GENERAL-ASPECTS OF DRUG-INDUCED LIVER-DISEASE

Medicinal agents can produce various types of hepatic injury by severa l mechanisms. Hepatic injury may lead to acute syndromes that resemble viral hepatitis, fatty liver of pregnancy, and obstructive jaundice, as well as to a number of chronic syndromes. Acute liver damage relate s, at least in part, to the apparent mechanism of injury. Hepatic inju ry induced by large single overdose of intrinsically toxic drugs (e.g. , acetaminophen, ferrous salts) develops within 24 to 72 hours of inta ke and usually is accompanied by renal failure. Regular intake of some toxic drugs, (e.g., methotrexate) leads to slowly evolving chronic di sease. Liver damage due to hypersensitivity-type idiosyncrasy usually appears after 1 to 5 weeks of taking the drug unless there has been pr evious exposure and is preceded or accompanied by systemic features th at are hallmarks of hypersensitivity. Hepatic injury attributable to m etabolic idiosyncrasy may appear after weeks to months of taking the d rug and usually presents without the systemic features. Organs other t han the liver may be involved in the syndrome of drug-induced injury a s the result of selective injury or as part of a hypersensitivity reac tion.