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Medication-induced liver injury: not just by paracetamol

In view of the vital role played by the liver in drug metabolism, it is surprising how often this proceeds without any damage. Nevertheless it is clinically relevant for doctors and pharmacists to be aware of possible medication-induced liver injury. Even though it is relatively rare, drug-induced liver injury can cause serious complications for patients. The best known example of drug-induced liver injury is that of excessive doses of paracetamol. It goes without saying, however, that this is true for far more agents, such as the NSAIDs and antibiotics (doxycycline or nitrofurantoin) which are frequently prescribed in primary practice. In addition, there have been reports of sometimes severe liver injury due to dietary supplements and herbs. An understanding of the underlying causative mechanisms and manifestations can encourage practitioners to be more aware of potential drug-induced liver injury in their everyday practice. 

  • Liver injury is a rare, but potentially life-threatening adverse effect of many drugs, herbs and dietary supplements.
  • In cases of unexplained liver dysfunctions or other liver injury, drugs should always be considered as a possible cause.
  • Knowledge about the various ways in which liver injury may arise (direct, indirect or idiosyncratic) helps to estimate whether and how a drug can cause liver injury.
  • The website is an independent source of case studies and background information about liver injury caused by medications and other substances.

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The literature refers to the Dutch text


  • Sander van den Bogert, dr, pharmacist