Drug-induced acute liver failure

Eur J Gastroenterol Hepatol. 2005 Feb;17(2):141-3. doi: 10.1097/00042737-200502000-00002.


Acute liver failure is the most severe expression and represents the first cause of fatalities related to drugs. As a consequence, it is also the first cause of drug withdrawal from the pharmaceutical market. The incidence of drug-induced hepatotoxicity in the general population has been recently estimated to be around 14/100,000 inhabitants in a Western country. Drugs appear to be responsible for 10-52% of all causes of acute liver failure. In Western countries, paracetamol (acetaminophen) represents the first cause of all liver failures. The contribution of non-paracetamol drugs given at normal doses is equivalent to that of combined viral hepatitis A and B. The natural prognosis varies between drugs. The spontaneous mortality rate ranges from 32% to 50% for paracetamol intoxication and more than 75% for other drugs. The preventive occurrence of drug hepatotoxicity and the course to acute liver failure is rather limited. It is recommended to stop the administration of a suspected drug when alanine aminotransferase levels increase to more than 3-5 times the upper limit of normal. In paracetamol intoxication, the rapid administration of N-acetylcysteine is a classical antidote. At the stage of liver failure, treatment is mostly supportive. Since irreversible damage is unpredictable, early transfer to a transplantation centre should be considered.

Publication types

  • Review

MeSH terms

  • Acetaminophen / poisoning
  • Analgesics, Non-Narcotic / poisoning
  • Humans
  • Liver Failure, Acute / chemically induced*
  • Liver Failure, Acute / epidemiology
  • Liver Failure, Acute / therapy
  • Prognosis
  • Risk Factors


  • Analgesics, Non-Narcotic
  • Acetaminophen