⚠️ Key Point: Drug-induced liver injury (DILI) ranges from mild enzyme derangement to fulminant hepatic failure. Some drugs (e.g. paracetamol, methotrexate, Co-Amoxiclav) are classically examined causes. Early recognition + withdrawal of the drug is lifesaving.

📊 Types of Liver Injury & Drug Associations

Side Effect	Associated Drugs	Typical Onset
Cholestasis 🟡	Chlorpromazine, high-dose OCPs, Amoxicillin–Clavulanate	Within 1 month → jaundice + pruritus
Mixed Hepatocellular/Cholestatic Injury ⚖️	NSAIDs, Statins, Co-Amoxiclav, Co-trimoxazole	Variable onset; can occur any time during therapy
Acute Hepatitis 🧪	Isoniazid, Rifampicin, Methyldopa, Halothane, Paracetamol (OD)	Weeks–months; marked ALT/AST rise
Steatohepatitis (NASH-like) 🍔	Amiodarone, Tamoxifen, Valproate, Tetracyclines	Months–years; hepatocyte fat accumulation
Venous Outflow Obstruction (VOD) 🩸	Azathioprine, 6-MP, Busulfan, chemotherapy agents	Weeks–months; hepatic congestion, fibrosis
Fibrosis / Cirrhosis 🪵	Methotrexate (dose-dependent), Antiretrovirals, Methyldopa	Years of cumulative use
Granulomatous Hepatitis 🧩	Allopurinol, Quinidine, Sulfonamides, Phenytoin	Weeks–months; biopsy shows non-caseating granulomas

🩺 Assessment of Suspected DILI

LFT Monitoring: ALT/AST (hepatocellular), ALP/GGT (cholestatic), bilirubin. Always compare to baseline.
Imaging: USS or CT to exclude obstruction; MRCP if biliary cause suspected.
Liver Biopsy: Confirms diagnosis + defines pattern (hepatitic, cholestatic, granulomatous).
Risk Factors: Age, alcohol, pre-existing liver disease, polypharmacy, genetic susceptibility.

🛡️ Prevention & Monitoring Strategies

Baseline LFTs: For high-risk drugs (e.g. methotrexate, isoniazid, statins).
Patient Education: Warn about jaundice, dark urine, pale stools, RUQ pain.
Medication Review: Check for drug interactions that increase hepatotoxicity.
Alternative Therapy: Use safer agents if risk factors present.

💡 Clinical Pearls

Co-Amoxiclav → exam-favourite cause of cholestatic jaundice.
Paracetamol → commonest cause of fulminant hepatic failure in UK (treat with NAC promptly).
Methotrexate → monitor LFTs & cumulative dose → risk of fibrosis/cirrhosis.
Halothane hepatitis → rare but severe immune-mediated hepatitis after anaesthetic exposure.

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Drug induced liver disease

📊 Types of Liver Injury & Drug Associations

🩺 Assessment of Suspected DILI

🛡️ Prevention & Monitoring Strategies

💡 Clinical Pearls

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