Exploring the influence of sex on idiosyncratic DILI: impact on prediction

INTRODUCTION: drug-induced liver injury (DILI) is a poorly understood condition which can be caused by various medications, including herbals and anti-cancer drugs. A literature review of studies published 1995-2025 was by search of PubMed and Google Scholar. Sex seems to play a role in the etiology of specific medication as women are more prone to DILI due to certain drugs, whereas male sex is a risk of factor of DILI due to other drugs. AREAS COVERED: The current article highlight new studies on sex regarding risk factors of DILI, prediction of liver injury and predictors of severe outcomes. Studies on sex related differences in pharmacokinetics, and drug-specific differences of DILI are discussed. In addition the differences in the incidence of DILI and severity in women are discussed. EXPERT OPINION: Although sex related differences have been reported, the reason for drug-specific risk factors for DILI are poorly characterized. A better understanding of drug vs. host related factors in terms of sex, is needed in order to predict the risk in women vs. men. Further studies need to determine if differences in different phenotypes and severity in women compared to men, are due to hormonal and/or pharmacokinetics or other factors.