TABLE 9. Recommended interventions for patients with idiosyncratic DILI.

Intervention	Target population	Dosing	Comments
General intervention
APAP analgesics	Mild to moderate pain	2 g maximum per day in divided doses	Consider short acting opiates if moderate to severe pain
Antiemetics	Moderate nausea/vomiting	Per package insert
Ursodeoxycholic acid	Severe pruritus	10–15 mg/kg in divided doses	Prospective efficacy data lacking; likely safe
Hospitalization	Dehydrated, coagulopathic, encephalopathic patients	NA	Transfer to transplant center if ALF
N‐acetylcysteine	Hospitalized with ALF	See Table 10 for dosing; 72‐h duration in studies	Requires cardiac monitoring (i.v.); greatest benefit in early‐stage ALF
Corticosteroids	Severe hypersensitivity reactions; DRESS; checkpoint inhibitor with ALT > 5× ULN; histology showing AIH‐like features	1 mg/kg per day of methylprednisolone equivalents for ICI cases; 40–60 mg of prednisone for others	Optimal dose and duration not established but frequently can be tapered in 1–3 months
Drug‐specific interventions
l‐carnitine	Valproate with hyperammonemia (hospitalized children)	100 mg/kg load followed by 50 mg/kg every 8 h	Short‐term use
Cholestyramine	Leflunomide cases with persistent cholestasis	1 packet every 6–8 h for 14 days	Taper once cholestasis/pruritus resolves; give separately from other medications
Penicillin (i.v.)/silymarin and dialysis	Amanita mushroom toxicity	Hospitalized patients or ALF	Short‐term use to remove enterohepatic toxin
Defibrotide (i.v.)	Hematopoietic cell transplant recipients with severe sinusoidal obstruction syndrome	6.25 mg/kg every 6 h for > 21 days up to a maximum of 60 days	Shown to improve survival in children and adults compared with historical controls

Abbreviations: AIH, autoimmune hepatitis; ALF, acute liver failure; APAP, acetaminophen; DILI, drug‐induced liver injury; DRESS, drug reaction with eosinophilia and systemic symptoms; ICI, immune checkpoint inhibitor; IV, intravenous; NA, not applicable; ULN, upper limit of normal.