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Drug-Induced Liver Injury (DILI)

Hepatotoxicity caused by prescription or over-the-counter medications, herbal products, and supplements.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Drug-Induced Liver Injury (DILI)?

Drug-induced liver injury (DILI) is damage to liver cells caused by a drug or toxin through direct or immune-mediated mechanisms. It can be dose-dependent (intrinsic, such as paracetamol) or idiosyncratic (dose-independent and unpredictable).

In developed countries, paracetamol (acetaminophen) poisoning is the most common cause of acute liver failure. Amoxicillin-clavulanate, isoniazid, nitrofurantoin, antiepileptics, statins, and herbal/complementary products (green tea extract, kava, St. John's wort) are among the frequent culprits.

Diagnosis is by exclusion; viral hepatitis, autoimmune hepatitis, and biliary obstruction must be ruled out. The RUCAM (Roussel Uclaf Causality Assessment Method) scoring system is used to assess causality.

Symptoms

Nausea, vomiting, and loss of appetite
Right upper quadrant pain and hepatomegaly
Fatigue and weakness
Jaundice (skin and sclera)
Dark urine and pale stools
Itching (in the cholestatic type)
Rash and eosinophilia (hypersensitivity reaction)

Risk Factors

Polypharmacy (especially in older adults)
Chronic alcohol consumption
Pre-existing liver disease
Female sex (for some drugs)
Older age (>60) and obesity
Malnutrition and glutathione deficiency
Unsupervised use of herbal and complementary products

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • If jaundice or rising enzymes occur after starting a new drug
  • When the paracetamol dose is exceeded (requires emergency intervention)
  • If nausea, vomiting, and right upper quadrant pain develop together
  • If liver complaints begin after using an herbal product
  • If altered consciousness develops with jaundice (emergency)

Treatment Methods

01
Immediate discontinuation of the suspected drug (most important step)
02
Early N-acetylcysteine (NAC) initiation in paracetamol poisoning
03
Supportive care: fluid-electrolyte support and nutrition
04
Ursodeoxycholic acid and itch management in severe cholestasis
05
Short-course corticosteroids in hypersensitivity reactions
06
Transplant evaluation if acute liver failure develops

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.