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11 - Drug induced liver injury

Published online by Cambridge University Press:  06 January 2010

Nigel Kirkham  and
Neil A. Shepherd
By
Susan E. Davies  and
Clare Craig
Nigel Kirkham
Affiliation:
Royal Victoria Infirmary, Newcastle
Neil A. Shepherd
Affiliation:
Gloucestershire Royal Hospital
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Summary

INTRODUCTION AND INCIDENCE

This chapter provides an extensive but not completely exhaustive overview of drug induced liver injury, with key concepts illustrated by examples of individual drugs. It also considers the problems associated with making a diagnosis of drug induced liver injury (DILI).

Our society has a massive desire for the consumption of active compounds; the drug industry is worth billions of pounds – many more billions being derived from the sale of over-the-counter preparations and the ever-growing market for complementary and alternative medicines (CAM).

The annual budget for prescription drugs in the UK is staggering; over £8 billion being spent in England alone in 2004 [1]. This corresponds to over 40 million prescription items being written every month in England. Undesirable effects of some drugs have become a major clinical problem: in a 6-month period in northern England, 6.5% of all cases admitted to hospital were associated with an Adverse Drug Reaction (ADR), many were related to GI haemorrhage and many probably avoidable [2]. Previously this rate was closer to 2%, although this may reflect the way information had been gathered, being dependent upon published data [3]. Certain groups of people appear to be more at risk of drug induced injury: a Norwegian study has implicated an ADR contributing to nearly 20% of hospital deaths in elderly patients, particularly in those with more than one illness and receiving multiple medications [4]. Major drug culprits were cardiovascular, anti-thrombotic and sympathomimetic.

Type
Chapter
Information
Progress in Pathology , pp. 247 - 270
Publisher: Cambridge University Press
Print publication year: 2007

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