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Fulminant Liver Failure 15 December 1998 There are many things I'd rather spend my time on, so I really want to end this Tasmar thing, but this seems important, so here we go: "Hundreds of drugs can cause hepatitis that may be indistin- guishable from acute viral hepatitis. These idiosyncratic drug reactions are infrequent, unpredictable, and not dose dependent. Clinical onset usually occurs within two to six weeks after starting therapy but may occur on the first day that the drug is administered or not until six months later." (1) And: "Although hepatitis A is the most common form of acute viral hepatitis,...The risk of developing fulminant hepatic failure is higher with hepatitis B, occurring in 1% to 4% of hospitalized patients... Most cases of fulminant hepatic failure (58% to 79%) were due to superinfection in chronic hepatitis B virus (HBV) carriers...Fulminant hepatic failure may also occur during spontaneous reactivation of hepatitis B infection..." (2) And: Fulminant liver failure was the cause of the 3 or 4 deaths among 60,000 or more recipients of tolcapone (Tasmar), that have prompted the recent worry about safety of that drug, even though a causal link is far from clear. Notwithstanding reassurance by Roche of no special risk to users with impaired liver function (3), I wonder if it would be a good idea for those proposing to take Tasmar, besides periodic monitoring of alanine aminotransferase (ALT) level, to be checked for presence of HBV and, perhaps, have the vaccination that is available. 1. Keefe E; Scientific American Medicine; Vol. 4:Chap. VII:10 2. O'grady J et al in:Diseases of the Liver; Schiff L, Schiff E, eds: Chapter 39:1077 3. Tasmar product description leaflet:Clinical Pharmacology Some listmembers must know a lot more about this than I do- learned comment would be welcome.. Cheers, Joe -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013