UMEM Educational Pearls

Category: Toxicology

Title: drug-induced liver injury and its implicated agents

Keywords: drug-induced liver injury (PubMed Search)

Posted: 8/16/2019 by Hong Kim, MD, MPH (Updated: 9/23/2020)
Click here to contact Hong Kim, MD, MPH


Direct hepatotoxicity from a drug is predictable and dose-dependent.

Most commonly implicated agents include:

  • Acetaminophen
  • Niacin
  • Aspirin
  • Cocaine
  • IV Amiodarone
  • IV methotrexate
  • Cancer chemotherapy

On the contrary, idiosyncratic prescription drug-induce liver injury is rare, unpredictable and not related to dose.

Most commonly implicated agents are:

  1. Amoxicillin-clavulanate
  2. Isoniazid
  3. Nitrofurantoin
  4. TMP-SMZ
  5. Miocycline
  6. Cefazolin
  7. Azithromycin

Bottom line:

  • Drug-induced liver injury is uncommon and can be a diagnostic challenge.
  • Recognition of commonly implicated agents can help recognize/identify drug-induced liver injury.