Author details

**Patients with elevation of ALT > 3 or ALP > 2 ULN**

> 6 Months

1. Viral Hepatitis (A, B, C or E) 2. Alterations or biliary obstruction

3. Alcoholism 4. Autoimmune diseases 5. Hearth diseases

88 Pharmacokinetics and Adverse Effects of Drugs - Mechanisms and Risks Factors

of the liver

**ALT > 3 ULN and normal ALP**

R 5

Identification of the drug with greater probability of cause hepatocellular lesion

Diagram 1. Identification of hepatotoxicity.

**Identification of other causes:**

NO YES

6. Sepsis, primary biliary cirrhosis, cholangitis, neoplasms, genetic diseases

> **ALT > 3 ULN y ALP > 2 ULN**

**Assess R: (ALT/(ALP)** Hepatocellular Cholestatic

Mixed

Identification of the drug with greater probability of cause mixed lesion

Establish hepatotoxicity causality (RUCAM Scale)

Suspicious hepatotoxic drug and causality assessment (Highly probable, probable, possible, unlikely or relationship excluded)

ALT: alanine-aminotransferase; ALP: alkaline phosphatase; ULN: upper limit of normal

2 < R < 5

NO YES

**Exclude**

**Normal ALT and ALP > 2 ULN**

R 2

Identification of the drug with greater probability of cause cholestatic lesion

Alejandra Cano Paniagua and Pedro Amariles\*

\*Address all correspondence to: pedro.amariles@udea.edu.co

Research Group on Pharmaceutical Prevention and Promotion, University of Antioquia, Medellin, Colombia
