Chinese Medical Information Portal Website (Taiwan Medical Network-TMN) - OldDoc Wu's Series
(Established in March 1996)
Drug-induced liver disease
Dr. Wu's Liver diseases
for professionals (medical students and residents)

(by Jau-Shin WU, M.D., Ph.D.)
(Posted Sep. 16, 1996; Updated May 14, 2009)


Drug-induced liver disease

(Key words: hepatitis, drug, drug-induced liver disease, toxic hepatitis)

For consumers:

For professionals:

Metabolism of drug and toxic agent in the liver

Drug induced and toxic liver diseases:

Farell's Classification of Drug-induced Liver Damage:

Type Drugs

1) Impaired liver function 1.1 Microsomal enzyme induction Phenitoin, Warfarin 1.2 Hyperbilirubinemia Flavasdic acid, Novobiocin, Rifampcin 2) acute hepatocyte necrosis 2.1 Focal necrosis Isoniazid, Cloxacilin, Halothane 2.2 Bridging necrosis Isoniazid, Alphamethyldopa, Phosphorus 2.3 Zonal necrosis Paracetamol, Halothane, Phosphorus 2.4 Massive necrosais Halothane, Valproic acid, NSAID 3)Fatty liver 3.1 Acute fatty change Tetracycline, Valproic acid, NSAID, Corticosteroid, L-asparaginase 3.2 Steatohepatitis Perhexiline maleate, Amidodarone 4) Granulomatou change Hydralazine, Allopurinol, Carmabazepine 5) Acute cholestatic type 5.1 Without hepatitis OCS, Anabolic androgen 5.2 With hepatitis Chlorpromazine, Erythromycin, Flucloxacillin 5.3 With bile duct injury Flucloxacillin, Chlorpromazine, 4,4'- diaminodiphenylmethane 6) Cholestatic type 6.1 Vanishing bile duct syndrome Chlorpromazine, Flucloxacillin, Amitriptyline 6.2 Sclerosing cholangitis Intra-arterial 5-fluorodeoxyuridine 7) Chronic parenchymal injury 7.1Chronic active hepatitis Alpha-methyldopa, Nitrofurantoin, Dantrolene 7.2 Fibrosis and necrosis Methotrexate, Hypervitaminosis A 8) Vascular change 8.1 Sinusoid widening OCS 8.2 Peliosis hepatis Anabolic androgen 8.3 Non-cirrhotic portal hypertension Vinyl chloride, Hypervitaninosis A, Azathioprine 8.4 Hepatic venous outflow obstruction 6-thioguanine, OCS, Pyrrolizidine alkaloid 8.5 Nodular regenerative hyperplasia Azathioprine, Actinomycin D 8.6 Other vascular lesions OCS 9) Liver tumor 9.1 Hemangioma OCS 9.2 Focal nodualr hyperplsia OCS 9.3 Hepatic adenoma OCS, Androgen 9.4 Hepatocellualr carcinoma OCS, Androgen 9.5 Rare carcinoma Hepatoblastoma, OCS Chlangiocarcinoma, Carcinosarcome 9.6 Hemoangiosarcoma Arsenioc, Vinyl chloride, Thorium dioxide 9.7 Epithelioid hemoangioendothelioma OCS
(From:Farwell GC:The clinicopathological spectrum of drug-induced liver diseases. Drug-induced liver disese, ed by GC Farewell, Churchill Livingstone, London, p:101,1994)

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(By Jau-Shin Wu, M.D.; Posted Sep. 16, 1996; Revised May 12, 2009)

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