Drug-Induced Liver Injury: What You Need to Know
In general, the treatment of patients with suspected DILI entails withdrawal of the offending medication and provision of supportive care.
For patients with acetaminophen overdose, administration of the unapproved medication N-acetylcysteine (NAC) should be considered. ACG guidelines do not recommend NAC administration to children.
Abnormal laboratory tests, including aminotransferases, AP, and bilirubin, should be repeated after drug withdrawal until they become normal.
Chronic DILI can occur and may respond to corticosteroids after other causes of the liver injury have been excluded.
One question that frequently comes up is whether there is a risk for statin-induced acute liver injury in patients with cirrhosis from such diseases as nonalcoholic steatohepatitis. No significant risk for hepatotoxicity from statin use in patients with advanced liver disease has been observed.
Patients with medication-induced acute hepatocellular injury tend to have a worse prognosis than those with drug-induced cholestasis or mixed hepatocellular/cholestatic liver injury. Medication-related acute hepatic failure remains the most frequent cause of liver transplantation for acute liver failure in the United States.
Hyman Zimmerman suggested that patients with acute hepatocellular injury who also developed jaundice had a 10% likelihood of hepatic failure and death, an observation that has been referred to as "Hy's Law." Other studies have found that a serum ALT value > 3 times normal occurring with a bilirubin level at least twice normal is associated with 10% mortality.
Among patients with drug-induced acute hepatic failure, 40% will require liver transplantation or die as a result of their liver injury. Patients with drug-induced cholestasis may require months or up to 1 year or more for their liver tests to return to normal.
Chronic DILI resembling autoimmune hepatitis can develop. Treatment with corticosteroids should be considered if clinical findings support the diagnosis and liver tests do not improve with cessation of the offending drug.
As a rule of thumb, rechallenging a patient with a drug suspected of causing DILI should be avoided.
Treatment of Drug-Induced Liver Injury
In general, the treatment of patients with suspected DILI entails withdrawal of the offending medication and provision of supportive care.
For patients with acetaminophen overdose, administration of the unapproved medication N-acetylcysteine (NAC) should be considered. ACG guidelines do not recommend NAC administration to children.
Abnormal laboratory tests, including aminotransferases, AP, and bilirubin, should be repeated after drug withdrawal until they become normal.
Chronic DILI can occur and may respond to corticosteroids after other causes of the liver injury have been excluded.
One question that frequently comes up is whether there is a risk for statin-induced acute liver injury in patients with cirrhosis from such diseases as nonalcoholic steatohepatitis. No significant risk for hepatotoxicity from statin use in patients with advanced liver disease has been observed.
Prognosis
Patients with medication-induced acute hepatocellular injury tend to have a worse prognosis than those with drug-induced cholestasis or mixed hepatocellular/cholestatic liver injury. Medication-related acute hepatic failure remains the most frequent cause of liver transplantation for acute liver failure in the United States.
Hyman Zimmerman suggested that patients with acute hepatocellular injury who also developed jaundice had a 10% likelihood of hepatic failure and death, an observation that has been referred to as "Hy's Law." Other studies have found that a serum ALT value > 3 times normal occurring with a bilirubin level at least twice normal is associated with 10% mortality.
Among patients with drug-induced acute hepatic failure, 40% will require liver transplantation or die as a result of their liver injury. Patients with drug-induced cholestasis may require months or up to 1 year or more for their liver tests to return to normal.
Chronic DILI resembling autoimmune hepatitis can develop. Treatment with corticosteroids should be considered if clinical findings support the diagnosis and liver tests do not improve with cessation of the offending drug.
As a rule of thumb, rechallenging a patient with a drug suspected of causing DILI should be avoided.
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