{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T14:30:23Z","timestamp":1777905023364,"version":"3.51.4"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"18","license":[{"start":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T00:00:00Z","timestamp":1599177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>Drug-induced liver injury (DILI) that progresses to acute liver failure (ALF) has a high mortality rate, and therapeutic options are limited. Acetylcysteine has a labeled indication for use as an antidote for acetaminophen toxicity and has also been used with limited success in treatment of non\u2013acetaminophen-induced liver injury, with small clinical trials indicating an increase in transplant-free survival. Recommendations for management of non\u2013acetaminophen-induced DILI include withdrawal of the offending agent and supportive care. Treatment guidelines generally discourage a rechallenge with an offending medication, except in cases where there are no other therapeutic options for management of a serious disease, such as active tuberculosis (TB).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>This case report describes the reversal of ALF due to DILI in a patient receiving antitubercular agents for active TB. After withdrawal of initially prescribed antitubercular agents, the patient was switched to a less hepatotoxic anti-TB regimen and intravenous acetylcysteine pending results of antimicrobial susceptibility testing. After stabilization of the patient\u2019s liver enzyme levels, intravenous acetylcysteine was discontinued and oral acetylcysteine was continued for 5 days without an increase in hepatic enzyme levels or clinical deterioration. After 5 days, oral acetylcysteine was discontinued due to patient-reported nausea and vomiting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Given the limited number of therapeutic interventions shown to be beneficial in ALF and data suggesting a protective effect against DILI with initiation of acetylcysteine at the start of treatment with anti-TB medications, acetylcysteine can be considered for patients with anti-TB \u2013 associated DILI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxaa202","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T09:02:38Z","timestamp":1599210158000},"page":"1482-1487","source":"Crossref","is-referenced-by-count":6,"title":["Possible role for acetylcysteine as a treatment for acute liver failure secondary to antitubercular medication use"],"prefix":"10.1093","volume":"77","author":[{"given":"Ashley N","family":"Fox","sequence":"first","affiliation":[{"name":"Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooke E","family":"Nation","sequence":"additional","affiliation":[{"name":"Total Dose Community Pharmacy, Oklahoma City, OK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus Tad","family":"Autry","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Stevenson Cancer Center, Oklahoma City, OK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter N","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,9,4]]},"reference":[{"key":"2020090405022184000_CIT0001","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1038\/ajg.2014.131","article-title":"ACG clinical guideline: the diagnosis and management of idiosyncratic drug-induced liver injury","volume":"109","author":"Chalasani","year":"2014","journal-title":"Am J Gastroenterol"},{"key":"2020090405022184000_CIT0002","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1164\/rccm.200510-1666ST","article-title":"An official ATS statement: hepatotoxicity of antituberculosis therapy","volume":"174","author":"Saukkonen","year":"2006","journal-title":"Am J Respir Crit Care Med."},{"key":"2020090405022184000_CIT0003","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/S1665-2681(19)31379-1","article-title":"Use of acetylcysteine for non-acetaminophen-induced acute liver failure","volume":"12","author":"Sales","year":"2013","journal-title":"Ann Hepatol"},{"key":"2020090405022184000_CIT0004","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1177\/0960327111433901","article-title":"Protective effect of curcumin, silymarin and N-acetylcysteine on antitubercular drug-induced hepatotoxicity assessed in an in vitro model","volume":"31","author":"Singh","year":"2012","journal-title":"Hum Exp Toxicol"},{"key":"2020090405022184000_CIT0005","first-page":"413","article-title":"Efficacy of N-acetylcysteine on prevention of antitbuerculosis drug-induced hepatotoxicity","volume":"12","author":"Farazi","year":"2015","journal-title":"World J Med Sci"},{"key":"2020090405022184000_CIT0006","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1053\/j.gastro.2009.06.006","article-title":"Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure","volume":"137","author":"Lee","year":"2009","journal-title":"Gastroenterology"},{"key":"2020090405022184000_CIT0007","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/lt.21246","article-title":"Safety and efficacy of N-acetylcysteine in children with non-acetaminophen-induced acute liver