A Literature Review on Drugs Associated with Liver Enzyme Abnormalities: Mechanisms, Clinical Patterns, and Diagnostic Approaches

Drug-induced liver damage (DILI) presents a substantial problem in pharmacological and clinical settings. Decreases in liver enzymes including bilirubin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) are frequently early markers of hepatic dysfunction, so identifying them early is essential for prompt diagnosis and treatment. With an emphasis on their hepatotoxic mechanisms, clinical presentation patterns, and implications for patient management and monitoring, this literature review looks at the variety of medications that are frequently linked to abnormalities in liver enzymes. DILI can be broadly divided into two types: idiosyncratic, which is unpredictable and influenced by a host's genetic predisposition, as seen with medications like isoniazid and amoxicillin-clavulanate, and intrinsic, which is predictable and dose-dependent, as exemplified by agents like acetaminophen. Numerous pharmacological types, such as statins, antifungals, antiepileptics, antitubercular medicines, antibiotics, and herbal supplements, have been shown to elevate liver enzymes to differing degrees of severity, from biochemical alterations that are asymptomatic to potentially fatal liver failure. Reactive metabolite production, immune-mediated damage, and mitochondrial dysfunction are some of the pathophysiological pathways that are examined in this review. Additionally, it highlights how important it is to diagnose the pattern of elevated liver enzymes, whether hepatocellular, cholestatic, or mixed, as this aids in therapeutic therapy. The review concludes by liver enzyme abnormality due drugs, mechanism, diagnosis approaches and the incorporation of liver safety education into clinical practice in order to prevent and lessen DILI.