Exploring the influence of sex on idiosyncratic DILI: impact on risk assessment

Idiosyncratic drug-induced liver injury (DILI) is a poorly understood condition which can be caused by various medications, including herbals and anti-cancer drugs. A literature review of studies published 1995-2025 was conducted by searching PubMed and Google Scholar. Sex seems to play a role in the etiology of specific medications, as women are more prone to DILI due to certain drugs, whereas male sex is a risk factor of DILI due to other drugs.

The current article highlights new studies on sex regarding risk factors of DILI, prediction of liver injury, and predictors of severe outcomes. Studies on sex-related differences in pharmacokinetics and drug-specific differences of DILI are discussed. In addition, the differences in the incidence of DILI and severity in women are discussed.

Although sex-related differences have been reported, the reasons for drug-specific risk factors for DILI are poorly characterized. A better understanding of drug vs. host-related factors in terms of sex is needed in order to predict the risk in women vs. men. Further studies are needed to determine if differences in different phenotypes and severity in women compared to men are due to hormonal and/or pharmacokinetics or other factors.