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

The NIDDK’s Liver Disease Research Branch, in collaboration with the National Library of Medicine (NLM), provides an online resource for information on drug induced liver injury resulting from prescription and over-the-counter drugs, herbal products and dietary supplements. Called “LiverTox,” this resource is accessed internationally and includes up-to-date, accurate and easily accessible information on the diagnosis, cause, frequency, patterns and management of liver injury attributable to these agents. LiverTox represents a collaborative effort by medical and scientific specialists to provide a central repository of clinical information in support of research on drug induced liver injury and also provides guidance to clinicians and health care providers on the diagnosis and management of this important cause of liver disease.

Liver injury from medications, herbal products or dietary supplements has emerged as an increasingly important health problem in the United States. Although most cases of such liver injury are mild and resolve quickly, some individuals develop liver injury so severe that it can lead to acute liver failure and, ultimately, need for liver 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 agent(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 distinguishing 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.

LiverTox has two major components: 1) an introduction and overview of drug-induced liver injury that includes discussions of clinical patterns, diagnostic criteria, and assessment of causality and severity; and 2) individual drug chapters on specific medications or classes of medications, herbal products and dietary supplements which describe their liver toxicity, along with relevant case histories and a comprehensive list of references. The LiverTox database currently includes information on over 1400 drugs or supplements available in the United States. Case reports of liver toxicity are culled 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. The LiverTox 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 from LiverTox users, in hopes of reducing these forms of liver injury in the future. The LiverTox website is accessible on the NLM Bookshelf platform.