Drug-induced liver disease

Drug-induced liver disease is common in clinical practice, accounting for between 6% and 70% of adverse and lethal drug reactions. Some drugs that injure the liver do so in a predictable, dose-dependent manner. Other drug-induced liver injury is peculiar to the individual and is called idiosyncratic or allergic. Drug-induced liver disease may be an incidental finding on routine monitoring of liver function, or may present as frank liver disease. Evaluation of drug-induced liver disease requires that the following questions be asked: Can a causal relationship be established between the use of a drug and abnormal liver functions? Is underlying liver disease present? How sick is the patient? Can the pattern of enzyme abnormalities help predict the mode of injury and the most likely offending drug?l/lig When is a liver biopsy indicated? Drug-induced liver disease is usually treated by stopping the drug. In some cases, where no other liver disease is present and the enzyme derangement is mild, liver function can simply be monitored without stopping the drug. Drugs that are most commonly implicated in drug-induced liver disease in South Africa are NSAIDs, certain antibiotics and methotrexate.