Drug induced liver injury medical therapy
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Drug induced liver injury Microchapters |
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Differentiating Drug Induced Liver Injury from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Drug Induced Liver Injury On the Web |
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American Roentgen Ray Society Images of Drug induced liver injury |
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Risk calculators and risk factors for Drug induced liver injury |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]
Overview
The mainstay of therapy for drug induced liver injury is prompt withdrawal of the offending drug.
Medical Therapy
It has been hypothesized that early drug withdrawal prevents progression to acute liver failure, but there is insufficient data to support this, as sometimes even a few days of exposure to a drug can cause a fatal outcome.[1]
There is no antidote approved by the Federal Drug Administration for idiosyncratic drug induced liver injury. N-Acetylcysteine has only been approved for acetaminophen-induced liver injury, though a randomized placebo-controlled trial suggested that this therapy significantly improves transplant-free survival from drug induced liver injury: 58% with N-acetyl cysteine versus 27% with placebo.[1]
Corticosteroid therapy has also been proposed as treatment for acute liver failure resulting from drug induced liver injury, but there are no controlled trials to support this therapy, unlike for alcoholic or autoimmune hepatitis. Symptoms such as pruritis can be managed with antihistamines including hydroxyzine and diphenhydramine. Ursodeoxycholic acid was also used in approximately 30% of patients in the DILIN prospective study, but there is no clear evidence to support this therapy.
References
- ↑ 1.0 1.1 Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ; et al. (2014). "ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury". Am J Gastroenterol. 109 (7): 950–66, quiz 967. doi:10.1038/ajg.2014.131. PMID 24935270.