Drug-induced liver injury (DILI) refers to damage to the liver caused by drugs or metabolites. Drug-induced liver injury can occur with the use of a drug in the absence of liver disease or in the presence of previous liver disease.

The main clinical manifestations of drug liver damage are weakness, nausea, epigastric discomfort, dark urine color, and even jaundice and liver failure.

Below is a list of some common western and Chinese medicines that are hepatotoxic:

Western drug class:

1. Some lipid-lowering drugs, such as fibrates, fenofibrate, benzafibrate and so on. In addition statin drugs such as pravastatin, simvastatin, etc. can also cause liver function damage.

2. Antiarrhythmic drugs: Amiodarone may cause liver damage if used for a long time.

3. Some non-steroidal antipyretic and analgesic drugs: such as acetaminophen, indomethacin, nimesulide, propofol, etc., the use of these drugs need to be used in accordance with the dosage, and the risk of overdose liver damage will be significantly increased.

4. Some anti-infective drugs: such as macrolides erythromycin, and tetracyclines, anti-tuberculosis drugs rifampicin, isoniazid, etc., antifungal drugs fluconazole, voriconazole, etc. may cause liver damage.

5. Sedative-hypnotics like phenobarbital and secobarbital are also harmful to the liver.

6. Anti-parasite: chloroquine, albendazole, levamisole, etc.

7. Antigout drugs such as colchicine and allopurinol may cause liver damage.

Some western medicines have hepatotoxicity, similarly Chinese medicines are also likely to cause liver damage, some people think that Chinese medicines have no side effects, this is a wrong understanding. This is a wrong understanding. There are many cases of liver damage caused by the abuse of traditional Chinese medicine in the clinic.

Herbal groups with high hepatotoxicity: e.g. He Shou Wu, Tu San Qi, Lei Gong Teng, Qian Li Guang, Wu Bei Zi, Cang Er Zi, Piercing Neem Zi, Huang Er Zi, Senna Leaf, etc.

Some Hepatotoxic Proprietary Chinese Medicines: such as Bone Strengthening and Joint Pills, Liushen Pills, Fangfeng Tongsheng San, Dampness Toxin Clearing, Niu Huang Antidote Tablets, Tianma Pills, and so on.

In short, drugs are a double-edged sword, use the right cure, use the wrong cause disease. In order to avoid drug liver damage, taking western medicine should strictly follow the instructions said usage, especially the drugs with clear liver damage, do not overdose, if there is discomfort during the taking, to stop the drug and timely access to medical care.

As for most Chinese medicines, proprietary Chinese medicines, they should not be used blindly due to less clinical research data and imperfect pharmacological and toxicological studies.

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The liver is the largest metabolic organ in the human body, undertaking a variety of physiological functions such as digestion, metabolism, detoxification, secretion and immunity.

The process of disposal of drugs by the body is altered in the case of liver insufficiency, so try to choose drugs that are not eliminated by the liver when administering medication, and prohibit or use with caution drugs that are detrimental to liver function.

Prohibited drugs are, analgesics: morphine, fentanyl, pethidine, codeine (especially hepatic encephalopathy such as agitation, restlessness); antimicrobials: erythromycin, isoniazid, rifamycin, sulphonamides, amphotericin B, pallidomycin (especially cholestasis is prohibited); antipyretic and analgesic: aspirin, acetaminophen, indomethacin; antitumor drugs: fluorouracil, mitomycin, and so on.

The drugs to be used with caution are: sedative drugs: iprazine, diazepam (should not be used for a long time, prohibited in the aura of hepatic encephalopathy); antibacterial drugs: cephalosporin, erythromycin, carbenicillin; oral hypoglycemic drugs: chlorosulfonylpropanilide, methylsulfonylbenzurea; oral contraceptives: steroidal sex hormones (cholestasis is prohibited by the use of oral contraceptives); diuretics: thiazides, furosemide, etanercept; antipyretic and analgesic: pau tazone.

Possibly related to medication habits, the proportion of liver injury caused by herbal medicines is much greater in Eastern countries than in Western countries. Chemotherapeutic drugs, anti-tuberculosis drugs, and Chinese herbs are the top three causes of acute drug-related liver injury. Among them, liver damage caused by Chinese herbs is also relatively common and can account for 30% of all drug-related liver diseases. Herbal medicines that can lead to acute drug-related liver injury include Lei Gong Teng, Torch Flower Root, and Herbal Soup [1].

bibliography

[1] MA Bo,LIU Sichun. Clinical analysis of 179 cases of acute drug-induced liver injury[J]. Journal of Gastroenterology and Hepatology,2008(03):246-248.

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　　Medicines are three times poisonous, and the liver is one of the most important organs in the human body. All kinds of prescription or non-prescription chemical drugs, biological agents, traditional Chinese medicines, natural medicines, health care products, dietary supplements and their metabolites and even excipients may induce liver injury.

