title: Diclofenac-induced liver injury: a paradigm of idiosyncratic drug toxicity.
abstract: The advances in the drug development that allowed the replacement of many potentially hepatotoxic agents by safer alternatives have been out-weighed by the vast expansion of the total number of agents now available for use. Now, rare adverse reactions to several commonly prescribed medications contribute to the total burden of drug-induced liver injury. Studies involving well-characterised patients with diclofenac-induced hepatotoxicity indicate that multiple steps are involved in the development of liver injury. Individual susceptibility to idiosyncratic hepatotoxicity is determined by the interaction of metabolic and immunological factors. Immunomodulatory and anti-inflammatory cytokines, such as IL-10, may have a protective role in reducing drug-induced liver injury. Understanding the mechanisms of idiosyncratic hepatotoxicity may increase our ability to identify susceptible individuals and hence, prevent serious adverse reactions.
authors.forename: Guruprasad P
authors.initials: GP
authors.lastname: Aithal
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000276:immunology / Q000493:pharmacokinetics; D001711:Biotransformation; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics / Q000378:metabolism; D004008:Diclofenac / Q000009:adverse effects* / Q000276:immunology / Q000493:pharmacokinetics; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D020719:Glucuronides / Q000378:metabolism; D006801:Humans; D007527:Isoenzymes / Q000235:genetics / Q000378:metabolism; D008862:Microsomes, Liver / Q000201:enzymology; D015262:Xenobiotics / Q000493:pharmacokinetics
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020719:Glucuronides; D007527:Isoenzymes; D015262:Xenobiotics; D004008:Diclofenac; D003577:Cytochrome P-450 Enzyme System