Drug-Induced Liver Injury Guidelines Released by ACG Janis C. Kelly June 18, 2014 Am J Gasterenterol. Published online June 17, 2014. Abstract

Drug-induced liver injury is among the most challenging disorders for gastroenterologists to diagnose and treat, but the American College of Gastroenterology has issued new clinical guidelines to help physicians and other healthcare providers manage this disorder. The guidelines were published online June 17 in the American Journal of Gastroenterology.
Lead author Naga P. Chalasani, MD, writing on behalf of the ACG Practice Parameters Committee, presented an evidence-based approach to diagnosing and managing DILI, “with special emphasis on DILI due to herbal and dietary supplements and DILI occurring in individuals with underlying liver disease.”

DILI is commonly categorized as intrinsic (because of drugs that predictably cause liver injury in humans or in animal models, such as acetaminophen) and idiosyncratic (affecting only susceptible individuals, having less-consistent dosage relationship, and more varied in presentation). “Despite its low incidence in the general population, gastroenterologists must always consider the possibility of DILI in patients with unexplained acute and chronic liver injury, as well as when prescribing certain gastrointestinal medications (e.g., azathioprine, anti-tumor necrosis factor agents, sulfonamides). Many herbal and dietary supplements…can cause DILI, and thus they must be considered as a cause for DILI,” the authors write.

The guidelines include a table of the most common over-the-counter and prescription drugs and supplements that cause DILI, and their usual patterns of liver injury. The table lists antibiotics (amoxicillin/clavulanate is the most commonly associated with DILI) and herbal and dietary supplements.

Green tea extract tops the list of herbal and dietary supplements associated with liver damage. According to Dr. Bonkovsky, the average cup of green tea has around 50 to 150 mg catechins, whereas some green tea extract pills (commonly used for weight loss) have catechin levels more than 700 mg and may be taken multiple times a day.