Drug-induced Liver Injury

Abstract

Drug-induced liver injury (DILI) is common and nearly all classes of medications can cause liver disease. Most cases of DILI are benign, and improve after drug withdrawal. It is important to recognize and remove the offending agent as quickly as possible to prevent the progression to chronic liver disease and/or acute liver failure. There are no definite risk factors for DILI, but pre-existing liver disease and genetic susceptibility may predispose certain individuals. Although most patients have clinical symptoms that are identical to other liver diseases, some patients may present with symptoms of systemic hypersensitivity. Treatment of drug and herbal-induced liver injury consists of rapid drug discontinuation and supportive care targeted to alleviate unwanted symptoms.

Figure 1. Mechanisms of Drug-induced Liver Injury

Drugs are metabolized by the liver p450 system in a series of phase I and phase II reactions (left column). Toxic intermediates can illicit hepatocyte damage and death by inducing apoptosis or necrosis (center column). Drugs that bind to cellular membranes can elicit an immunologic reaction upon presentation to major histocompatibility complex (MHC) particles, resulting in inflammation (right column).