Abstract
Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.
Highlights
Drug-induced liver injury (DILI) refers to liver injury induced by all types of prescription or non-prescription drugs, including small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS) [1,2,3,4]
In forming our recommendations, we considered the quality of evidence, and the balance among the advantages and disadvantages, burdens of interventions, the variability of patient preferences and values, the rational use of resources, and the fairness and practicability of the recommended measures
In 2013, a prospective study from Iceland indicated that herbal and dietary supplements (HDS) accounted for 16% of the causes of DILI [1], while recent Drug-Induced Liver Injury Network (DILIN) (American) data showed that HDS accounted for over 20% of the causes of DILI
Summary
Drug-induced liver injury (DILI) refers to liver injury induced by all types of prescription or non-prescription drugs, including small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS) [1,2,3,4]. Information about liver injury caused by nearly 700 and over 400 types of common drugs are separately recorded in LiverTox and HepaTox websites, respectively. Such information provides clinicians with an important basis for prudent prescription of potentially hepatotoxic drugs, as well as the assessment of their respective risks and benefits. Liver injury caused by TCM-NM-HP-DS [22] is seen more frequently in females
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