Drug-induced liver disease.
OBJECTIVE
To summarize the pertinent case reports, case series and clinical studies that described clinical, histological, epidemiological and mechanistic features of drug-induced liver disease in 2005.


RESULTS
Acetaminophen, highly active antiretroviral therapy and drugs for tuberculosis retained their preeminent position as the most commonly reported agents causing drug-induced liver disease, with acetaminophen continuing to be the leading cause of acute liver failure in the USA. While the frequency of drug-induced liver disease remains low, a large case-series of acute drug-induced liver disease from Spain and Sweden supported the observation that acute hepatocellular jaundice from a drug is associated with death or the need for transplant in at least 10% (known as Hy's Law). With respect to using potentially hepatotoxic medications in patients with underlying liver disease, statins and second-generation thiazolidinediones were shown to be safe when used in patients with elevated baseline alanine aminotransferase or aspartate aminotransferase levels.


CONCLUSIONS
Drug-induced liver disease remains an important cause of acute liver failure, and research efforts by the National Institutes of Health and others are underway to better determine the risk factors and other host susceptibilities that will allow for the safer use of drugs in the future.
Division of Gastroenterology, Georgetown University Medical Center, Washington DC 20007, USA. lewisjh@gunet.georgetown.edu
James H
JH
Lewis
Moustafa
M
Ahmed
Ahmed
A
Shobassy
Caren
C
Palese
D000082:Acetaminophen / Q000009:adverse effects; D016907:Adverse Drug Reaction Reporting Systems; D000410:Alanine Transaminase / Q000032:analysis; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D044966:Anti-Retroviral Agents / Q000009:adverse effects; D000995:Antitubercular Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D000075202:Contraindications; D016903:Drug Monitoring; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D004364:Pharmaceutical Preparations; D008517:Phytotherapy / Q000009:adverse effects
D018712:Analgesics, Non-Narcotic; D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D007004:Hypoglycemic Agents; D004364:Pharmaceutical Preparations; D000082:Acetaminophen; D000410:Alanine Transaminase