title: Drug Hepatotoxicity: Environmental Factors.
abstract: Drug-induced liver injury presents as various forms of acute and chronic liver disease. There is wide geographic variation in the most commonly implicated agents. Smoking can induce cytochrome P450 enzymes but this does not necessarily translate into clinically relevant drug-induced liver injury. Excessive alcohol consumption is a clear risk factor for intrinsic hepatotoxicity from acetaminophen and may predispose to injury from antituberculosis medications. Understanding of the role of infection, proinflammatory states, disorders of coagulation, and the hepatic clock in predisposing patients to drug-induced liver injury is evolving. More study focusing specifically on environmental risk factors predisposing patients to drug-induced liver injury is needed.
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, 1215 Lee Street, PO Box 800708, MSB 2145, Charlottesville, VA 22908, USA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Stine
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 702 Rotary Building, Suite 225, Indianapolis, IN 46202, USA. Electronic address: nchalasa@iu.edu.
authors.forename: Naga P
authors.initials: NP
authors.lastname: Chalasani
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000428:Alcohol Drinking / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents; D000082:Acetaminophen
keywords: Acute liver failure; Alcohol; Cirrhosis; Drug-induced liver injury; Liver toxicity; Smoking