1.What is drug-induced liver injury (DILI)
It refers to the liver injury caused by the direct toxicity of the drug itself or its metabolites to the liver, or the allergic or metabolic idiosyncratic reaction of the body to the drug or its metabolites after exposure to conventional doses or high doses of drugs, and is one of the common causes of liver biochemical abnormalities.
2, why improper use of drugs is harmful to the liver, which drugs are most likely to cause liver damage?
The liver is the biochemical factory of the body, and the metabolism and excretion of various drugs are mainly completed in the liver, so it also bears the brunt of drug damage to the target organs. In foreign countries, antibiotics and antipyretic and analgesic drugs (such as paracetamol) are the main drugs that cause liver injury; in China, liver injury caused by herbal medicines and dietary supplements is increasing and receiving more attention.
3.Diagnostic criteria of drug-related liver injury
(1) Within 5-90 days after the use of drugs, or within 15 days after stopping drugs
2） Abnormal liver function: a 3-fold increase in glutamyl transpeptidase (ALT) or a 2-fold increase in alkaline phosphatase (AKP), or a 2-fold increase in bilirubin (TBIL), accompanied by an increase in ALT or AKP, should be considered drug-induced liver injury.
3） Except for other diseases causing abnormal liver function
4） There is a recurrence of liver injury after re-medication
4, how to determine the link between a drug and liver injury?
1）Timing relationship: there is a logical relationship between the time of taking the drug and liver function injury in time. Most liver injury occurs within 5-90 days after the drug is used, or within 15 days after stopping the drug, a small number of drugs can be less than 5 days latency period. If the drug is used for more than 90-180 days without liver injury, the abnormal liver function caused by the drug is not considered.
(2) Most drugs that can cause liver injury have been registered or are described in the “Adverse Reactions” section of the drug’s instruction manual.
(3) The abnormal elevated liver parameters can be recovered quickly after stopping the drug. In the hepatocellular injury type, the peak serum ALT level decreases < 50 within 30 d; in the cholestasis type, the peak serum ALP or TB level decreases < 5 within 180 d.
(4) The international universal RUCAM scale is a scale that can assist in determining the relationship between drugs and liver injury.
5.What is the general treatment of drug-related liver injury?
(1) The key to treatment is to stop and prevent the use of drugs that cause liver injury, and should also avoid the use of drugs that belong to the same class as the causative drug in biochemical structure and (or) drug action as far as possible
(2) Patients who mistakenly take a large number of hepatotoxic drugs, early gastric lavage, catheterization, dialysis, diuresis and other measures are appropriate to promote their excretion and clearance.
(3) Application of special detoxifying drugs to treat liver injury caused by certain drugs
4）Apply drugs to protect liver cells and treat complications
6.To avoid drug-related liver injury, what should patients pay attention to when using drugs?
(1) Avoid the abuse of drugs, especially Chinese medicine and health products of unknown origin.
(2) Use less and more drugs, avoid taking multiple drugs and health care products at the same time.
3）Take drugs under the guidance of doctors and test liver function to detect liver injury at an early stage.