Practical Approach to Identifying and Managing Idiosyncratic Drug-Induced Liver Injury

Background

Drug-induced liver injury (DILI) can be separated into two categories: Intrinsic type, where a drug can cause injury in a predictable fashion (e.g., acetaminophen), and idiosyncratic type, where injury is less predictable. The focus of this guideline is the idiosyncratic type, often associated with commonly used antimicrobials, oncologic agents, dietary supplements, and herbal supplements.

Key Points

• Liver biopsy should be considered when immunosuppressive therapy is being contemplated, liver enzymes rise despite discontinuing the suspected offending agent, or delayed resolution of liver enzyme elevation is noted. Liver biopsy also should be considered when autoimmune hepa…