Drug-induced liver injury

Drug-induced liver injury (DILI) accounts for 9.5% of all suspected adverse drug reactions (ADRs) and for a significant proportion of fatal ADRs. DILI may be a direct toxic effect or an immunological reaction to either the drug or an active metabolite. Drugs can cause a diverse array of liver injury, which may be acute or chronic. Adaptation to injurious effects, with only a transient increase in liver function, can occur. Inherited or acquired factors affect the risk of DILI. There is marked geographic variation in responsible agents; in the West antibiotics, anticonvulsants, psychotropic and recreational drugs are the most common offending agents, whereas in Asia, herbal and dietary supplements are more common. This contribution focuses on the pathogenesis and consequences of DILI, their investigation and management. Information on specific ADRs can be obtained from the British National Formulary, drug data sheets and other web-based databases (WHO Adverse Drug Reactions Monitoring; AERS and DIOGENES®: Adverse Drug Events Database – FDA sites; Canada Vigilance Adverse Reaction Online Database; Drug Adverse Reaction Target Database (DART)).