While the human liver is an extraordinarily resilient organ, it can become irreparably damaged from both prescription and non-prescription drugs. Most drugs have side effects but responses to these side effects vary among the population due to genetic factors, general health, metabolism and interaction with other medications. As the human liver metabolises or breaks down medicines, allowing them to be removed from the body, occasionally medications might break down into another, more potent byproduct which can cause liver damage if allowed to build up to toxic concentrations. Drug induced liver injury (DILI) from both prescribed antibiotics or medication and non-prescription drugs is not uncommon and people, and their livers, in general, recover well. In some instances, however, the liver is permanently damaged.
DILI might be described by a physician as intrinsic, idiosyncratic, hepatocellular, cholestatic, mixed pattern and autoimmune DILI. These infer liver injury due to a medication with liver injury as a recognised side effect, injury from a medication not anticipated to cause liver injury, liver cell-damaging medication, medication which causes bile duct damage, medication that causes both liver cells and bile duct damage and injury caused by an immune response by your own body to attack your liver as though it is a foreign object, respectively.

Drug induced liver injury can also be caused by alternative, natural, traditional Chinese and herbal medicines, though many people discount side effects from these products as they are perceived as ‘natural’.

Typical symptoms
Symptoms may include general liver disease indicators such as jaundice, abdominal distension, itching or pruritis, fatigue, appetite loss, nausea and an overall feeling of being ‘unwell.’ These may be acute, having a sudden onset, but many people may also be asymptomatic (have no symptoms).

Diagnosis
Blood tests for liver function enzymes (LFTs), abdominal examination, ultrasound, fibroscan or liver biopsy may be undertaken. DILI is diagnosed following elimination of other illnesses, particularly other liver diseases.

Incidence
Drug induced liver injury has a worldwide estimated annual incidence between 14 to 19.1 per 100,000 persons, though the prevalence and cause of DILI varies geographically. Furthermore, approximately one in 100 patients develops DILI during hospitalisation as a consequence of heparins and antibacterials, while DILI incidence is notably higher for those on antineoplastic agents (anti-cancer or chemotherapeutic drugs) and tuberculostatics (drugs used to treat tuberculosis and leprosy). The main antibacterials responsible for DILI and their incidence is shown in the pie chart.

Treatment
Treatment is very closely linked to the type of drugs, the concentration ingested, and the duration they were taken for. As the liver is generally capable of recovering well, treatment might just include adjustment or replacement of the medicine suspected of causing the injury to one’s liver.

Prognosis
Generally, a positive recovery is probable and there are no lasting consequences. In rare incidences, the liver does not recover, and a liver transplant might be a consideration.