Comprehensive Practical Hepatology

Acute and chronic liver disease is a global endemic healthcare concern. More than 500 million people around the world are infected with the hepatitis B or C virus. Approximately 500,000 patients die ...
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Approach to Liver Injury Caused by Drugs and Toxins

Pp. 177-191 (15)

Kazuto Tajiri and Yukihiro Shimizu


The liver is an essential organ involved in elimination of drugs and toxins. Any drug, including herbal remedies or dietary supplements, can be a causative agent for drug-induced liver injury (DILI). An aging society or requirement for advanced medical care with multiple medications may complicate the management of DILI, especially in developed countries. The possibility of developing DILI should always be considered when starting new drugs. The classification of DILI—hepatocellular, cholestatic, or mixed—is useful for management. Discontinuation of the causative drug is usually sufficient to manage patients with DILI, but liver injury may persist or progress even after the drug has been stopped, especially in cholestatic type DILI.


Causality assessment, DILI, liver function, Toxic liver injury.


The Third Department of Internal Medicine, University of Toyama,Toyama, Japan.