Incidence of drug-induced liver injury in medical inpatients

Abstract

Approximately 1 in 100 patients develops DILI during hospitalisation in a department of medicine. Incidences of DILI were highest for antineoplastic agents and tuberculostatics. DILI is frequently missed and, therefore, DILI detection by diagnoses will result in misleadingly low incidence rates.

The Role of the Sodium-Taurocholate Cotransporting Polypeptide (NTCP) and of the Bile Salt Export Pump (BSEP) in Physiology and Pathophysiology of Bile Formation

“…In addition, drug induced liver injury is an important factor leading to attrition of drugs during development or to withdrawal of drugs from the market [274,285]. Among drug induced liver injury in medical inpatients, about 30 % are cholestatic or mixed [216]. Unfortunately, is not possible estimating from the literature to what extent cholestatic liver injury is caused by direct BSEP inhibition [10,39,202].…”

Hepatotoxicity in 2011: advancing resolutely

“…Toxicity is believed to represent 4-10% of jaundice cases admitted to general hospitals (2). Among inpatients the incidence of idiosyncratic hepatotoxicity has been estimated between 0.7% and 1.4% (3). Antibacterials, nonsteroidal anti-inflammatory drugs, and anticonvulsants rank at the top of the list of drug classes involved in hepatotoxicity (4,5), and amoxicillin/clavulanic acid is in absolute figures the most commonly involved molecule (4,5).…”

The bile salt export pump

“…Although inherited mutations in the BSEP gene are very rare [75,77], acquired forms of cholestasis such as, for example, primary biliary cirrhosis, primary sclerosing cholangitis, cholestasis associated with pregnancy, or drug-induced cholestasis are more frequent [62,77]. A recent genetic screen of patients identified three nonsynonymous ABCB11 variants to be specifically associated with primary biliary cirrhosis and primary sclerosing cholangitis [76].…”