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Abstract
A large number of drugs may be associated with impaired bile flow. Drug-associated
cholestasis presents like other forms of cholestasis with pale stools, dark urine,
pruritus and jaundice. Abdominal pain may be present in some instances and can be
so severe as to lead to a false diagnosis of acute cholecystitis. Biochemically, drug-associated
cholestasis resembles other forms of cholestasis although the presence of eosinophilia
may suggest drug involvement. Many types of drug-induced cholestasis run a benign
course with resolution of signs and symptoms within 3 months but occasionally the
jaundice can take a year or more to resolve. Progression to cirrhosis is uncommon.
Some patients may develop a syndrome resembling primary biliary cirrhosis. The mechanisms
of drug-associated cholestasis are uncertain but may arise from alteration of bile
formation within the hepatocyte or bile excretion at the level of the canaliculus
or the extrahepatic ducts. Histological examination of the liver may be helpful in
classifying the types of jaundice but the diagnosis of drug-induced cholestasis is
usually one of temporal association and exclusion of other causes.