Drug-Induced Hepatotoxicity

Excerpt

Drug-induced hepatotoxicity or drug-induced liver injury (DILI) is an acute or chronic response to a natural or manufactured compound. DILI can be classified based on clinical presentation (hepatocellular, cholestatic, or mixed), mechanism of hepatotoxicity, or histological appearance from a liver biopsy. The true incidence is difficult to estimate, yet it has become the leading cause of acute liver failure (ALF) in the United States. The two mechanisms of hepatotoxicity are intrinsic, which is dose-dependent, and idiosyncratic, which is more unpredictable. Most cases of DILI are asymptomatic; however, the most common sign is jaundice. Laboratory tests in hepatocellular injury will have elevation in aminotransferases, while in cholestatic injury, alkaline phosphatase (ALP) is elevated. Liver biopsy is not mandatory for diagnosis but could exclude other causes of liver disease. Treatment begins with the removal of the offending agent, and the prognosis for recovery is usually favorable after discontinuation of the drug.