Via practica 4-5/2008

DRUG-INDUCED LIVER INJURY IN GENERAL PRACTITIONER´S OFFICE

Drug-induced liver injury (DILI) is a relatively frequent and potentially serious complication of a routine pharmacotherapy. Its importance increases in view of its higher prevalence in patients with serious forms of various diseases, in newborns, children, or elderly persons that are treated by numerous medicinal drugs simultaneously. In economically developed countries (Europe, North America), DILI belongs to the most frequent causes of acute liver failure in the elderly. Molecular etiopathogenesis of DILI remains poorly understood in most cases. Diagnosis of DILI is based on meticulous medicinal drug anamnesis (relationship in time with the administrationof the drug) and on the clinical and laboratory features of a hepatocellular, cholestatic or mixed liver injury. Specific laboratory tests performed with the suspected drug may be helpful, their negativity, however, cannot rule the DILI out. In the case of a toxic injury (e. g. overdose or a metabolic polymorphism), measurement of the plasma level of suspected drug and/or of its metabolites may be helpful. In differential diagnostics of DILI, it is necessary to rule out liver injuries or diseases of different etiologies. Liver biopsy is usually not necessary. The most important treatment measure consists of a withdrawal of the suspected drug or drugs. Subsequent therapeutic procedures depend on the type and severity of the liver injury or disease, and on the overall health status of the patient (e. g. concomitant diseases). In some cases, the administration of a specific antidote is possible (e. g. N-acetyl-cysteine in the acetaminophen overdose).

Keywords: drug-induced liver injury, predictable and non-predictable hepatotoxicity.