Drug induced liver injury screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]

General screening guidelines for drug induced liver injury do not exist. However, certain specific guidelines have been established for drugs associated with a high incidence of severe liver injury, e.g. methotrexate.^[1] These guidelines remain controversial.

Periodic screening of serum alanine aminotransferase is sometimes initiated for drugs associated with a high incidence of liver injury, at provider discretion.^[2]

However, because frequent laboratory monitoring is often not possible for both patients and providers, compliance with any drug-specific surveillance guidelines is variable and drug-specific guidelines remain controversial. This is largely because the significance of a mildly elevated serum alanine aminotransferase is unclear and may result in inappropriate drug withdrawal in patients who would otherwise adapt to ongoing use of the inciting drug.