- Direct Hepatotoxins with Intrinsic Reaction (Onset within 48 hours)
- Background
- Predictable, dose-dependent injury
- Biopsy (if performed) shows necrosis at terminal hepatic venule
- Causes
- See Hepatotoxin
- Carbon tetrachloride
- Benzene derivative
- Mushroom Poisoning
- Herbal Toxicity
- Antiepileptics
- Amiodarone
- Methotrexate
- Acetaminophen (42% of acute liver injury in U.S.)
- Antibiotics (second most common cause in U.S.)
- Amoxicillin-clavulanate
- Trimethoprim-sulfamethoxazole
- Isoniazid
- Nitrofurantoin
- Idiosyncratic Reaction (Variable onset)
- Background
- Often not dose-dependent
- Variable timing (may occur over days or months)
- Transaminases improve within weeks after drug cessation
- However, full transaminase normalization may take 2-3 months after stopping causative agent
- Transaminase resolution after drug cessation is sufficient for diagnosis (liver biopsy not needed)
- Signs
- Causes
- See Hepatotoxin
- NIDDK/NLM Liver Tox