What is drug-induced liver damage?

Article by Pharmacist Nguyen Le Trang - Clinical Pharmacist, Faculty of Pharmacy, Vinmec Times City International General Hospital.

Drug-induced liver damage is a general concept that refers to the effects on the liver by modern drugs, functional foods, and drugs derived from plants. Effects on the liver are determined through liver function tests or clinical signs of impaired liver function. The incidence of drug-induced liver injury is approximately 10-15/100,000-100,000 annual drug users in the United States. In addition, drugs are responsible for more than 50% of cases of acute liver failure.

Drugs cause liver damage through various mechanisms. The drug can directly degrade or produce metabolites that alter the structure and function of hepatocytes. The drug can also initiate a systemic hypersensitivity response, which in turn destroys hepatocytes. Several drug-related factors may increase the risk of liver damage such as high daily dose, strong metabolism by the liver, drug interactions.
More than 60% of drug-related liver injury cases are related to acetaminophen, antibiotics, and anticonvulsants/epileptics.
Direct liver damage, which can develop hours to days after dosing, is often predictable and dose related. Liver enzymes increased rapidly, even without signs of jaundice. If the suspected drug is identified and stopped in time, most liver enzymes will return to normal. Some drugs damage the liver in this way, such as paracetamol, amiodarone, aspirin, niacin...
Idiosyncratic liver damage is often unpredictable, with a delayed onset of months to years.

Some drugs that cause liver damage include:
Allopurinol Amiodarone Amoxicillin-clavulanate Androgen contains the steroid framework Azathioprin Quinolone antibiotics (ciprofloxacin, levofloxacin..); Macrolide group (azithromycin, clarithromycin..) Methotrexate Sulfamethoxazole - trimethoprim Antiepileptic drugs: Carbamazepine, phenytoin, valproic acid Inhaled anesthetics Anti-inflammatory analgesics NSAIDs Proton pump inhibitors (PPIs) stomach acid reducers: omeprazole, pantoprazole...

To minimize the risk of drug-induced liver damage, it is necessary to educate patients on the safe use of drugs that can cause hepatotoxicity (especially paracetamol), note on dosage and possible drug interactions, including interactions when drinking alcohol. Do not arbitrarily increase the dose of drugs or use more drugs or supplements without consulting a doctor or pharmacist. Instruct patients to monitor and detect signs and symptoms related to liver damage such as jaundice, yellow eyes...

On the part of medical staff prescribing and prescribing drugs, it is necessary to assess the patient's risk of liver damage, including the patient's underlying liver disease and the extent of the drug's effect on the liver. Follow the dosing recommendations, be cautious when prescribing drugs that are extensively metabolized by the liver, when prescribing drugs that cause liver damage, and monitor liver function periodically as recommended.
Currently, Vinmec International General Hospital has Hepatobiliary Screening packages, which help detect Hepatitis Virus at an early stage even when there are no symptoms. In addition, the Comprehensive Hepatobiliary Screening Package helps customers:

Evaluation of the liver's ability to work through liver enzyme tests; Evaluation of bile function; vascular nutrition; Early screening for liver cancer; Perform tests such as Total blood cell analysis, blood clotting ability, screening for hepatitis B, C Assessment of hepatobiliary status through ultrasound images and diseases that are at risk of affecting liver disease/treating liver disease. more severe liver disease In-depth analysis of parameters to evaluate hepatobiliary function through laboratory and subclinical; the risk of affecting the liver and early screening for hepatobiliary cancer