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Liver toxicity from drugs, and also from alternative medicine products such as herbalist’s remedies and dietary supplements, is currently an increasingly relevant health issue. A great majority of hepatic adverse reactions seen in clinical practice are unpredictable (unrelated to a drug’s pharmacological characteristics) and basically result from an interaction of three circumstances: a drug with potential to generate hepatotoxic radicals in a genetically susceptible individual under certain environmental factors. This type of reaction, which occurs only rarely, goes undetected during a drug’s development process, and hence typically manifests when dozens of thousands of patients are exposed to it post-marketing; this still represents the first cause for a drug’s market withdrawal. On the other hand, the absence of objective diagnostic tests and variable clinical presentation commonly entail a delayed diagnosis of liver toxicity. In the present article, we review recent advances in this area and new consensus as result of investigators from different countries. EPIDEMIOLOGY

Hepatotoxicity in 2011: advancing resolutely