Drug-Induced Liver Injury in Older Adults

The estimated incidence of idiosyncratic drug-induced liver injury (DILI) in the general population is 13.9 to 19.1 per 100,000 patients per year. Age itself is not a risk factor, but older adults appear to be at risk for DILI from a few, specific drugs, including several antibiotics. Older adults with DILI do not have a higher mortality compared to other age groups. The pathogenesis of idiosyncratic DILI remains poorly understood. Patients with suspected DILI may present with a variety of clinical signs and symptoms. DILI remains a diagnosis of exclusion, and its identification involves obtaining a careful history, select lab and imaging studies, and sometimes a liver biopsy. Older adults may exhibit a cholestatic biochemical profile compared to younger patients in response to the same offending agent. The suspected drug should be discontinued, followed by close monitoring. Spontaneous resolution occurs in most, but normalization of liver function may take days to months, while some progress to cirrhosis. Drug re-challenge is not advisable but is on rare occasions unavoidable. Sometimes steroids are needed to treat DILI, especially when there is an autoimmune hepatitis-like reaction. Biomarkers to predict and monitor DILI are needed. There is under-reporting of DILI worldwide. More information regarding DILI in older adults is needed, including from clinical trials and case reports in registries.