About 1000 drugs produced world-wide may lead to clinically relevant hepatotoxic reactions which are unpredictable at normal doses and occur at various frequencies. Among these are well established therapeutic drugs which have been in use for years or decades as well as newly introduced drugs, the number of which is steadily increasing. For the development of
drug-induced liver disease, various pathogenetic mechanisms, many risk factors and variable latency periods are known. The histological picture may imitate practically all known non-toxic
liver diseases from which toxic
liver disease needs to be differentiated. Patients under
drug therapy require regular medical follow-up with regard to the development of toxic
liver disease since the prognosis is only good with early recognition and immediate withdrawal of the alleged
drug. Specific therapeutic modalities to prevent toxic
liver disease are limited to
paracetamol overdosage which is treated by the application of
N-acetylcysteine. For other
drug-induced liver diseases characterised by a prolonged course,
therapy with
ursodeoxycholic acid or
steroids may be helpful. When fulminant
drug-induced
liver failure occurs,
liver transplantation is the
therapy of choice with a better prognosis than a conventional
therapy. Despite this therapeutic option more than 40 different drugs are known to have caused lethal forms of toxic
liver disease. Physicians have therefore to be alert to early recognize
drug-induced liver disease and to withdraw the
drug at first suspicion of the diagnosis.