Review article: drug hepatotoxicity.
BACKGROUND
Drug toxicity is the leading cause of acute liver failure in the United States. Further understanding of hepatotoxicity is becoming increasingly important as more drugs come to market.


OBJECTIVE
(i) To provide an update on recent advances in our understanding of hepatotoxicity of select commonly used drug classes. (ii) To assess the safety of these medications in patients with pre-existing liver disease and in the post-liver transplant setting. (iii) To review relevant advances in toxicogenomics which contribute to the current understanding of hepatotoxic drugs.


METHODS
A Medline search was performed to identify relevant literature using search terms including 'drug toxicity, hepatotoxicity, statins, thiazolidinediones, antibiotics, antiretroviral drugs and toxicogenomics'.


RESULTS
Amoxicillin-clavulanic acid is one of the most frequently implicated causes of drug-induced liver injury worldwide. Statins rarely cause clinically significant liver injury, even in patients with underlying liver disease. Newer thiazolidinediones are not associated with the degree of liver toxicity observed with troglitazone. Careful monitoring for liver toxicity is warranted in patients who are taking antiretrovirals, especially patients who are co-infected with hepatitis B and C. Genetic polymorphisms among enzymes involved in drug metabolism and HLA types may account for some of the differences in individual susceptibility to drug hepatotoxicity.


CONCLUSIONS
Drug-induced hepatotoxicity will remain a problem that carries both clinical and regulatory significance as long as new drugs continue to enter the market. Future results from ongoing multicentre collaborative efforts may help contribute to our current understanding of hepatotoxicity associated with drugs.
Chang
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The Division of Liver Diseases, Department of Internal Medicine, The Mount Sinai School of Medicine, New York, NY 10029-6574, USA. charissa.chang@mssm.edu
Schiano
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D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008099:Liver / Q000378:metabolism*; D008107:Liver Diseases / Q000378:metabolism; D045162:Thiazolidinediones / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D045162:Thiazolidinediones