Gastroenterology and hepatology
Drug-induced hepatitis
Intrinsic, idiosyncratic and indirect liver injury, the R ratio and Hy's law, the usual culprits including flucloxacillin, amoxicillin-clavulanate, TB drugs, supplements and checkpoint inhibitors, excluding hepatitis E, when to stop a drug, and paracetamol in brief.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Drug, herbal and supplement injury accounts for most acute liver failure in Australia and other Western countries, mainly from paracetamol.
- Idiosyncratic DILI is rare (about 14 to 19 per 100,000 a year), unpredictable and a diagnosis of exclusion. There is no confirmatory test.
- Classify by pattern with the R ratio. Hepatocellular injury with jaundice (Hy's law) carries about 10% risk of death or transplant.
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Sources
- Chalasani NP et al. ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol 2021;116:878-98American College of Gastroenterology, 2021
- Fontana RJ et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology 2023;77:1036-65American Association for the Study of Liver Diseases, 2022
- EASL Clinical Practice Guidelines: Drug-induced liver injury. J Hepatol 2019;70:1222-61European Association for the Study of the Liver, 2019
- Chiew AL et al. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust 2020;212:175-83AU/NZMedical Journal of Australia, 2020
- Haanen J et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline. Ann Oncol 2022;33:1217-38European Society for Medical Oncology, 2022
- Saukkonen JJ et al. An official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med 2006;174:935-52American Thoracic Society, 2006
- LiverTox: Clinical and Research Information on Drug-Induced Liver InjuryUS National Institute of Diabetes and Digestive and Kidney Diseases
- Last updated
- 14 November 2026
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