Drug-induced hepatoxicity can be direct (eg, acetaminophen, niacin, aspirin, cocaine, intravenous [IV] amiodarone, IV methotrexate, chemotherapy), idiosyncratic (eg, amoxicillin-clavulanate, cephalosporins, isoniazid, nitrofurantoin, minocycline, fluoroquinolones, macrolide antibiotics), or indirect (eg, antineoplastic agents, glucocorticoids, certain monoclonal antibodies, protein kinase inhibitors).
Hallmarks of therapy include removal of the offending agent and supportive care. Particular drug-related injuries (eg, acetaminophen overdose) benefit from administration of the hepato-protective medication N-acetylcysteine.
For a list of medications associated with drug-induced hepatotoxicity, see Drug Reaction Data below. The National Library of Medicine maintains a searchable database, LiverTox, with a comprehensive list of agents and drug classes.
Related topics: drug-induced jaundice, drug-induced splenomegaly
K71.9 – Toxic liver disease, unspecified
197354009 – Toxic liver disease
Differential Diagnosis & Pitfalls
- Acute or chronic viral hepatitis (eg, hepatitis A, B, C, D, E, Epstein-Barr virus, cytomegalovirus, herpes simplex virus, varicella zoster virus, adenovirus)
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Nonalcoholic steatohepatitis (see nonalcoholic fatty liver disease)
- Alcoholic steatohepatitis (see alcoholic hepatitis)
- Systemic lupus erythematosus
- Shock liver secondary to cardiovascular causes, especially right-sided heart failure (see congestive hepatopathy)
- Budd-Chiari syndrome
- Wilson disease
- Cholestatic liver disease
- Pregnancy-related conditions of liver, eg, acute fatty liver of pregnancy, intrahepatic cholestasis of pregnancy
- Malignancy (especially hepatocellular carcinoma and lymphoma)
- Hepatic artery thrombosis
Drug Reaction Data