A hepatotoxin (Gr., hepato = liver) is a toxic chemical substance that damages the liver. It can be a side-effect, but hepatotoxins are also found naturally, such as microcystins and pyrrolizidine alkaloids, or in laboratory environments, such as carbon tetrachloride, or far more pervasively in the form of ethanol (drinking alcohol). The effects of hepatotoxins depend on the amount, point of entry and distribution speed of the [toxin], and on the health of the person. Intrinsic hepatotoxins (type A) have a predictable, dose-dependent effect. Idiosyncratic (type B) hepatotoxic reactions are unpredictable, independent of dose, and appear to be determined by the individual exposed. Compounds that preferentially affect bile ducts are referred to as "cholestatic", one example being chlorpromazine. Those that target mostly the hepatocytes themselves are termed "hepatocellular", one example being paracetamol. "Mixed" toxicity, affecting both the bile ducts and hepatocytes, is not uncommon. Hepatocellular injury is clinically marked by a high ratio of ALT to ALP, and cholestatic injury by a lower ratio. Hepatotoxic substances α-amanitin, a deadly cellular toxin found in Amanita phalloides mushroom (death cap) - intrinsic Aflatoxin - intrinsic Ethanol - intrinsic Halothane - idiosyncratic Paracetamol - intrinsic Pyrrolizidine alkaloids, found in many plants in the Boraginaceae, Compositae, and Leguminosae families - intrinsic Luteoskyrin Kava (disputed) - idiosyncratic Allyl alcohol - intrinsic Allopurinol - idiosyncratic Amiodarone - idiosyncratic Aroclor 1254 Arsenic - intrinsic Carbamazepine - idiosyncratic Carbon tetrachloride - intrinsic Chlorpromazine - idiosyncratic Cocaethylene Diclofenac - idiosyncratic Diethylnitrosamine Dimethylformamide Diquat Etoposide Indomethacin - idiosyncratic Inhalants Iproniazid (withdrawn) - idiosyncratic Methapyrilene Methotrexate 3-methylcholanthrene. All penicillins - idiosyncratic Sulfonamide antibiotics - idiosyncratic Tricyclic antidepressants - idiosyncratic See also Mycotoxins Hepatotoxicity Nephrotoxicity Neurotoxicity Ototoxicity References Toxins by organ system affected Hepatology Hepatotoxins