Drugs are an important cause of liver injury. More than 900 drugs, toxins, and herbs have been reported to cause liver injury, and drugs are responsible for 20–40% of all cases of fulminant liver failure. Approximately 75% of idiosyncratic drug reactions result in liver transplantation or death. Drug-induced liver injury is the most common reason for the recall of an approved drug, and one-third of all drugs withdrawn from the market are recalled due to liver injury.
Physicians should be vigilant in identifying drug-induced liver injury, as early detection can reduce the severity of hepatotoxicity if the drug is discontinued. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevations of liver enzymes to fulminant liver failure. Differential diagnosis includes the following conditions: Acute viral hepatitis, Autoimmune hepatitis, Nonalcoholic steatohepatitis (NASH), Shock liver/cardiovascular failure, especially right-sided heart failure, Cholecystitis, Cholangitis, Budd-Chiari syndrome, Alcoholic liver disease, Cholestatic liver disease, Pregnancy-associated liver disease, Malignancies, Wilson’s disease, Hemochromatosis, Coagulation disorders.
Treatment and management of patients with drug-induced liver injury
Early recognition of drug-induced liver reactions is important to minimize damage. Monitoring liver enzymes is appropriate and necessary with a number of agents, especially those that cause overt injury.
No specific treatment is indicated for drug-induced liver disease. Treatment is primarily supportive and symptomatic. The first step is to stop taking the suspected drug.
In general, corticosteroids do not play a decisive role in treatment. Cholestyramine can be used to relieve itching. Ursodeoxycholic acid can be used. Finally, it is also useful to contact a hepatologist for referral, if necessary, to a liver transplant center.
