Conclusions
Drug-induced hepatotoxicity will remain a problem that carries both clinical
and regulatory significance as long as new drugs continue to enter the market.
Future results from ongoing multicentre collaborative efforts may help
contribute to our current understanding of hepatotoxicity associated with
drugs.
Further understanding of
hepatotoxicity is becoming increasingly important as more drugs come to market.
Aims
(i)
To provide an update on recent advances in our understanding of
hepatotoxicity of select commonly used drug classes.
(ii)
To assess the safety of
these medications in patients with pre-existing liver disease and in the post-liver
transplant setting.
(iii)
To review relevant advances in toxicogenomics which contribute
to the current understanding of hepatotoxic drugs.
Methods A Medline
search was performed to identify relevant literature using search terms
including 'drug toxicity, hepatotoxicity, statins, thiazolidinediones,
antibiotics, antiretroviral drugs and toxicogenomics'. Results
Amoxicillin-clavulanic acid is one of the most frequently implicated causes of
drug-induced liver injury worldwide. Statins rarely cause clinically
significant liver injury, even in patients with underlying liver disease. Newer
thiazolidinediones are not associated with the degree of liver toxicity
observed with troglitazone. Careful monitoring for liver toxicity is warranted
in patients who are taking antiretrovirals, especially patients who are
co-infected with hepatitis B and C. Genetic polymorphisms among enzymes
involved in drug metabolism and HLA types may account for some of the
differences in individual susceptibility to drug hepatotoxicity.
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