2 (median, 33; IQR, 27-39). DILI was hepatocellular (R ≥ 5) in 98 (77.8%) subjects, a mixed reaction (2 < R < 5) in 12 (9.5%), and cholestatic (R ≤ 2) in 16 (12.6%). Data were missing in seven subjects. Sixty-one different agents, alone or in combination, were thought to cause DILI ALF (Table 1A-C). Causality assessment, by expert opinion, indicated that a selected agent was

highly likely in 108 (81.1%), probable in 20 (15.0%), and only possible in five (3.8%) cases. Four cases were considered only possible due to use of LY294002 research buy many compounds, unknown temporal associations, comorbid conditions, or use of agents of low DILI potential; the fifth case had taken atorvastatin as the only medication with DILI potential, for 36 months. In 27 (20.3%) cases, only one drug was used, including nine isoniazid cases. In three cases, a combination of two to four antituberculosis drugs (isoniazid, rifampin, pyrazinamide, and ethambutol) were the only medications used. The remaining 103 (77.4%) cases were taking several and sometimes many other agents besides the prime suspect(s), including drugs of varying hepatotoxic potential (Table 2). Antimicrobials were most commonly responsible for DILI ALF (Table 1A), among which antituberculosis therapies predominated. Isoniazid was the sole antituberculosis drug in 15 cases, and in six cases in combination. Sulfur drugs frequently selleck compound caused ALF, especially trimethoprim-sulfamethoxazole

(TMP-S) alone (nine cases); this agent was also implicated in combination with azithromycin, a statin, and/or antiretroviral compounds. Nitrofurantoin was implicated 12 times. Terbinafine and azole antifungal drugs were relatively common, but antiretroviral drugs were infrequent. CAM, nonprescription medications,

dietary supplements, weight loss treatments, and illicit substances—several of which carry FDA warnings24—were responsible for 14 (10.6%) cases. Of the neuropsychiatric drugs, phenytoin use (eight cases) was frequent, 上海皓元 along with other antiepileptics (n = 5), and psychotropic drugs (n = 4). Halogenated anesthetic hepatotoxicity occurred twice. Disulfiram for alcoholism, and propylthiouracil for thyrotoxicosis, accounted for nine cases each. Bromfenac was implicated in four cases, whereas other nonsteroidal anti-inflammatory drugs (NSAIDs), biological agents, and leukotriene inhibitors were infrequent hepatotoxins. One patient treated with gemtuzumab following bone marrow transplantation developed sinusoidal obstruction syndrome. Fifteen subjects were taking statins, in four of whom another drug was the likely cause of DILI ALF (TMP-S, nitrofurantoin, and cefopime, respectively, and one subject was treated with amoxicillin-clavulanic acid followed by amoxicillin). Cerivastatin was used in two cases, simvastatin in two (alone or with ezetemibe), and atorvastatin in two. In one subject taking nitrofurantoin, atorvastatin was changed after 1 month to simvastatin, which was used for 2 months.