Understanding and Preventing Drug-Induced Liver Injury

Overview

Drug-induced liver injury (DILI) is a significant health concern that arises from the inappropriate use of medications. This article delves into the causes, symptoms, diagnosis, treatment, and prevention strategies for DILI, providing essential information for healthcare professionals and patients alike.

The Basics of Drug-Induced Liver Injury

What is DILI?

Drug-induced liver injury refers to liver damage caused by the overuse or prolonged use of certain medications, particularly when multiple drugs are combined inappropriately. Common offenders include antibiotics, antipyretics, and antituberculosis drugs. The exact mechanisms behind DILI are not fully understood but involve drug metabolism abnormalities, mitochondrial damage, immune injury, and genetic factors.

Types of DILI

DILI is categorized into acute and chronic forms. Acute DILI, with a duration of less than three months, can be categorized into three types: hepatocellular damage, cholestatic liver damage, and mixed liver damage. Chronic DILI, with a duration of three months or more, encompasses a range of conditions including chronic hepatitis, fatty liver, phospholipidosis, liver fibrosis and cirrhosis, cholestasis, biliary cirrhosis, granulomatous lesions, and tumors.

Risk Factors

DILI is more common in certain populations, including those with a history of drug-induced liver damage, the elderly, children, women, individuals with immune dysfunction, those with pre-existing liver disease, individuals who have undergone liver radiation or interventional therapy, those on immunosuppressants, individuals with lipid metabolism disorders, long-term heavy drinkers, and individuals with malnutrition. Pregnant women and the obese are also at higher risk.

Diagnosis

Clinical Presentation

Acute DILI is more common and often presents with symptoms such as fatigue, loss of appetite, abdominal distension, nausea, and vomiting, followed by mild jaundice. Cholestatic liver damage is characterized by jaundice, fever, chills, nausea, abdominal distension, and pruritus, with jaundice gradually deepening and becoming more severe. Mixed liver damage presents with symptoms between the two types.

Laboratory and Imaging Tests

Blood tests, including liver function tests and bile acid levels, are essential for diagnosing DILI. Imaging techniques like ultrasound and CT scans can also be used, with liver biopsy serving as a gold standard for diagnosing DILI and excluding other liver diseases.

Treatment

Immediate Measures

The primary treatment for DILI is the immediate discontinuation of the suspected drug. This is followed by dietary adjustments and the use of medications to reduce inflammation, detoxify, protect the liver, and promote bile flow.

Dietary Adjustments

Increasing protein and vitamin intake is crucial for liver cell repair and regeneration. This includes consuming high-quality proteins like animal proteins and legumes, as well as fresh vegetables and vitamin-rich foods. Avoiding fried and刺激性 foods, as well as broths, can help reduce the liver's workload.

Medications

Medications used to treat DILI include anti-inflammatory drugs,解毒 agents, hepatoprotective agents, and bile acid sequestrants. In some cases, corticosteroids may be used to alleviate symptoms. Research has shown that certain drugs, such as double环醇 and silymarin, can be effective in treating DILI caused by specific medications.

Prevention

General Guidelines

Preventing DILI is crucial, and the key is to avoid unnecessary medication use, reduce the duration and dose of medications, minimize polypharmacy, and avoid drugs with potential hepatotoxicity. Those with a history of drug-induced liver damage, those with allergic histories, and individuals with pre-existing liver disease should exercise extreme caution when taking medications.

Drug Prophylaxis

Using drugs like double环醇 can reduce the risk of liver damage in patients receiving certain medications, such as antitumor drugs and antifungal agents. Regular monitoring of drug-induced liver toxicity in new drug development is also vital.

Conclusion

Drug-induced liver injury is a serious health issue that requires careful medication management and monitoring. By understanding the risks, symptoms, and treatment options, both healthcare professionals and patients can take steps to prevent and manage DILI effectively.