　　Pharmacologic liver injury is caused by a variety of Western or Chinese medicines and has also been referred to as pharmacologic liver disease, pharmacologic hepatitis, or pharmacologic liver damage. It has been found that more than a thousand of marketed drugs are potentially hepatotoxic and many drug excipients, herbs, and nutraceuticals also have the potential to cause liver injury. Pharmacologic liver injury can occur both in healthy individuals with no history of liver disease and in patients with pre-existing severe liver disease.

　　Drug-induced liver injury is commonly thought to be a rare disease; in fact, the incidence of liver injury in exposed populations ranges from 10 to 20 /100,000 cases. The incidence of drug-related liver injury has been reported to be as high as 1% in hospitalized patients in internal medicine. Among drug-related injuries, the incidence of liver injury is 10-15%, second only to drug-induced skin and mucous membrane damage and drug fever.

　　Since the 1990s, the number of cases of drug-related liver injury has been increasing year by year. The liver is the main site of drug metabolism, which means that most drugs in the body have to be converted or bound by the liver and then excreted from the liver, and some drugs in this process will produce metabolites that are toxic to the liver. Therefore, the liver is the organ most susceptible to the effects of drugs and is prone to "drug-related liver injury".

　　The simplest and safest way to prevent drug-induced liver injury is not to take health supplements, herbal medicines, etc. You need to standardize the use of medication under the guidance of your physician and monitor your liver function on a regular basis if necessary.

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There are more common clinical drugs that can cause liver injury, so I'll mention a few commonly used ones;
1, acetaminophen: this drug is the most commonly used cold antipyretic and analgesic, but if the dosage exceeds the recommended, then it may bring liver damage, so before the FDA warned us not to overdose on acetaminophen. Because many cold medicines have this ingredient, if you take two cold medicines in a row, then you may have eaten a double dose of acetaminophen, which is likely to cause liver damage, remember.

2, atorvastatin: many elderly people have coronary heart disease, diabetes, hyperlipidemia, etc., often have to take lipid-lowering drugs, of which atorvastatin is the most used, this drug is good to lower the effect of blood lipids, but it may also bring about liver damage, manifested as elevated aminotransferases, abdominal pain, etc., so when using this drug should remember to test liver function, in addition to atorvastatin, other statin drugs will also have liver damage.

3, amiodarone: many patients with arrhythmia will use amiodarone, long-term oral amiodarone, there may be liver damage, pulmonary fibrosis, etc. In addition, amiodarone itself is an antiarrhythmic drug, which can also lead to arrhythmia. So when using amiodarone, you should also pay attention not to overdose, and regularly monitor liver function.

In addition, some anti-tuberculosis drugs, such as rifampin; and many antibiotics, can cause liver damage. Usually just stopping the medication is not a problem; severe liver damage may require intravenous drug therapy. We should have respect for drugs, not just take drugs, and read the instructions before taking them. It's best to take medication under a doctor's supervision to be on the safe side.

Chinese medicine is not taken correctly, it is easy to cause drug liver injury to the body, on the one hand, cause substantial damage to the liver, on the other hand, damage to the liver blood vessels, therefore, before taking Chinese medicine, you must keep your eyes peeled to understand which Chinese medicines can cause liver damage.

These herbs may cause harm to the body

◆ Individual botanicals

After years of clinical research, it has been found that the current Chinese medicines that can cause direct damage to the liver include Lei Gong Teng, Tu San Qi, Shan Dou Gen, Huang Yao Zi, Strychnine, Bai He, Tu Fu Ling, Rhubarb, Poppy Husk and so on, so it is best to take these kinds of Chinese medicines under the guidance of a professional physician.

◆ Individual mineral drugs

Among the mineral herbs that can be harmful to the liver are andrographis, arsenic, and vermilion, to name a few.

◆ Individual proprietary Chinese medicines

In addition to the direct materials in traditional Chinese medicine, there are also some proprietary Chinese medicines that can harm the liver, and common medicines include Strong Bone and Joint Pills, Bone Immortal Tablets, Dampness Toxin Clearing, Ox-Huang Detoxification Pills, and Shouwu Tablets, to name a few.

These Chinese medicines or pCms mentioned above can cause some damage to the liver after entering the human body, and therefore have attracted attention, but why these Chinese medicines can harm the high, in fact, there are multiple aspects, and recognizing these aspects can reduce the damage caused by Chinese medicines to the liver.

