Genetic predisposition to drug-induced liver disease.

Rarely do otherwise safe drugs administered at recommended doses produce liver damage that may progress to liver failure and death. Because we are generally unable to identify the patients most susceptible to this "idiosyncratic" form of toxicity, many potentially useful medications are not made available to patients. The most promising developments in identifying susceptible patients have stemmed from recent advances in characterization of bioactivation and detoxification enzyme systems, and the discovery of marked variation in the activities of these enzymes among patients. Tests capable of quantitating the activities of specific relevant enzymes have been recently developed and are now being applied in clinical trials to assess risk factors for drug-induced liver disease. These tests hold promise of identifying subsets of patients who may need close monitoring or who may be best served with an alternate treatment.