DRUG-INDUCED LIVER DISEASE
How important is this problem?
More than 800 drugs (prescription and over-the-counter) can potentially cause liver damage. Drug-induced liver disease is the most common cause of fulminant hepatic failure, a life-threatening condition. In most cases, the drug causes mild liver damage in a few percent of patients and severe liver damage in rare individuals. It is not clear what determines susceptibility in these rare cases. Increasing numbers of cases of severe or fatal liver injury is being recognized due to herbal remedies and dietary supplements.
What is the nature of the injury?
Although some drugs produce a predictable, dose-related injury (e.g., acetaminophen), most adverse events are unpredictable. These tend to occur in two patterns: allergic, occurring in the first six weeks (e.g., dilantin); or metabolic, occurring up to one year after continuous use (e.g., isoniazid). The liver problems caused by drugs can resemble any other form of acute or chronic liver disease.
Can drug-induced liver disease be prevented?
Surveillance of serum liver enzymes on a regular basis is recommended in those cases where the drug causes an increased frequency of mild liver injury. It is expected that stopping the drug early will then prevent severe damage, which might develop in a fraction of those individuals who continue the drug. Patients who drink alcohol on a daily basis should limit their intake of acetaminophen as they are at increased risk of liver injury due to this drug.
(update October 2005)