IDIOSYNCRATIC DRUG-INDUCED LIVER INJURY: DIAGNOSIS AND TREATMENT

Abstract

Drug-induced drug liver lesion (DILL) means the pathology of a wide spectrum – from clinically asymptomatic laboratory changes in liver function tests to fulminant acute hepatic insufficiency as a result of application of drugs, herbs or dietary supplements. There are two main options of DILL when direct (dose-dependent) and indirect damage (idiosyncratic) effect is exerted. Direct damage DILL cases are predictable, the more rare idiosyncratic variant can appear quite unexpectedly. Idiosyncratic DILL is more complex to diagnose and treat. The most common reason for DILL are use of antibiotics, nonsteroidal anti-inflammatory drugs and immunosuppressants. The diagnosis of DILL is stated by a mehod of elimination. The treatment begins with the immediate discontinuation of the administration of drugs, herbal medication or dietary supplements that can cause liver damage. There are no specific antidotes for the treatment of idiopathic DILL, symptomatic treatment is administered. In case of cholestasis ursodeoxycholic acid is often used. With the development of acute liver failure the positive forecast is significantly improved only by liver transplantation.

Keywords

• drug-induced liver lesion
• idiosyncrasy
• cholestasis
• acute hepatic failure
• ursodeoxycholic acid
• urdoxa