Clinical characteristics of drug‐induced liver injury in the elderly

Onji, Masahiro; Fujioka, Shin; Takeuchi, Yasuto; Takaki, Toshiyuki; Osawa, Toshiya; Yamamoto, Kazuhide; Itoshima, Tatsuya

doi:10.1111/j.1872-034x.2009.00492.x

Cited by 29 publications

(27 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…37,38 A recent study in Japan directly evaluated the clinical characteristics of DILI in a predominantly elderly population consisting of 142 hospitalized patients. 39 They found that older patients (!75 years) had higher alkaline phosphatase levels, were taking a greater number of concomitant drugs at liver injury onset, and developed cholestatic liver injury more frequently. Indeed, an important consideration in the elderly is their use of multiple medications due to underlying illnesses, which may contribute to their increased risk of serious ADRs through alterations in cytochrome P450 expression and activity.…”

Section: Female Sexmentioning

confidence: 99%

“…In addition, several studies have shown strong association between older age and cholestatic or mixed patterns of DILI. 22,23,30,39,41 Children No population-based studies have systematically examined the epidemiology of DILI in children. Nonetheless, DILI is a significant clinical problem because it accounts for up to 20% of ALF cases requiring liver transplant surgery.…”

Section: Female Sexmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of Idiosyncratic Drug-Induced Liver Injury

Bell¹,

Chalasani²

2009

Semin Liver Dis

180

135

View full text Add to dashboard Cite

Idiosyncratic drug-induced liver injury (DILI) is a significant health problem because of its unpredictable nature, poorly understood pathogenesis, and potential to cause fatal outcomes. It is also a significant hurdle for drug development and marketing of safe prescription medications. Idiosyncratic DILI is generally rare, but its occurrence is likely underappreciated due to the lack of active reporting or surveillance systems and substantial challenges involved in its recognition and diagnosis. Nonetheless, DILI is a common cause of potentially serious and fatal acute liver failure in both children and adults. Population-based studies that accurately estimate the incidence and full spectrum of DILI are limited. However, using a prospective, population-based French study with an annual estimated incidence of 13.9 ± 2.4 DILI cases per 100,000 inhabitants, it has been extrapolated that nearly 44,000 individuals in the United States will suffer from DILI each year. Although increasing numbers of patients are also being seen with DILI due to herbal and dietary supplements, the epidemiology of this entity requires further investigation. In this article, the epidemiology of DILI, both in the general population and in potentially high-risk subgroups, is reviewed.

show abstract

Section: Female Sexmentioning

confidence: 99%

Section: Female Sexmentioning

confidence: 99%

Epidemiology of Idiosyncratic Drug-Induced Liver Injury

Bell¹,

Chalasani²

2009

Semin Liver Dis

180

135

View full text Add to dashboard Cite

show abstract

“…In addition to any effect of age on physiologic reserves, the influence of age may be multifactorial as it relates to the number and type of medications and underlying comorbidities. In a recent Japanese study of 396 hospitalized patients with acute hepatitis (142 for DILI), age at least 65 was associated with a higher proportion of patients with DILI (62 vs. 26%, P < 0.001) [7]. Age at least 75 was associated with more frequent use of concomitant drugs and a cholestatic injury pattern.…”

Section: Risk Factorsmentioning

confidence: 99%

Drug-induced liver injury: a clinical update

Ghabril

Chalasani

Bjõrnsson

2010

Current Opinion in Gastroenterology

115

View full text Add to dashboard Cite

Purpose of review To gather new and important data published on idiosyncratic drug-induced liver injury (DILI) over the past 2 years in the peer-reviewed literature. Clinical studies focusing on mechanisms of injury, clinical evaluation and prognosis will be reviewed. Recent findings The most common drugs leading to DILI in the United States are antibiotics, central nervous system agents, herbal/dietary supplements and immunomodulatory agents. Hepatocellular type of DILI is more common in younger patients, whereas cholestatic pattern increases with older age. Certain human leukocyte antigen genotype increases the likelihood of flucloxacillin-induced liver injury. Idiosyncratic DILI was shown to have an important dose-dependency and drugs with extensive hepatic metabolism are associated with higher frequency of DILI. Chronic DILI may occur, but development of clinically important liver injury after severe DILI is rare. N-acetylcysteine seems to be beneficial for patients with acute liver failure caused by medications or herbal agents.

show abstract

“…CYP3A is a prominent subfamily, and it has been postulated that age-related reductions in hepatic blood flow, and hepatic volume may have an impact on the clearance of some CYP3A substrates (Cotreau et al 2005). Yet, in practice, there is a lack of evidence that these alterations are significant or can be used to anticipate or manage DILI (Onji et al 2009;Stine et al 2013). Also, it has been pointed out that such changes would, if relevant to DILI, be expected to account for intrinsic rather than idiosyncratic DILI (Chalasani and Bjornsson 2010).…”

Section: Pathophysiologymentioning

confidence: 99%

“…Indeed, it has been reported that older patients may be under-prescribed many medications, including statins (Barry et al 2007). Second, "polypharmacy," the presence of more than five medications in a routine regimen, has also been cited as a risk factor for DILI in the elderly (Bell and Chalasani 2009;Onji et al 2009;Stine et al 2013). Although it has been questioned as to whether polypharmacy itself a risk factor for DILI (Chalasani and Bjornsson 2010;Chalasani et al 2014), it is nevertheless a valid concern that with a longer list of medications, additional vigilance for the risk of hepatotoxicity is needed to ensure hepatic issues do not overtake other medical conditions as a primary focus.…”

Section: Introductionmentioning

confidence: 99%