DRUG-INDUCED hepatic injury, particularly that associated with jaundice, is becoming more frequent because of the increasing use of potent drugs. Nevertheless, its pathogenesis remains mysterious, and its classifications is difficult. Initially, drug-induced hepatic injury followed use of established hepatotoxins as exemplified by diethylene glycol, the vehicle of an early sulfonamide preparation which proved to be a fatal poison.1 Subsequently, new disease entities were recognized after patients were exposed to drugs. For instance, intrahepatic cholestasis, then called intrahepatic biliary obstruction, following the administration of organic arsenicals, was reported by Hanger and Gutman.2 This led to the appreciation of intrahepatic cholestasis caused by agents other than drugs.3 Today, however, confusion about the many hepatic changes associated with drug therapy produces apprehension on the part of the physician when prescribing which sometimes protects the patient but almost as frequently prevents beneficial treatment or causes senseless testing for hepatotoxicity. The
POPPER H, RUBIN E, GARDIOL D, SCHAFFNER F, PARONETTO F. Drug-Induced Liver Disease: A Penalty For Progress. Arch Intern Med. 1965;115(2):128–136. doi:10.1001/archinte.1965.03860140008003
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