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Although most patients experience milder drug hepatotoxic reactions such as hepatitis, cholestasis, or asymptomatic enzyme elevation, it is important to recognize the potential for progression to ALF. The most common cause of drug\u2010induced ALF in children is acetaminophen (15% of all ALF in children in the United Kingdom and the United States), whereas other drugs such as antituberculous and antiepileptic therapy account for 5%. The pathogenesis of liver injury includes direct hepatotoxicity and idiosyncratic reactions for most drugs, although for others the mechanism of injury is assumed on the basis of clinical presentation and hepatic histological findings. We review the adult and pediatric literature of drug\u2010induced hepatotoxicity and ALF, with special attention to commonly used or offending medications, mechanism of the toxicity, clinical presentation, diagnosis, treatment, and prognosis. Although most of the available information is based on experience in adult patients, we have included that which is applicable to children, or we have cited pediatric examples. Enhanced awareness of the potential hepatotoxicity of commonly prescribed medications may minimize the frequency of serious hepatotoxicity and ALF in pediatric patients.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0b013e3181709464","type":"journal-article","created":{"date-parts":[[2008,10,10]],"date-time":"2008-10-10T07:09:00Z","timestamp":1223622540000},"page":"395-405","source":"Crossref","is-referenced-by-count":103,"title":["Drug\u2010related Hepatotoxicity and Acute Liver Failure"],"prefix":"10.1002","volume":"47","author":[{"given":"Karen F","family":"Murray","sequence":"first","affiliation":[{"name":"Hepatobiliary Program Division of Gastroenterology and Nutrition UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nedim","family":"Hadzic","sequence":"additional","affiliation":[{"name":"Department of Child Health\/Institute of Liver Studies King's College Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Wirth","sequence":"additional","affiliation":[{"name":"HELIOS Klinikum Children's Hospital Witten\/Herdecke University Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikelle","family":"Bassett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Seattle Children's Hospital University of Washington Seattle WA UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdre","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Paediatric Hepatology Birmingham Children's Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.12.051"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90101-6"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2165\/00148581-200709040-00007"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510260319"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2006.05.009"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2005.076836"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(97)70359-7"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2006.01.033"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MPG.0000158524.30294.E2"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1007248"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00008480-200104000-00016"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200124070-00003"},{"key":"e_1_2_6_15_1","first-page":"635","article-title":"Halothane\u2010induced acute liver failure: continuing occurrence and use of liver transplantation","volume":"10","author":"Lo SK","year":"1998","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.294.6581.1209"},{"key":"e_1_2_6_17_1","first-page":"480","article-title":"Multiple halothane anesthesias in a child: a case report","volume":"45","author":"Pratilas V","year":"1978","journal-title":"Mt Sinai J Med"},{"key":"e_1_2_6_18_1","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/S0026-895X(25)09316-2","article-title":"Cytochrome P450 2E1 is a cell surface autoantigen in halothane hepatitis","volume":"50","author":"Eliasson E","year":"1996","journal-title":"Mol Pharmacol"},{"key":"e_1_2_6_19_1","volume-title":"Current Problems.","year":"1986"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2002.126175"},{"key":"e_1_2_6_21_1","first-page":"1499","article-title":"The influence of risk factors on the severity of anti\u2010tuberculosis drug\u2010induced hepatotoxicity","volume":"8","author":"Fern\u00e1ndez\u2010Villar A","year":"2004","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.157.6.9711039"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510310129"},{"issue":"2","key":"e_1_2_6_24_1","first-page":"128","article-title":"National Consensus Conference on Tuberculosis: preventative treatment of tuberculosis","volume":"87","author":"Centers for Disease Control.","year":"1985","journal-title":"Chest"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200510-1666ST"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200303-390OC"},{"key":"e_1_2_6_27_1","unstructured":"LarsonAM GrazianiAL.Isoniazid hepatotoxicity. 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