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Drug Induced Liver Injury

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Clinical Cases in Hepatology

Abstract

Hepatotoxicity is toxic damage to the liver that includes the nature of the hepatotoxic agent, the type and mechanism of liver injury, the circumstances of the exposure, and the medical and social context in which it occurs.

Drug induced liver injury (DILI) is the injurious effect to the liver by an agent, natural or produced, manifested by a hepatocellular, cholestatic, or mixed liver profile with or without hyperbilirubinemia and hepatic synthetic dysfunction, including acute liver failure.

Rapid identification of the toxic agent and its discontinuation is the most critical measure in DILI. The approach to a patient with suspected DILI concerns identifying time to onset or latency, i.e., challenge, time to recovery, i.e., dechallenge, injury pattern and clinical phenotype, exclusion of other causes of liver disease, and the likelihood of the agent to cause DILI. Rechallenge with the same agent, intentional or accidental, is avoided; the second episode of DILI can be worse than the index reaction. Expert opinion and access to LiverToxNIH.gov provides information regarding the potential involvement of agents in the DILI episodes.

Genetic susceptibility for DILI to certain agents, including flucloxacillin, amoxicillin-clavulanate, and diclofenac, has been identified. Susceptibility genes related to drug metabolism have also been documented.

Prudent patient follow up is necessary for patients on medications. Medication reconciliation during clinic visits is a standard practice that allows for the identification of DILI. A genetic, cellular, organoid, and human-scale evidence testing platform recently developed may provide the opportunity to test the potential for DILI in drug development and clinical trials phases.

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Authors and Affiliations

  1. Department of Medicine, H+H/Metropolitan, New York, NY, USA

    Nora V. Bergasa

  2. New York Medical College, Valhalla, NY, USA

    Nora V. Bergasa

  3. Hepatology, H+H/Woodhull, Brooklyn, NY, USA

    Nora V. Bergasa

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  1. Department of Medicine, H+H/Metropolitan Physician Affiliate Group of New York, New York, NY, USA

    Nora V. Bergasa

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Bergasa, N.V. (2022). Drug Induced Liver Injury. In: Bergasa, N.V. (eds) Clinical Cases in Hepatology. Springer, London. https://doi.org/10.1007/978-1-4471-4715-2_14

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