Drug-Induced Liver Injury (DILI): A Short Review on Current Scenario
Drug Induced Liver Injury (DILI) is acute and chronic liver injury secondary to drugs and herbal compounds. DILI can be caused by overdose or even at therapeutic doses of some drugs such as NSAIDs and antitubercular drugs. It can be direct, indirect or idiosyncratic based on the mechanism of liver injury caused by the drug. It is also classified based on the histopathological and clinical features. Several mechanisms and hypotheses like immune mediation, mitochondrial injury and Hapten’s role are proposed to cause DILI. It can result in acute liver failure and even death if the suspected drug is not stopped. In India, antitubercular drugs are the major group of drugs known to cause DILI, apart from other antimicrobial drugs and NSAIDs. The International DILI Expert Working Group under CIOMS has put forward a grading system to assess severity of DILI based on clinical and laboratory findings. FDA evaluates hepatotoxicity of a drug before approval using Hy's rule, which states that 3 times elevation of Alanine aminotransferase (ALT) enzyme along with jaundice results in 5 to 50% fatality. The most useful approach for DILI detection and risk assessment is based on comprehensive hepatic data collection, assessment, and interpretation during clinical trials of drug development.
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