Drug-induced hepatitis: clinical aspects

Drug-induced liver injury (DILI) is a complex clinical problem. The diagnosis of drug-induced hepatitis (DIH) is generally a difficult task, since there are no special diagnostic markers, and it is mainly based on the exclusion of other causes of liver damage. The main diagnostic criteria are clinical features, the presence of a latent period (the interval between the start of using a proposed drug and the manifestation of DIH), relief of liver injury after drug discontinuation, a relapse upon repeated exposure to drugs, and knowledge of the potential of hepatotoxicity for a certain drug. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure. A wide range of herbal medicines, prescription drugs, over-the-counter medications, as well as food additives, toxic metals, and toxins can cause liver damage, which makes this problem relevant. The past few decades have been marked by a significant development in understanding various (viral, metabolic, autoimmune) liver diseases and by improved approaches to their prevention and treatment; however, there have been no significant positive changes in these areas with respect to DIH. This brief review presents some of the clinical aspects of DIH, including general principles, current management concepts, and current problems.

hepatology, hepatitis, drugs, drug-induced hepatitis, hepatotoxicity, idiosyncrasy, liver failure