cardiovascular-agents and Cholestasis

Drug-induced liver injury (DILI) is a rare, unpredictable, and potentially serious adverse reaction. It is induced by many drugs, herbs, and dietary supplements and represents a diagnostic challenge to clinicians. Older people (aged 65 years and older) are often polymedicated, and their declining physiological function affects drug pharmacokinetics. There is no consistent evidence that age is a general risk factor for DILI; however, age might be a risk factor with specific medications, with antimicrobials and cardiovascular drugs being the most likely medications to cause DILI in older people. Ageing influences DILI phenotypes, making cholestatic damage and chronic DILI more likely. In older people with DILI, comorbidities act as confounding causes and account for higher mortality unrelated to the liver. There are no specific therapies for DILI and supportive measures are still the mainstay of management. This Review highlights current advances and gaps in DILI epidemiology, mechanisms, and diagnosis that are pertinent to older individuals.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Anti-Infective Agents; Cardiovascular Agents; Chemical and Drug Induced Liver Injury; Cholestasis; Comorbidity; Dietary Supplements; Female; Humans; Incidence; Male; Middle Aged; Palliative Care; Pharmacokinetics; Phenotype; Plants, Medicinal; Polypharmacy; Risk Factors

Topics: Analgesics; Anti-Infective Agents; Anticonvulsants; Cardiovascular Agents; Chemical and Drug Induced Liver Injury; Cholestasis; Drug-Related Side Effects and Adverse Reactions; Humans; Hypoglycemic Agents; Hypolipidemic Agents; Liver; Pharmaceutical Preparations; Psychotropic Drugs

The incidence of drug-induced liver disease appears to be increasing, reflecting the increasing number of new agents that have been introduced into clinical use over the past several decades. Among the topics covered, the author discusses incidence, diagnosis, risk factors, clinical presentations, hepatitis, and vascular injury. The author also reviews the hepatic injury seen with commonly prescribed drugs, emphasizing newer developments in the field and recent publications and reports.

Topics: Acetaminophen; Alanine Transaminase; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspartate Aminotransferases; Cardiovascular Agents; Chemical and Drug Induced Liver Injury; Cholestasis; Humans; Hypoglycemic Agents; Incidence; Liver; Liver Diseases; Prognosis; Risk Factors; Vascular Diseases

Drug-induced jaundice is relatively uncommon but can be a diagnostic puzzle. Because so many pharmaceutical classes and individual agents can produce jaundice, a thorough history of medications taken should be obtained from a patient presenting with jaundice. Jaundice usually resolves when the offending agent is discontinued.

Topics: Anti-Infective Agents; Antineoplastic Agents; Cardiovascular Agents; Central Nervous System Agents; Cholestasis; Hormones; Humans; Jaundice