[Drug-induced liver damage from a clinical viewpoint]

Biotransformation of xenobiotics is a life saving function of the liver. As a consequence of the tremendous development of new and highly effective drugs this function is frequently overburden. In recent years the number of patients with pharmocotoxic liver damage has become greater than that of patients with viral hepatitis. The liver answers xenobiotic overcharge by a limited spectrum of functional, morphological and clinical reaction patterns that can be caused also by other noxious agents. The manifestation of liver damage depends on a variety of factors such as properties of the drug, mode of administration, reactivity of the whole organism and of the liver as the target organ. From the clinical point of view, xenobiotics can be divided into compounds with foreseeable liver damage and into others in which liver damage is not foreseeable as well as into drugs which produce mainly cholestasis and others in which hepatitis dominates. Mixed patterns are possible. For clarifying diagnostic, differential diagnostic and therapeutic problems a graduated program is proposed. Prophylactic measures are based on this program. The increase of pharmacotoxic damage of the liver and other organs and the expected development leads to consequences and recommendations in health care.