Drug-induced liver injury acetaminophen

For reasons that are unclear, drug-induced liver injury affects females more than males Females accounted for approximately 79% of all reactions to acetaminophen and 73% of all idiosyncratic drug-induced reactions (88). Females exhibit increased risk of hepatic injury from drugs such as atorvastatin, nitrofurantoin, methyidopa, and diclofenac. 

Howell BA, Siler SQ, Watkins PB (2014a) Use of a systems model of drug-induced liver injury (DlLlsym( )) to elucidate the mechanistic differences between acetaminophen and its less-toxic isomer, AMAP, in mice. Toxicol Lett 226, 163-72. 

Alcoholics are susceptible to drug toxicity, because alcohol induces liver injury and cirrhotic changes that alter drug metabolism. Alcohol causes depletion of glutathione (hepatoprotective) stores, making the person more susceptible to toxicity by drugs (e.g., acetaminophen, statins). 

Bourdi M, Eiras DP, Holt MP, Webster MR, Reilly TP, Welch KD, Pohl LR (2007) Role of IL-6 in an IL-10 and IL-4 double knockout mouse model uniquely susceptible to acetaminophen-induced liver injury. Chem Res Toxicol 20 208-216 Britschgi M, Steiner UC, Schmid S, Depta JP, Senti G, Bircher A, Burkhart C, YawalkarN, PichlCT WJ (2001) T-cell involvement in drug-induced acute generalized exanthematous pustulosis. J Clin Invest 107 1433-1441... 

II. Indications. Unproven but possibly effective as adjuvant therapy in cases of acute hepatic injury due to Amanita phaiioides mushroom ingestion, acetaminophen toxicity, and potentially other chemical and drug-induced liver diseases. Silymarin is not available as a pharmaceutical drug in the United States, but milk thistle extracts can be purchased for oral use as dietary supplements. However, these products may not be comparable in quality and consistency to European prescription preparations. 

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