Acute liver failure following atorvastatin dose escalation: Is there a threshold dose for idiosyncratic hepatotoxicity?

The bulk of hepatotoxicity (drug induced liver injury, DILI) cases in clinical practice is idiosyncratic in nature. This assumption is based on the apparent absence of dose dependency and the unpredictability of the reaction, which presents after a relatively long latency period of drug exposure in susceptible individuals. Recent evidence suggests that the administration of high oral daily dose of drugs that undergo extensive hepatic metabolism does influence the risk of developing idiosyncratic DILI (IDILI) [1,2].