Drug-induced hepatotoxicity: analysis of clinical cases and therapeutic options

Drug-induced hepatotoxicity: analysis of clinical cases and therapeutic options

E.I. Busalaeva^1,2, S.M. Zhuchkova^2,3

¹Institute of Continuing Medical Education, Cheboksary

²I.N. Ulianov Chuvash State University, Cheboksary

³Republican Clinical Oncology Dispensary, Cheboksary 

Any medicinal product may cause adverse reactions, among which particular attention is paid to drug-induced liver injury (DILI). To establish a causal relationship between drug exposure and hepatic injury, the semi-quantitative RUCAM (Roussel Uclaf Causality Assessment Method) scale is employed. For the practicing physician, determining the clinical and laboratory pattern of liver injury is of key importance, as it defines subsequent patient management. This article presents the results of a retrospective analysis of 4,175 reports of adverse drug reactions (ADRs) submitted to the Chuvash Regional Pharmacovigilance Center between 01.09.2008 and 30.09.2025. In total, 462 reports of ADRs involving the digestive system were registered, accounting for 11.07% of all notifications received. Sixty‑one cases of drug‑induced hepatotoxicity were documented (1.46% of the total number of reports and 13.2% of all digestive system disorders). Three clinical cases are presented in detail: severe hepatitis associated with the use of paracetamol and antibiotics; hepatotoxicity due to irrational prescription of fluoroquinolones; and liver injury occurring in the setting of polychemotherapy. Analysis of these clinical observations confirms that the risk of hepatic injury increases with unjustified polypharmacy and the presence of a number of additional risk factors (age, female sex, ongoing infectious process, and others). In established drug‑induced liver injury, timely discontinuation of the offending agent and initiation of appropriate hepatotropic therapy are essential. There is no universal hepatotropic drug suitable for all DILI phenotypes; treatment choice must be individualized. According to current recommendations, ademetionine, ursodeoxycholic acid (in the absence of severe hepatic failure), and a fixed‑dose combination of inosine + meglumine + methionine + nicotinamide + succinic acid may be used in all types of DILI. The latter has proven effective not only for treatment, but also for the prevention of hepatotoxicity during polychemotherapy, thereby helping to avoid dose reductions of cytotoxic agents.

Keywords: drug‑induced liver injury, RUCAM scale, chemotherapy, hepatotoxicity, hepatoprotective agents, inosine + meglumine + methionine  + nicotinamide + succinic acid, pharmacovigilance, case report.

For citation: Busalaeva E.I., Zhuchkova S.M. Drug-induced hepatotoxicity: analysis of clinical cases and therapeutic options. RMJ. 2025;9:44–48. DOI: 10.32364/2225-2282-2025-9-8