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Drugs and liver damage 

Drugs and liver damage

Chapter:
Drugs and liver damage
Author(s):

J. Neuberger

DOI:
10.1093/med/9780199204854.003.152208_update_001

Update:

Pathogenesis—new information on genetic associations of DILI.

Classification—new information on genetic associations of DILI.

A relevant case history from Oxford Case Histories in Gastroenterology and Hepatology has been added to this chapter.

Updated on 28 Nov 2012. The previous version of this content can be found here.
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date: 25 March 2017

Drug-induced liver injury (DILI) is relatively uncommon but can very rarely be fatal. Almost all patterns of liver disease can be induced by drugs, and some drugs may be associated with more than one type of reaction. Some cases of DILI have a genetic component. Most cases present with jaundice and/or hepatitis.

Good data on incidence are hard to find. The diagnosis of drug-induced liver damage is largely circumstantial and by exclusion of other causes of liver disease, and many cases are not reported to regulatory or monitoring bodies. The more common culprits are antibiotics (especially amoxicillin/clavulanate, flucloxacillin) and nonsteroidal anti-inflammatory drugs (especially diclofenac); chlorpromazine and isoniazid are both associated with a high incidence of liver injury; recognized causes of fatal liver injury are halothane, perhexiline and erythromycin. Natural remedies and herbal remedies may also be associated with DILI.

Withdrawal of the drug will usually lead to resolution of the liver damage, but liver damage sometimes progresses despite this, particularly if there is cholestatic hepatitis and with amoxicillin/clavulanate, atorvastatin, captopril, and bentazepam.

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