Hepatotoxicity

Drug-induced liver injury (DILI) resulting from direct toxicity, immune-mediated reactions, or metabolic idiosyncrasy. The most common cause of post-market drug withdrawal and acute liver failure in the US. Monitored through serum ALT, AST, bilirubin, and alkaline phosphatase levels, with Hy's Law (ALT >3x ULN + bilirubin >2x ULN) predicting serious outcomes.

Examples

• Acetaminophen dose-dependent hepatotoxicity above 4g/day
• Isoniazid idiosyncratic DILI in tuberculosis treatment
• Troglitazone withdrawn for severe hepatotoxicity (2000)