19th May 2025

Introduction

The term drug-induced liver injury (DILI) refers to all forms of hepatotoxicity that result from the administration of a medicinal agent. It encompasses a broad range of presentations of hepatic disease and may manifest as either acute or chronic disease. DILI is the commonest cause of acute liver failure (ALF) in the UK. 

A diagnosis of DILI is one of exclusion, once liver injury has been identified clinically and/or biochemically. Nearly all cases of DILI are idiosyncratic, with the notable exception of paracetamol overdose. Idiosyncratic drug reactions affecting the liver are generally understood to arise from immune-mediated processes. 

The treatment of DILI involves cessation of the causative therapeutic agent. ALF may benefit from treatment with N-acetylcysteine early within the disease course and liver transplantation should be considered early.