Drug-induced Liver Injury
Drug-induced liver injury (DILI) occurs when medications, herbal remedies, or other chemical substances cause damage to the liver. Because the liver plays a central role in processing drugs and removing toxins from the body, it is especially susceptible to damage from these substances.
Types
There are two primary forms of drug-induced liver injury: intrinsic and idiosyncratic.
- Intrinsic: This type is predictable, depends on the dosage, and typically develops soon after exposure to a toxic substance—an acetaminophen (Tylenol®) overdose being the most common example.
- Idiosyncratic: This typeis unpredictable and not directly related to the drug dose. It can affect a small subset of individuals who take a medication that most people tolerate without issue. This type is believed to be influenced by genetic factors or immune system responses.
Additionally, it can be categorized by which part of the liver it impacts, often referred to as the “injury pattern”.
- Hepatocellular - The most common type of DILI that causes damage to liver cells
- Cholestatic - When the damage occurs to the bile ducts
- Mixed - Damage to both the liver and the bile ducts
Symptoms
Symptoms of drug-induced liver injury can vary widely. Some people may have no symptoms and only show abnormal liver test results, such as elevated liver enzyme levels, while others may experience fatigue, nausea, abdominal pain, dark urine, jaundice (yellowing of the skin or eyes), or itching. In severe cases, DILI can lead to acute liver failure, a life-threatening emergency that can require a liver transplant.
Diagnosis
Diagnosing DILI can be challenging, as it requires ruling out other causes of liver disease, such as viral hepatitis or alcohol-related injury.
Your hepatologist will use blood tests, imaging studies, and sometimes a liver biopsy if necessary to help confirm the diagnosis.
treatment
The key part of treating DILI is immediately stopping the offending drug. Supportive care is then provided to help the liver heal. In cases of acetaminophen toxicity, early treatment with the antidote N-acetylcysteine (NAC) can prevent serious damage.
Most people recover fully once the drug is discontinued, but severe cases can cause lasting liver damage. Awareness, early detection, and careful medication management are key to preventing drug-induced liver injury.