Drug-Induced Liver Injury Cases Rising

Date: Jun-27-2013Drug-induced liver injury is affecting more people today than ever before, researchers from the National University Hospital, Reykjavik, Iceland, reported in the journal Gastroenterology.

Drug-induced liver injury (DILI) is associated with the use of certain OTC (over-the-counter) an prescription drugs, as well as dietary supplements.

Doctors say that DILI is difficult to predict, diagnose and manage.

Einar S. Björnsson and colleagues carried out an Icelandic population-based study, which found there were 19.1 cases of DILI per 100,000 people per year. The last similar type study was carried out in France (1997-2000) which reported 13.9 cases of DILI per 100,000 people annually.

Medications most commonly associated with drug-induced liver injury were:
Amoxicillin-clavulante - a penicillin antibiotic used to treat infections
Azathioprine - an immunosuppressive medication used in organ transplantation and autoimmune diseases
Infliximab - a monoclonal antibody against tumor necrosis factor alpha used to treat autoimmune disease. Researchers from the University of California, San Francisco, reported on the danger of liver injury caused by tumor necrosis factor-alpha (TNF-α) antagonists in Clinical Gastroenterology and Hepatology (May 2013 issue).
Einar Björnsson said:

"Drug-induced liver injury is not a single, uncommon disease of the general population, but rather a series of rare diseases that occur only in persons who take specific medications.

Our study identified which medications put patients most at risk for developing liver diseases. With this information, physicians can better monitor and manage patients who are prescribed potentially liver-injuring drugs."

The researchers also found that drug-induced liver injury was caused by:
Just one prescription medication in 75% of all cases
Dietary supplements in 16% of cases
Multiple agents in 9%
The authors found no difference in the rate of drug-induced liver injury between men and women. DILI is more common as people get older, which is not surprising since older people tend to take more prescription and OTC drugs.

Symptoms related to DILI include jaundice, itching, nausea, lethargy and abdominal discomfort.

After receiving medical attention, most patients made a full recovery, the authors added.

In an Abstract in Gastroenterology, the authors concluded:

"In a population-based study in Iceland, the incidence of DILI was the highest reported to date. Amoxicillin-clavulanate was the most commonly implicated agent. The highest risk of hepatotoxicity was associated with azathioprine and infliximab, but the actual number of cases attributed to these agents was small."

In the "Gastroenterology" journal video abstract below, Dr. Björnsson discusses his research.

Moxifloxacin and levofloxacin linked to higher risk of severe liver injury in older patients - scientists from the Institute for Clinical Evaluative Sciences (ICES), Toronto; the University of Toronto and McMaster University, Hamilton, Ontario, reported in CMSJ (Canadian Medical Association Journal) that the commonly used broad-spectrum antibiotics - levofloxacin and moxifloxacin - used for bacterial infections such as respiratory infections, sinus infections, and others are more likely to cause severe liver injury in elderly people compared to other antibiotics.

Written by Christian Nordqvist

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