Drug-induced liver injury (DILI) remains a foremost cause of drug development cessation and postmarketing cautions and constraint of use. 

DILI is a comparatively occasional hepatic condition in response to the use of medications, illegal drugs, herbal products or dietary supplements. It happens in vulnerable individuals through a mixture of hereditary and environmental risk factors believed to modify drug metabolism and/or excretion leading to a cascade of cellular events, including oxidative stress formation, apoptosis/necrosis, haptenization, immune response activation and a disappointment to adapt. The succeeding liver damage can occur with an arrangement of phenotypes, which mimic almost every other liver disorder, and differs in severity from asymptomatic elevation of liver tests to fulminant hepatic failure. 

The most vital step in DILI management is stopping the offending drug. However, DILI is occasionally not suspected in the preliminary valuation and the culprit drug is therefore not instantaneously withdrawn, which can end in worsening the liver injury leading to liver failure or chronic damage. Therefore, clinicians facing any patient with new onset liver injury should keep in mind that DILI is always a potential etiology. To make advancement in the management of DILI there is an imperative need for well-designed randomized clinical trials evaluating the effectiveness of some marketed drugs with known potential welfares as well as for the proper clinical development of new molecules.

Source: Garcia-Cortes, M., Robles-Diaz, M., Stephens, C. et al. Drug induced liver injury: an update. Arch Toxicol 94, 3381–3407 (2020)