AI Summary Drug-induced liver injury (DILI) is liver damage caused by a medicine, herb, or supplement. No single test confirms it, so doctors review the timing of each product you take, read the blood test pattern, and rule out other causes such as viral hepatitis. Imaging or a biopsy may help. Care usually starts with stopping the suspected product on your doctor's advice, followed by supportive care and repeat liver tests. Jaundice, dark urine, or severe tiredness need prompt medical attention.
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Drug-induced liver injury (DILI) is liver damage caused by a medicine. A DILI evaluation is the step-by-step work-up doctors use to decide whether a drug, herb, or supplement explains abnormal liver tests or symptoms.
This page introduces the group and points you to detailed guides on the acetaminophen level and DILI causality assessment.
Below, you will find key facts, how liver injury patterns are read, the steps of an evaluation, key terms, warning signs, and answers to common questions.
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Drug-Induced Liver Injury Basics
Drug-induced liver injury (DILI), also called drug-induced liver disease or hepatotoxicity, is liver damage caused by a medicine. It includes prescription and over-the-counter drugs. Damage from herbal and dietary supplements has its own name, HILI, but doctors evaluate it in much the same way.
There is no single test that proves DILI. Doctors rely on clinical judgment, a careful history of when you took each product, and ruling out other liver diseases. For that reason, DILI is called a diagnosis of exclusion.
DILI can look very different from person to person. The most common form, idiosyncratic DILI, affects only rare, susceptible people and depends less on the dose. It can range from raised liver enzymes with no symptoms to jaundice, liver failure, or long-lasting hepatitis. Some causes, such as an acetaminophen overdose, need urgent treatment.
This group has two detailed guides: the acetaminophen level and DILI causality assessment.
Do not stop a prescribed medicine on your own. Call the clinician who prescribed it.
Blood Test Patterns
Doctors group liver injury by which blood tests rise most. The pattern helps narrow the list of possible causes.
| Pattern | What rises most | What it tells doctors |
|---|---|---|
| Hepatocellular | AST and ALT rise far more than alkaline phosphatase (ALP) | Points to injury of liver cells. The work-up includes viral hepatitis, autoimmune hepatitis, and alcohol-related causes. |
| Cholestatic | ALP rises far more than AST and ALT | Points to a problem with bile flow. Imaging of the bile ducts helps rule out a blockage. |
| Mixed | ALP and AST/ALT both rise | Falls between the two patterns. Doctors weigh timing, drug history, and other test results. |
Patterns often overlap. They guide the work-up and may suggest certain drugs, but they do not prove a cause.
DILI Test Guides
This test measures how much acetaminophen (paracetamol) is in your blood. It matters because acetaminophen is a leading cause of sudden liver injury. Very high AST and ALT readings (above 15 times the upper limit of normal) suggest acute causes such as acetaminophen toxicity. In some people the drug is already undetectable when they reach care, so doctors also use the lab pattern and your history.
Causality assessment is the structured review of how likely a specific drug is to be the cause. It looks at timing, the injury pattern, other possible causes, and how liver tests change after the drug stops. Because no specific biomarkers exist, this careful review is essential.
Step-by-Step DILI Work-Up
No two evaluations look the same, but doctors follow a common approach.
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DILI Glossary
DILI Warning Signs
DILI symptoms are often vague, which makes early recognition hard. Some people have no symptoms, and abnormal liver tests are the first sign. Liver damage can progress to liver failure within days, so medical help is needed for a diagnosis.
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Common Question
No single test confirms it. Doctors diagnose DILI by matching the timing of a drug to the liver injury, classifying the blood test pattern, and ruling out other causes such as viral hepatitis, autoimmune liver disease, and alcohol-related liver disease. Imaging, and sometimes a biopsy, can help.
Yes. Both prescription and over-the-counter drugs can injure the liver, as can herbal and dietary supplements. Researchers have found that 75% of acute liver failure cases linked to medicines involved over-the-counter products such as acetaminophen or herbal supplements. Tell your care team about everything you take.
No. Some people have no symptoms, and the problem shows up on routine blood tests. When symptoms occur, they can include jaundice, dark urine, pale stools, upper right abdominal pain, fatigue, nausea, and itching.
Often, but it depends on the person and the drug. Management generally starts with stopping the suspected agent, followed by supportive care and repeat liver tests. Some people develop chronic DILI, defined as abnormal tests that persist 6 to 9 months after onset.
Ask your prescriber before stopping. Stopping the suspected agent is usually the first step when DILI is suspected, but the right timing depends on why you take the medicine. Call your doctor promptly if you have jaundice, dark urine, or severe fatigue.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
