What drugs to avoid in HepC

• A. Methotrexate
• B. Leflunomide
• C. TNF inhibitors
• D. All of the above

Answer: (D)

In Hepatitis C, the focus is on preserving liver function, so drugs with known hepatotoxic potential or those that can worsen viral liver disease are avoided. Methotrexate is a well-established hepatotoxin and can accelerate liver injury, fibrosis, or cirrhosis in someone with preexisting liver disease like HCV, so it’s avoided. Leflunomide shares a similar risk of serious liver injury and has a long half-life, making it particularly risky in liver disease; it’s contraindicated when hepatic impairment is present. TNF inhibitors are powerful immunosuppressants, and while they can be necessary for autoimmune conditions, they carry concerns about altering liver disease progression and increasing infection risk in chronic viral hepatitis; in the setting of Hep C, they are generally avoided or used only with careful monitoring. Because each of these classes poses potential harm to the liver in the context of Hep C, all of the above are drugs to avoid.