Drug- and herb-induced liver injury: Progress, current challenges and emerging signals of post-marketing risk

Core Tip

Core tip: Drug- and herb-induced liver injury remains a clinical challenge, attracting multidisciplinary interest for its translational aspects (from bench to bedside approach and vice versa). When considering differential diagnosis in patients with liver damage, clinicians should always keep in mind drugs and herbs as possible liver offenders, especially in subjects with comorbidities requiring long-term multiple therapies (likelihood of drug interactions). Drug withdrawal and therapy reconciliation represent key issues in patient’ management to minimize the risk of acute liver failure. Notwithstanding the progress in the tools for early detection of hepatotoxicity, there is growing literature on drugs and herbs possibly associated with liver injury in the post-marketing phase: often undetected during drug development, signals of liver toxicity emerge from spontaneous reporting systems and registries. This calls for a joint, multidisciplinary action to improve predictivity of pre-clinical assays, continuing post-marketing surveillance and designing ad hoc population-based studies.