💊 Drug-Induced Liver Injury (DILI): A Silent Threat to Your Liver Health

By Dr. Chetan Kalal – Liver & Transplant Specialist, Mumbai

🧬 What Is Drug-Induced Liver Injury (DILI)?

Drug-Induced Liver Injury, commonly known as DILI, is liver damage caused by prescription medications, over-the-counter (OTC) drugs, herbal supplements, or even seemingly harmless health tonics. It’s a major but under-recognized cause of acute liver failure, especially in countries like India where self-medication and polypharmacy are common.

Many people don’t realize that the liver is the body’s chemical processing plant—everything we swallow, including medicines, passes through it. But when the liver gets overwhelmed or reacts poorly to a drug, it can get inflamed, scarred, or even stop functioning.

🚨 Why Is DILI Dangerous?

DILI can be unpredictable. It may happen:

• Immediately after taking a high dose (e.g., paracetamol overdose)

• Or slowly over weeks/months after starting a new drug

If not detected early, DILI can cause:

⚠️ Jaundice
⚠️ Acute liver failure
⚠️ Hospitalization or liver transplant
⚠️ Death in severe cases

🧪 Common Causes of Drug-Induced Liver Injury

✅ Prescription Medicines

• Antibiotics (e.g., Amoxicillin-clavulanate, Isoniazid)

• Antitubercular drugs (INH, Rifampicin, Pyrazinamide)

• Antiepileptics (Valproate, Phenytoin)

• NSAIDs & painkillers (Diclofenac, Nimesulide, Paracetamol)

✅ Over-the-Counter (OTC) Drugs

• Excessive paracetamol (especially with alcohol)

• Long-term use of painkillers

✅ Herbal & Ayurvedic Supplements

• Unknown mixtures and heavy metals in unregulated supplements

• 'Liver tonics' marketed without scientific validation

🔍 Signs & Symptoms of DILI

Most patients are asymptomatic in early stages. Watch for:

• Yellow eyes or skin (jaundice)

• Nausea, vomiting, or abdominal pain

• Dark urine, pale stools

• Fatigue or itching

• Loss of appetite

• Confusion in severe cases (hepatic encephalopathy)

👉 If you feel unwell after starting a new medication, see a liver specialist immediately.

🧫 How Is DILI Diagnosed?

There is no single test. It’s a diagnosis of exclusion and involves:

• Liver function tests (LFTs)

• Imaging (ultrasound, FibroScan, or MRI)

• Ruling out other causes (viral hepatitis, alcohol, autoimmune)

• Sometimes, liver biopsy if diagnosis is unclear

🩺 Who’s at Higher Risk?

You may be more prone to DILI if you:

• Take multiple medications together

• Have existing liver disease (like NAFLD or Hepatitis B)

• Consume alcohol regularly

• Are elderly, obese, or malnourished

• Use unregulated herbal or gym supplements

💡 Prevention Tips for Drug-Induced Liver Injury

✅ Always follow dosage instructions
✅ Never self-medicate—especially antibiotics or liver tonics
✅ Inform your doctor if you have pre-existing liver conditions
✅ Limit alcohol when on medication
✅ Choose supplements only if clinically advised
✅ Get regular LFTs if on long-term medications
✅ Prefer treatment under a liver specialist for high-risk drugs

👨‍⚕️ Treatment: What Happens If You Have DILI?

• Immediate discontinuation of the offending drug

• Supportive care and monitoring of liver function

• Hospital admission in severe cases

• Liver transplant evaluation if acute liver failure occurs

At Gleneagles Hospital, Mumbai, Dr. Chetan Kalal leads a specialized liver care team experienced in managing all forms of DILI, from mild elevations to acute liver failure.

📌 Keywords

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🌟 Patient Tip

"Even natural isn’t always safe. Check with your liver doctor before taking any new medicine or supplement—your liver will thank you."