title: Assessing liver injury associated with antimycotics: Concise literature review and clues from data mining of the FAERS database.
abstract: OBJECTIVE
  To inform clinicians on the level of hepatotoxic risk among antimycotics in the post-marketing setting, following the marketing suspension of oral ketoconazole for drug-induced liver injury (DILI).
  
  
  METHODS
  The publicly available international FAERS database (2004-2011) was used to extract DILI cases (including acute liver failure events), where antimycotics with systemic use or potential systemic absorption were reported as suspect or interacting agents. The reporting pattern was analyzed by calculating the reporting odds ratio and corresponding 95%CI, a measure of disproportionality, with time-trend analysis where appropriate.
  
  
  RESULTS
  From 1687284 reports submitted over the 8-year period, 68115 regarded liver injury. Of these, 2.9% are related to antimycotics (1964 cases, of which 112 of acute liver failure). Eleven systemic antimycotics (including ketoconazole and the newer triazole derivatives voriconazole and posaconazole) and terbinafine (used systemically to treat onychomicosis) generated a significant disproportionality, indicating a post-marketing signal of risk.
  
  
  CONCLUSIONS
  Virtually all antimycotics with systemic action or absorption are commonly reported in clinically significant cases of DILI. Clinicians must be aware of this aspect and monitor patients in case switch is considered, especially in critical poly-treated patients under chronic treatment.
authors.affiliation: Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Raschi
authors.affiliation: Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poluzzi
authors.affiliation: Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy.
authors.forename: Ariola
authors.initials: A
authors.lastname: Koci
authors.affiliation: Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caraceni
authors.affiliation: Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy.
authors.forename: Fabrizio De
authors.initials: FD
authors.lastname: Ponti
keywords: Antimycotics; Drug safety; Drug-induced hepatotoxicity; Pharmacovigilance; Spontaneous reporting systems