__NOTOC__
{{Drug induced liver injury}}
{{CMG}}; {{AE}} {{rachita}}

==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.

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 non-acetaminophen drug induced liver injury: 58% with N-acetyl cysteine versus 27% with placebo.<ref name="pmid24935270">{{cite journal| author=Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ et al.| title=ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 7 | pages= 950-66; quiz 967 | pmid=24935270 | doi=10.1038/ajg.2014.131 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24935270 }} </ref>

Corticosteroid therapy has also been proposed as treatment for acute liver failure resulting from drug induced liver injury. However, unlike for alcoholic and autoimmune hepatitis, there are no controlled trials to support this therapy for drug induced liver injury.

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==
{{Reflist|2}}

[[Category:Hepatology]]

Drug induced liver injury medical therapy

2016-10-06T11:40:23Z

Rachita Navara:

__NOTOC__
{{Drug induced liver injury}}
{{CMG}}; {{AE}} {{rachita}}

==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.<ref name="pmid24935270">{{cite journal| author=Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ et al.| title=ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 7 | pages= 950-66; quiz 967 | pmid=24935270 | doi=10.1038/ajg.2014.131 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24935270 }} </ref>

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.<ref name="pmid24935270">{{cite journal| author=Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ et al.| title=ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 7 | pages= 950-66; quiz 967 | pmid=24935270 | doi=10.1038/ajg.2014.131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24935270 }} </ref>

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==
{{Reflist|2}}

[[Category:Hepatology]]

2016-08-10T22:47:22Z

Rachita Navara: /* Overview */

__NOTOC__
{{Drug induced liver injury}}
{{CMG}} {{AE}} {{rachita}}

==Overview==
Patients with drug induced liver injury usually appear normal on physical exam, unless they are presenting in acute liver failure. <ref name="pmid22541696">{{cite journal| author=Davern TJ| title=Drug-induced liver disease. | journal=Clin Liver Dis | year= 2012 | volume= 16 | issue= 2 | pages= 231-45 | pmid=22541696 | doi=10.1016/j.cld.2012.03.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22541696 }} </ref> Some patients may also present in chronic liver failure due to rare drugs associated with liver scarring, e.g. methotrexate.<ref name="pmid7986233">{{cite journal| author=Fries JF, Ramey DR, Singh G| title=Suggested guidelines for monitoring liver toxicity in rheumatoid arthritis patients treated with methotrexate: comment on the article by Kremer et al. | journal=Arthritis Rheum | year= 1994 | volume= 37 | issue= 12 | pages= 1829-30 | pmid=7986233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7986233 }} </ref>

==Physical Examination==
===General Appearance===
The general appearance of the patient will depend on the severity of the condition.
===Vital Signs===
The patient may be febrile.
===Skin===
The skin may be jaundiced. THere may also be excoriations from pruritis due to drug induced cholestatic injury.
===Abdomen===
There may be right upper quadrant tenderness. There may be ascites in cases of chronic drug induced liver injury.
===Extremities===
There may be stigmata of chronic drug induced liver injury including cachexia, spider angiomata and palmar erythema.

==References==
{{Reflist|2}}

[[Category:Hepatology]]