Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Sep 11;1(8):726-735.
doi: 10.1002/hep4.1088. eCollection 2017 Oct.

Drug-induced cholestasis

Vinay Sundaram  1 , Einar S Björnsson  2   3
Affiliations
Review

Drug-induced cholestasis

Vinay Sundaram et al. Hepatol Commun. .

Abstract

Cholestatic drug-induced liver injury (DILI) can be a diagnostic challenge due to a large differential diagnosis, variability in clinical presentation, and lack of serologic biomarkers associated with this condition. The clinical presentation of drug-induced cholestasis includes bland cholestasis, cholestatic hepatitis, secondary sclerosing cholangitis, and vanishing bile duct syndrome. The associate mortality of cholestatic DILI can be as high as 10%, and thus prompt recognition and removal of the offending agent is of critical importance. Several risk factors have been identified for drug-induced cholestasis, including older age, genetic determinants, and properties of certain medications. Antibiotics, particularly amoxicillin/clavulanate, remain the predominant cause of cholestatic DILI, although a variety of other medications associated with this condition have been identified. In this review, we summarize the presentation, clinical approach, risk factors, implicated medications, and management of drug-induced cholestatic liver injury. (Hepatology Communications 2017;1:726-735).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Central vein with lymphocytic infiltration and hepatocellular cholestasis, consistent with cholestatic hepatitis.
See this image and copyright information in PMC

References

    1. Siddique A, Kowdley KV. Approach to a patient with elevated serum alkaline phosphatase. Clin Liv Dis 2012;16:199‐229. - PMC - PubMed
    1. Ghabril M, Chalasani N, Bjornsson E. Drug‐induced liver injury: a clinical update. Curr Opin Gastroenterol 2010;26:222‐226. - PMC - PubMed
    1. Benichou C, Danan G, Flahault A. Causality assessment of adverse reactions to drugs–II. An original model for validation of drug causality assessment methods: case reports with positive rechallenge. J Clin Epidemiol 1993;46:1331‐1336. - PubMed
    1. DeLeve LD, Kaplowitz N. Mechanisms of drug‐induced liver disease. Gastroenterol Clin North Am 1995;24:787‐810. - PubMed
    1. Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ; Practice Parameters Committee of the American College of Gastroenterology . ACG clinical guideline: the diagnosis and management of idiosyncratic drug‐induced liver injury. Am J Gastroenterol 2014;109:950‐966. - PubMed