Drug-induced liver injury: a clinical update
- PMID: 20186054
- PMCID: PMC3156474
- DOI: 10.1097/MOG.0b013e3283383c7c
Drug-induced liver injury: a clinical update
Abstract
Purpose of review: To gather new and important data published on idiosyncratic drug-induced liver injury (DILI) over the past 2 years in the peer-reviewed literature. Clinical studies focusing on mechanisms of injury, clinical evaluation and prognosis will be reviewed.
Recent findings: The most common drugs leading to DILI in the United States are antibiotics, central nervous system agents, herbal/dietary supplements and immunomodulatory agents. Hepatocellular type of DILI is more common in younger patients, whereas cholestatic pattern increases with older age. Certain human leukocyte antigen genotype increases the likelihood of flucloxacillin-induced liver injury. Idiosyncratic DILI was shown to have an important dose-dependency and drugs with extensive hepatic metabolism are associated with higher frequency of DILI. Chronic DILI may occur, but development of clinically important liver injury after severe DILI is rare. N-acetylcysteine seems to be beneficial for patients with acute liver failure caused by medications or herbal agents.
References
-
- Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137:947–954. - PubMed
-
- Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med. 2006;354:731–739. - PubMed
-
- Chalasani N, Fontana RJ, Bonkovsky HL, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology. 2008;135:1924–1934. 34e1–4. [This landmark paper summarizes the findings from the first 300 enrolled patients in the ongoing prospective US multicenter DILI-Network study. It reports antibiotics as the most common causative class and highlights herbal and dietary supplements as an important cause of DILI in the United States.] - PMC - PubMed
-
- Andrade RJ, Lucena MI, Fernandez MC, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology. 2005;129:512–521. - PubMed
-
- Takikawa H, Murata Y, Horiike N, et al. Drug-induced liver injury in Japan: an analysis of 1676 cases between 1997 and 2006. Hepatol Res. 2009;39:427–431. - PubMed
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources