacin, tolmetin,
sulindac, ibuprofen, ketoprofen, mefenamic acid,
celecoxib Anaesthetic agents Halothane,
methoxyflurane Anticonvulsants Phenytoin,
carbamazepine, valproic acid, chlorpromazine Anti
bacterial agents Ampicillin, amoxicillinclavulani
c acid, oxacillin, cephalosporins, tetracycline,
sulfonamides, erythromycin, trimethoprimsulfameth
oxazole Antifungal agents Griseofulvin,
fluconazole, ketoconazole Antiparasitic
agents Albendazole, thiabendazole,
fansidar Antituberculous agents Isoniazid,
rifampin Antiviral agents Zidovudine, ribavirin,
nevirapine, efavirenz
Antitumour agents 6-Mercaptopurine, azathioprine,
L-asparaginase, mithramycin, vincristine,
cyclophosphamide, carmustine Antihypertensive
agents Methyldopa, hydralazine, lisinopril,
labetalol Antiarrhythmic agents Quinidine,
nifedipine, procainamide Hypolipidaemics Statins,
clofibrate, nicotinic acid, ezetimibe Hypoglycae
mics Rosiglitazone, troglitazone Antiandrogens Fl
utamide Other Sulfonylureas, troglitazone,
dantrolene, chlorzoxazone, dextropropoxyphene,
allopurinol, gold Toxins Aflatoxin, death cap
mushroom (Amanita phalloides), carbon tetrachlorid
e, ethylene dichloride, allyl compounds,
ferrous sulfate, phosphorus, MDMA
4
Now comes the toughest part, I need to choice 3
or 4 drugs as the potential next liver toxicity
target. I am still working on it. One of them may
be one of the Statin families such as Lipitor.