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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

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 November 2012. The previous version of this content can be found here.

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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