Boroń-Kaczmarska A. Polekowe uszkodzenia wątroby; Gastrologia – Medycyna Praktyczna dla pacjentów https://www.mp.pl/pacjent/gastrologia/choroby/watroba/50955,polekowe-uszkodzenia-watroby, accessed on: 27/04/2021 Wiela-Hojeńska A, Łapiński Ł. Niepożądane działania leków – rodzaje, podział, przyczyny i skutki ekonomiczne; Farm Pol, 2010, 66(4): 275-288 https://ptfarm.pl/pub/File/Farmacja%20Polska/2010/04-2010/08%20%20NDL.pdf accessed on: 04/05/2021

Drug-induced liver injury (DILI)

> What are the causes of DILI?

> How to recognize DILI?

> How is DILI diagnosed?

> How is DILI treated?

> How to prevent DILI?

The mechanisms of DILI development are not fully understood but most probably this disorder results from the interplay between the given compound (its composition, dose, duration of intake) and the individual characteristics of the person (such as age, sex, nutritional status, etc.). ¹

THE MECHANISMS FOR THE DEVELOPMENT OF DILI ARE NOT FULLY UNDERSTOOD

What are the causes of DILI?

Misuse or abuse of over 800 different drug substances and toxins may have a harmful effect on the liver and cause drug-induced liver injury (DILI).¹It may occur:

After overdosing on a medicine (poisoning)

As an adverse drug reaction

As an allergic reaction ¹

How to recognize DILI?

The DILI spectrum is wide and its symptoms may vary in type and intensity. They may include both minor abnormalities found incidentally in laboratory tests, and severe liver injury that results in its acute failure, thus threatening the patient's life and health.

DILI may have three forms:

acute liver failure (DILI is the most common cause of acute liver failure in Western countries) which may develop within a few days or weeks after the ingestion of a toxic substance,
latent or clinically overt liver injury (manifested by elevated liver enzymes AlAT and AspAT),
acute fatty liver.¹

How is DILI diagnosed?

Diagnosing DILI may pose a challenge to hepatologists, as there are no specific tests or markers for this disease. After a thorough interview with the patient, doctors first try to rule out other more common liver diseases such as fatty liver, viral hepatitis B or C, or autoimmune disease of the liver in the past. During the interview, it is extremely important for the doctor to collect information about medicines used presently and in the past, and about potential exposure to toxins. Laboratory tests may also prove useful for the diagnosis. In the case of symptoms persisting over a long time, liver biopsy may also be necessary.¹

THERE ARE NO SPECIFIC TESTS OR MARKERS FOR THIS DISEASE

How is DILI treated?

Treatment of DILI almost always starts from the discontinuation of the medicine considered to be hepatotoxic by the doctor. Treatment is supported by products that have a protective effect on the liver.¹ The prognosis is usually favorable if discontinuation of the medicine brings positive results. In the case of acute liver failure, it may be necessary to transplant this organ.¹

How to prevent DILI?

It is good to remember a few principles that will protect you from drug-induced hepatic injury:

always dose medicines as prescribed by your doctor or in accordance with the information in the package leaflet,^1.2
never combine drugs with alcohol,²
be careful with popular common cold remedies that contain acetaminophen – it is easy to overdose on it above the maximum allowable daily level. ²

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CLINICAL PARTICULARS
Indications
Nutritional support in the management of damaged liver (due to chronic liver disease, liver cirrhosis, fatty liver & intoxication by hepatotoxic substances). Each hard gelatin capsule contains: De-oiled enriched phospholipids from soya-beans …………… 300 mg

Phospholipids (Essentiale Forte P) 50s

Non-alcoholic fatty liver disease (NAFLD)

NAFLD, named new epidemic of the 21st century, is caused by factors other than excessive alcohol consumption.

Alcoholic liver disease

The prevalence of liver diseases is clearly linked to drinking habits – when alcohol is consumed regularly and in excess, the liver is doomed to fail.

Hepatitis B and C

Viral hepatitis B (HBV) and C (HCV) are the most common viruses in Poland causing acute or chronic hepatitis.

Cirrhosis

Some causes of cirrhosis of the liver can be classified as external - they have to do with our lifestyle or treatment that causes irreversible liver damage.

Autoimmune hepatitis

Autoimmune diseases can be compared to self-sabotage – it is a situation in which your body starts attacking its own tissues. In AIH, the immune system attacks hepatocytes, which are liver cells.