title: Drug-induced liver injury in older adults.
abstract: Drug-induced liver injury (DILI) is an important cause of hospitalisation and of medication deregistration. In old age, susceptibility to DILI is affected by changes in physiology and increased interindividual variability, compounded by an increased prevalence of disease and the frailty syndrome. While dose-related or predictable DILI reactions are often detected in preclinical trials, the occurrence of rare hypersensitivity or idiosyncratic reactions cannot be reliably predicted from preclinical studies or even by clinical trials. The limited participation of older adults in clinical trials means that the susceptibility of this population to DILI is largely unknown. Vigilance during clinical trials and postmarketing surveillance must be universally practised. A systematic approach should be taken to determine not only which medicines are hepatotoxic and should be removed from the market, but also the hepatotoxicity risks from marketed drugs to consumers with different characteristics, many of whom are older people.
authors.affiliation: Sydney Medical School, University of Sydney, and Departments of Clinical Pharmacology and Aged Care and Rehabilitation, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Mitchell
authors.affiliation: Departments of Clinical Pharmacology and Aged Care and Rehabilitation, Ward 11C Main Building, Royal North Shore Hospital, Pacific Highway, St Leonards NSW 2065, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
keywords: ageing; drug-induced liver injury; frailty; idiosyncratic; pharmacovigilance
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