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LiverTox: A New Online Resource for Information on Drug-induced Liver Injury

The NIDDK’s Liver Disease Research Branch, in collaboration with the National Library of Medicine’s Division of Specialized Information Services, has developed an online resource for information on drug induced liver injury resulting from prescription and over-the-counter drugs as well as from complementary and alternative medicines such as herbals and dietary supplements. Called “LiverTox,” this web-based resource provides up-to-date, accurate, and easily accessible information on the diagnosis, cause, frequency, patterns, and management of liver injury attributable to these agents.

Liver injury from medications, herbals, or dietary supplements has emerged as an increasingly important health problem in the United States. Although most cases of liver injury are mild and resolve quickly, some individuals develop liver injury so severe that it can lead to acute liver failure and, ultimately, transplantation or death. In the United States, liver injury due to drugs is the leading cause of acute liver failure, occurring with increasing frequency in recent years based on findings from the NIDDK’s Acute Liver Failure Study Group. One of the challenges in treating this form of liver injury is the accurate and timely identification of the drug(s) causing the injury so that steps can be taken to limit the damage. Different drugs or supplements can cause disparate patterns of liver injury that can sometimes mimic other forms of liver disease, making it difficult for physicians to recognize unless they first rule out all other potential causes of liver injury.

The creators of LiverTox set out to remedy this by providing a comprehensive source of information to aid health care providers and patients in diagnosing, and researchers in studying, liver injury due to specific drugs, herbals, or dietary supplements. The website serves as a centralized “one stop shop” for information relating to the prevention and control of drug-induced liver injury from multiple agents, as well as guidance on the diagnosis and management of this important cause of liver disease.

LiverTox has three major components: 1) an introduction and overview of drug-induced liver injury, 2) a series of individual drug records or monographs on specific medications, herbals, and dietary supplements describing their liver toxicity with specific case histories and a complete set of references, and 3) a case submission registry that allows users to report a case directly to LiverTox and which then can be forwarded to the U.S. Food and Drug Administration’s Adverse Event Reporting System (MedWatch). The LiverTox database currently includes information on approximately 700 drugs or supplements available in the United States, and the current plan is to add 300 more over the next few years. Case reports of liver toxicity were collected from several sources, including the published scientific literature, the database of the NIDDK’s Drug-Induced Liver Injury Network, and cases seen at the NIH Clinical Center. LiverTox’s creators envision it as a “living textbook” with ongoing updates and improvements. They will continue to draw upon the collective wisdom of the wider scientific and health care community by welcoming comments and information on all known drug- and supplement-related forms of liver injury from website users, in hopes of reducing these forms of liver injury in the future.

The LiverTox website is accessible at: livertox.nih.gov.

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