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Of the tens of thousands of drugs currently on the market, more than a thousand have been shown to cause drug-induced liver injury. With the exception of some rare idiosyncratic patients who are prone to acute liver injury from certain drugs, the most common drugs that cause liver injury include certain antitumor drugs and antibiotics. Common drugs that cause liver injury include certain antitumor drugs, antibiotics. Including antifungal drugs, cardiovascular disease drugs, cerebrovascular disease drugs, chemotherapy drugs, as well as food additives, traditional Chinese medicine, some natural herbs and so on. In fact, for many drug liver injury drugs, in the instructions will be prompted. For example, long-term use of lipid-lowering drugs or blood pressure-lowering drugs. We need to be alert to the possibility of liver injury and recommend regular liver function tests. We need to be even more wary of those that do not have detailed instructions, are of unknown composition, and have some organic or mixed herbs. Such medicines have the potential to cause liver damage or are easily caused by self-administration of certain natural medicines.

There are many medications that cause liver damage, here are a few of the more typical ones.

1. Acetaminophen

The cause of liver damage is mainly after long-term use in high doses and arises because of the way acetaminophen is metabolized in the body. At normal doses, most of it binds to the liver's course glucuronic acid as well as sulfuric acid, turning it into an inactive metabolite. When higher doses are ingested, the above binding reactions are saturated and the remaining acetaminophen is metabolized to p-acetylbenzoquinone imine via the mixed function oxidase pathway. While this type of metabolite is toxic, glutathione in the body will detoxify it by binding to p-acetylbenzoquinone imine. However, after long-term high-dose medication, the body's glutathione will be consumed, and then the toxicity of the toxic products will be in the form of covalent bonds with the metabolic enzymes or proteins in the liver tissue irreversibly binding, thus causing damage to the liver cells and tissues.According to the regulations, the maximum daily intake of acetaminophen for adults should not exceed 2,000 mg to avoid symptoms of toxicity。

2. Isoniazid

Isoniazid belongs to the group of anti-tuberculosis drugs, and among its side effects it can cause hepatotoxicity, in addition to a decrease in the neurological adverse reaction B6. The main manifestations are elevated aminotransferases and jaundice. It is especially common in alcoholics and in combination with rifampicin. The main reason is that isoniazid is acetylated in the body to produce acetylisonicotinic acid, which is further hydrolyzed to isonicotinic acid and acetylhydrazine to become hydrazine, and acetylisonicotinic acid and hydrazine can damage liver tissues and cause liver damage.

3. Pyrazinamide

Pyrazinamide is also a first-line therapeutic agent in anti-tuberculosis combinations. Like isoniazid, it suffers from hepatotoxicity, mainly due to liver damage caused by interfering with the generation of free radicals by dehydrogenation in the body, which in turn generates oxidative stress.

4. Rifampicin

Rifampicin anti-tuberculosis combination of first-line therapeutic drugs can also cause liver damage. The cause is primarily binding to certain proteins in the body, which prolongs their hepatic and intestinal circulation, thereby competitively inhibiting hepatic bilirubin excretion, leading to liver injury with jaundice and hepatic steatosis.

That is why the side effects of the anti-tuberculosis drugs rifampicin, isoniazid, and pyrazinamide on the liver should be a key concern when used in combination therapy.

5. Propylthiouracil
Propylthiouracil belongs to the thiourea class of antithyroid drugs and is used clinically for the treatment of severe hyperthyroidism, thyroid crisis, and thyroid in pregnancy. Hepatotoxicity is mainly due to the production of active metabolites in the body, which can cause liver cell damage and elevated aminotransferases. In addition to propylthiouracil, methimazole, which is part of this class of drugs, also produces the side effect of liver damage.

1. Antibiotics

There are a lot of antibiotics, for our body's liver and kidneys, are very toxic, they help the body to resist some germs attack at the same time, but also to our liver and kidneys, increased a lot of burden. For example, some antibiotics are specialized in increasing the toxicity of the liver, especially tetracyclines, which, if used for a long time, will bring irreversible effects to the liver. Therefore, it is recommended that you should not go for these types of antibiotics as a last resort, but should choose antibiotics that are gentle on the liver and kidneys.

2. Anti-tuberculosis

The so-called tuberculosis, in fact, is also caused by a class of germs, damage to the body, this bacillus in the long-term evolution, for the human body of some organs, but also caused an irreversible impact, the most common is the lungs, so there are a lot of people in the past, suffering from tuberculosis. However, in the treatment of this disease, it also requires a long-term process, especially the use of drugs, the negative impact on the liver is very large, so in such a long-term cumulative process, also caused by the damage to the liver.

3. Chemotherapy

Because many chemotherapy drugs are aimed at cancer cells, so they are trying to hurt the cancer cells at the same time, but also to some normal cells of the body, great damage, that is to say, "kill the enemy a thousand, but the self-loss of eight hundred", which is why some of the people who have undergone chemotherapy, after playing the chemotherapy drugs, will appear to be This is why some people who have received chemotherapy, after taking chemotherapy drugs, will have the phenomenon of hair loss, because the effects of these drugs on the liver and kidneys are also irreversible. If they are used for a long time, or if they go through several cycles of treatment, the damage to the liver is also very great.