Incidence: Hepatotoxicity can be severe in less than 1% ( single agent) or 10% ( combination). All grades less than 5% ( single) or upto 20% ( combination).
Presentation: Mostly presents as AST/ALT elevation ( hepatocellular injury pattern). Less likely to see ALKP and bili elevation( cholestatic)
When to expect: 2-3 months after starting rx.
Differential: rule out viral infections( hepatitis, EBV, CMV), drug toxicity ( chemo drug, ETOH), liver mets and obstruction, review all meds including pain meds and tylenol, oTC meds, alternative medicine ( ask about ivermectin which can cause hepatotoxicity)
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