Drug-Induced Liver Injury

When dealing with drug-induced liver injury, a condition where medications damage liver cells, causing inflammation and potential failure. Also known as DILI, it drug-induced liver injury often overlaps with hepatotoxicity, the toxic effect of drugs on the liver and requires close observation of liver enzymes, blood markers like ALT, AST, and ALP that rise when liver cells are damaged. The relationship is clear: DILI encompasses hepatotoxicity, hepatotoxicity influences liver enzyme levels, and monitoring liver enzymes helps catch DILI early. Understanding this trio lets clinicians spot problems before they spiral into serious disease.

Why Some Drugs Turn Toxic

Not every medication harms the liver, but a surprising number have a hidden risk. Statins such as Pravachol (pravastatin) can raise liver enzymes in a small subset of patients, especially when combined with other lipid‑lowering agents. Antivirals like Molnupiravir (Movfor) and Paxlovid have been linked to transient ALT spikes during COVID‑19 treatment. Even everyday drugs—buspirone for travel anxiety or benzoyl peroxide for acne—can cause mild hepatotoxic reactions in sensitive individuals. The key drivers are how the liver metabolizes the compound (via CYP450 pathways), dose intensity, and patient‑specific factors like pre‑existing liver disease or alcohol use. Risk assessment therefore blends drug‑specific data (e.g., known hepatotoxic profiles) with patient‑level attributes (age, genetic variants, comorbidities). When a drug is known to be hepatotoxic, guidelines usually advise baseline liver function testing and periodic follow‑up.

Monitoring isn’t just a checklist; it’s a proactive safety net. Baseline tests of ALT, AST, alkaline phosphatase, and bilirubin set a reference point. Subsequent testing—often at 2‑4 weeks after starting a new high‑risk drug—helps detect early enzyme elevation. If levels rise more than three times the upper limit of normal, clinicians may halt the medication, lower the dose, or switch to an alternative with a cleaner liver profile. In practice, physicians use tools like the RUCAM (Roussel Uclaf Causality Assessment Method) to weigh the likelihood that a drug caused the injury, balancing the timing of exposure, de‑challenge response, and exclusion of other causes. This systematic approach turns a potentially vague symptom into a clear, actionable plan.

For patients, the takeaway is simple: stay informed about the liver safety profile of every prescription, ask for baseline liver tests, and report any unexplained fatigue, jaundice, or abdominal pain promptly. Health professionals, on the other hand, should maintain a high index of suspicion for DILI, especially when prescribing drugs with known hepatotoxicity, and follow structured monitoring protocols. Below you’ll find a curated set of articles that dive into specific drug comparisons, safety tips, and practical guides—all aimed at helping you navigate the complex world of medication‑related liver health.