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Drug-induced liver injury: Is chronic liver disease a risk factor and a clinical issue?

Rolf Teschke1,2, Gaby Danan3

  • 1a Department of Internal Medicine II , Division of Gastroenterology and Hepatology , Klinikum Hanau , Hanau , Germany.

Expert Opinion on Drug Metabolism & Toxicology
|November 9, 2016
PubMed
Abstract

Insights

For most patients with chronic liver disease without cirrhosis, medications are generally safe. However, careful consideration is needed for specific therapies in patients with decompensated cirrhosis or viral hepatitis.

Area of Science:

  • Hepatology
  • Clinical Pharmacology
  • Drug-Induced Liver Injury (DILI)

Background:

  • Assessing the risk of drug-induced liver injury (DILI) in patients with chronic liver disease (CLD) is a clinical challenge.
  • Existing literature often presents retrospective and ambiguous findings regarding DILI risk in CLD patients.
  • Specific patient populations, such as those with decompensated liver cirrhosis, pose complex management dilemmas.

Purpose of the Study:

  • To review and analyze existing literature on the safety of drug therapy in patients with various forms of chronic liver disease.
  • To identify specific drug classes and patient conditions associated with an increased risk of DILI.
  • To provide expert opinion on drug tolerability and management strategies in CLD patients.

Main Methods:

  • Systematic search for case reports and series detailing DILI in patients with chronic liver disease (including non-alcoholic fatty liver disease, alcoholic liver disease, and cirrhosis).
  • Analysis of studies involving specific drug classes such as statins, acetaminophen, antitubercular drugs, antivirals, and antiretrovirals.
  • Focus on challenging cases, particularly drug therapy in patients with decompensated liver cirrhosis.

Main Results:

  • Many case reports suggest a potential increased risk of DILI in patients with pre-existing liver disease, but most are retrospective and lack clarity.
  • With few exceptions, drugs appear to be well-tolerated in the majority of patients with non-cirrhotic chronic liver diseases.
  • Antiviral therapy for chronic hepatitis B and C, and drug therapy in decompensated cirrhosis with impaired metabolism require special attention.

Conclusions:

  • Drugs are generally well-tolerated in patients with non-cirrhotic chronic liver diseases.
  • Special caution is advised for antiviral therapies in chronic hepatitis B and C, and for drug administration in decompensated liver cirrhosis due to potential impaired drug metabolism.
  • Prospective studies are necessary to validate these conclusions and refine clinical guidance on medication safety in CLD.
Keywords:
Drug-induced liver injury (DILI)Roussel Uclaf Causality Assessment Method (RUCAM)alcoholic liver diseaseantituberculous drugsantiviral drugschronic liver diseasedrug therapyhepatitis Bhepatitis Chepatitis Eliver cirrhosisnonalcoholic fatty liver disease (NAFLD)statins

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