REVISTA PERUANA DE INVESTIGACIÓN EN SALUD ORIGINAL ARTICLES 279 Introduction Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality (1). The liver places a prime target for reactive metabolites of medicines as is central to removal of lipophilic drugs and presence of specific enzyme disposal pathway(s) of biotransformation (metabolism) (2). Establish the frequency of DILI worldwide associated with the clinical use of drugs is challenge due lack of consistent reporting systems and definitions (3). Thought, there is the acquiescence of increasing frequency of hepatic drug reactions due to the rise of prescriptions and the number of pharmacological agents available (4, 5). Liver toxicity related to drugs have been divided into two varieties, based on the presumed mechanism of action of the chemical compound: intrinsic (direct or predictable) and idiosyncratic (indirect or unpredictable) (3). After the exposure to reactive metabolites, there are organelle stress and inflammation, resulting in necrosis and/or apoptosis of the hepatocyte or the induction of adaptive responses, with injury not occurring or being very mild. In the intrinsic DILI the process is determined by the individual drug and the hosts factors (especially genetic), with the role of innate and adaptive immune system (6). Intrinsic DILI is typically dose-related, onset is within a ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(4), october - december: 279-286 Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough Todavía se recetan medicamentos potencialmente hepatotóxicos a pacientes con enfermedad hepática que reciben atención terciaria: es hora de decir basta 1,5,a 2,5,b 1,5, d 1,5,c 2,5 1,5,g Rodrigo Dorelo , Samantha T.A. Barcelos , Magela Barros , Valeria Elustondo , Ysela Y.P. Pérez , Martin Oricchio , Nelson D.S. 2,5,h 1,f 2,e 2,3,4,5 Uribe , Nelia Hernandez , Dvora Joveleviths , Mario R. Alvares-da-Silva Abstract Introduction and aim: Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality. Patients with chronic liver disease (CLD), particularly hospitalized, are at high risk for developing DILI. We aimed to investigate the use of potentially hepatotoxic drugs (PHD) in patients with CLD in a tertiary university hospital. Materials and methods: Adult (≥ 18 years-old) with CLD admitted to the hospital from January 2016 to December 2018 were evaluated regarding PHD, assessing the risk of DILI and liver enzymes behavior after exposure. Results: From 931 hospitalized patients with CLD, 291 (31.3%) were exposed to hepatotoxic drugs during their hospitalization. Of those, 244 (83.8%) were cirrhotic. The most frequent causes of liver disease were hepatitis C (41.2%), followed by alcohol (13.2%), hepatitis C/alcohol (11.7%) and non-alcoholic fatty liver disease (5.8%). Decompensated cirrhosis (46.7%) was the main reason for hospital admission. The most often prescribed PHD were antibiotics (67.7%), cardiovascular drugs (34.4%), neuromodulators (26.1%) and anesthetics (19.9%). After exposure, 113 patients (38.8%) presented significant elevated liver enzymes. Surprisingly, PHD were more often prescribed in GI/Liver unit (48.8%) followed by emergency/intensive care unit (28.5%). A total of 65 patients (22%) died, however in neither case was it possible to safely infer causal relationship among PHD, liver enzymes and death. Conclusion: PHD prescription is frequent in patients with CLD even in a tertiary university hospital and in the gastroenterology and hepatology department, exposing these patients to an additional risk. Keywords: liver diseases, drug-induced liver injury, acute-on-chronic liver failure, acute liver failure. Resumen Introducción y objetivo: La lesión hepática inducida por fármacos (DILI) se manifiesta como un espectro de presentaciones clínicas que conlleva morbilidad y mortalidad. Los pacientes con enfermedad hepática crónica (EHC), en particular hospitalizados, tienen un alto riesgo de desarrollar DILI. Nuestro objetivo fue investigar el uso de fármacos potencialmente hepatotóxicos (FPH) en pacientes con EHC en un hospital universitario terciario. Materiales y métodos: Se evaluó la expossición a FPH en adultos (≥ 18 años) con EHC ingresados en el hospital entre enero de 2016 y diciembre de 2018, evaluando el riesgo de DILI y el comportamiento de las enzimas hepáticas tras la exposición. Resultados: De 931 pacientes hospitalizados con EHC, 291 (31,3%) estuvieron expuestos a fármacos hepatotóxicos durante su hospitalización. De ellos, 244 (83,8%) eran cirróticos. Las causas más frecuentes de enfermedad hepática fueron la hepatitis C (41,2%), seguida del alcohol (13,2%), la hepatitis C / alcohol (11,7%) y la enfermedad del hígado graso no alcohólico (5,8%). La cirrosis descompensada (46,7%) fue el principal motivo de ingreso hospitalario. Los FPH más prescritos fueron antibióticos (67,7%), fármacos cardiovasculares (34,4%), neuromoduladores (26,1%) y anestésicos (19,9%). Tras la exposición, 113 pacientes (38,8%) presentaron elevación significativa de las enzimas hepáticas. Sorprendentemente, los FPH se prescribieron con mayor frecuencia en la unidad GI / Hígado (48,8%) seguido de la unidad de emergencia / cuidados intensivos (28,5%). Un total de 65 pacientes (22%) fallecieron, sin embargo, en ninguno de los casos fue posible inferir con seguridad la relación causal entre el FHD, las enzimas hepáticas y la muerte. Conclusión: la prescripción de FPH es frecuente en pacientes con EHC incluso en un hospital universitario terciario y en el servicio de gastroenterología y hepatología, exponiendo a estos pacientes a un riesgo adicional. Palabras clave: enfermedad hepática, lesión hepática inducida por fármacos, insuficiencia hepática aguda sobre crónica, insuficiencia hepática aguda. 1 Department of Gastroenterology, Hospital de Clinicas, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay. 2 Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 3 Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. 4 Division of Gastroenterology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. 5 World Gastroenterology Organization Porto Alegre Hepatology Training Center, Porto Alegre, RS, Brazil. ORCID: a https://orcid.org/0000-0001-8516-3973 b https://orcid.org/0000-0002-1933-9034 c https://orcid.org/0000-0002-2239-3808 d https://orcid.org/0000-0002-3804-8750 e https://orcid.org/0000-0002-0741-0235 f https://orcid.org/0000-0001-6816-3699 g https://orcid.org/0000-0003-2474-3637 h https://orcid.org/0000-0003-4774-2311 Corresponding author: Rodrigo Dorelo, MD., Assistant Professor, Department of Gastroenterology, Hospital de Clínicas, Av. Italia S/n CP, 11600, Montevideo, Uruguay. Phone: +598-2-4808472; Fax: +598- 24872572 Address for correspondence: Serviço de Gastroenterologia do Hospital de Clinicas de Porto Alegre. Rua Ramiro Barcelos, n° 2350/ sala 2033, 2° andar. CEP 90035-903, Bairro Santana, Porto Alegre, Rio Grande do Sul (RS) – Brazil. Email: digo.castaldelli@gmail.com Reception date: june 05, 2021 Approval date: october 01, 2021 Quote as: Dorelo R, Barcelos STA, Barros M, Elustondo V, Perez YYP, Oricchio M, Uribe NDS, Hernandez N, Joveleviths D, Alvares-da-Silva MR. Potentially hepatotoxic drugs are still being prescribed to liver disease patients under tertiary care: it is time to say enough. Rev. Peru. Investig. Salud. [Internet]; 5(4): 279-286. Recovered from: http://revistas.unheval.edu.pe/index.php/repis/article/ view/1104 http://revistas.unheval.edu.pe/index.php/repis/ https://doi.org/10.35839/repis.5.4.1104