Table 1.

Classifications of Drug-Induced Human Liver injury

Classification	Pattern of Liver Injury	Example Drug
Simple Classification
Intrinsic	Dose dependent, predicable, reproducible in animals at sub lethal doses	super therapeutic acetaminophen
Non- Intrinsic allergic	No dose-dependency, unpredictable, not reproducible in animals	phenytoin
Non-Intrinsic Non-allergic	Adaptive immune response, short latency period Delayed latency, absence of hypersensitivity response	isoniazid
Clinical Laboratory Classification
Autoimmune	Circulating antibodies	tienilic acid
Hepatocellular	↑AST, ↑ALT, ↑Bilirubin	acetaminophen
Cholestatic	↑ALP, ↑Bilirubin	chlorpromazine
Infiltrative	↑ALP	tamoxifen
Histopathologic Classification
Acute hepatocellular injury	Spotty necrosis to fulminant liver failure (massive necrosis)	acetaminophen, ketoconazole, diclofenac, nefazodone
Chronic hepatocellular injury	Pigment accumulation, steatosis, steatohepatitis, phospholipidosis, fibrosis, cirrhosis	phenacetin, aspirin, valproic acid, amiodarone, methotrexate, tamoxifen
Acute cholestasis	Reduction in bile flow resulting from reduced secretion or obstruction	amiodarone, chloroquine, methotrexate, vitamin A, cyclosporine, troglitozone, amoxicillin-clavulanate
Chronic cholestasis	Portal inflammation with degeneration of the bile duct (vanishing bile duct syndrome)	tolbutamide, imipramine
Granulomatous hepatitis	Macrophage accumulation without necrosis located in periportal or portal areas.	chlorpropamide, amoxicillin-clavulanate carbamazepine, diltiazem
Autoimmune hepatitis	Necroinflammatory lesions	methyldopa, minocycline
Vascular lesions	Injury to sinusoids, hepatic veins, and hepatic arteries	dacarbazine vincristine, azathioprine
Neoplastic lesions	Focal nodular hyperplasia and hepatocellular adenomas	floxuridine, danazol

↑ - increase, AST - Aspartate Aminotransferase, ALT - Alanine Aminotransferase, ALP- Alkaline Phosphotase - Alkaline Phosphatase