failure","volume":"14","author":"Kortsalioudaki","year":"2008","journal-title":"Liver Transpl"},{"key":"2020090405022184000_CIT0008","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1002\/hep.26001","article-title":"Intravenous N-acetylcysteine in pediatric patients with nonacetaminophen acute liver failure: a placebo-controlled clinical trial","volume":"57","author":"Squires","year":"2013","journal-title":"Hepatology"},{"key":"2020090405022184000_CIT0009","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1038\/clpt.2010.355","article-title":"A fresh look at the mechanism of isoniazid-induced hepatotoxicity","volume":"89","author":"Metushi","year":"2011","journal-title":"Clin Pharmacol Ther"},{"key":"2020090405022184000_CIT0010","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1002\/hep.25551","article-title":"Introduction to the revised American Association for the Study of Liver Diseases position paper on acute liver failure 2011","volume":"55","author":"Lee","year":"2012","journal-title":"Hepatology"},{"key":"2020090405022184000_CIT0011","doi-asserted-by":"crossref","first-page":"7595","DOI":"10.3748\/wjg.v22.i33.7595","article-title":"Clinical management of acute liver failure: results of an international multi-center survey","volume":"22","author":"Rabinowich","year":"2016","journal-title":"World J Gastroenterol"},{"key":"2020090405022184000_CIT0012","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1016\/j.jhep.2019.02.014","article-title":"for European Association for the Study of the Liver. EASL clinical practice guidelines: drug-induced liver injury","volume":"70","author":"Aithal","year":"2019","journal-title":"J Hepatol"},{"key":"2020090405022184000_CIT0013","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s12072-009-9151-0","article-title":"Role of N-acetylcysteine in adults with non-acetaminophen-induced acute liver failure in a center without the facility of liver transplantation","volume":"3","author":"Mumtaz","year":"2009","journal-title":"Hepatol Int"},{"key":"2020090405022184000_CIT0014","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s10620-012-2512-x","article-title":"Improvements in hepatic serological biomarkers are associated with clinical benefit of intravenous N-acetylcysteine in early stage non-acetaminophen acute liver failure","volume":"58","author":"Singh","year":"2013","journal-title":"Dig Dis Sci"},{"key":"2020090405022184000_CIT0015","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1097\/MEG.0b013e32833aa11b","article-title":"Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity","volume":"22","author":"Baniasadi","year":"2010","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2020090405022184000_CIT0016","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1186\/s12866-016-0872-7","article-title":"N-acetyl-cysteine exhibits potent anti-mycobacterial activity in addition to its known anti-oxidative functions","volume":"16","author":"Amaral","year":"2016","journal-title":"BMC Microbiol"},{"key":"2020090405022184000_CIT0017","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1093\/cid\/ciw566","article-title":"Executive summary: official American Thoracic Society\/Centers for Disease Control and Prevention\/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis","volume":"63","author":"Nahid","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2020090405022184000_CIT0018","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.gtc.2018.01.005","article-title":"Modern management of acute liver failure","volume":"47","author":"Khan","year":"2018","journal-title":"Gastroenterol Clin North Am"},{"key":"2020090405022184000_CIT0019","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1345\/aph.1D209","article-title":"Acetylcysteine treatment for non-acetaminophen-induced acute liver failure","volume":"38","author":"Sklar","year":"2004","journal-title":"Ann Pharmacother"},{"key":"2020090405022184000_CIT0020","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.2146\/ajhp120645","article-title":"Intravenous acetylcysteine for indications other than acetaminophen overdose","volume":"70","author":"Bass","year":"2013","journal-title":"Am J Health-Syst Pharm"},{"key":"2020090405022184000_CIT0021","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1080\/15563650802665587","article-title":"Adverse reactions associated with acetylcysteine","volume":"47","author":"Sandilands","year":"2009","journal-title":"Clin Toxicol"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/77\/18\/1482\/33713051\/zxaa202.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/77\/18\/1482\/33713051\/zxaa202.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T09:02:48Z","timestamp":1599210168000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/77\/18\/1482\/5901275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,4]]},"references-count":21,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2020,9,4]]},"published-print":{"date-parts":[[2020,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxaa202","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,9,15]]},"published":{"date-parts":[[2020,9,4]]}}}