Antiseizure Treatments and Liver Injury: Expect (and Prevent) the Unexpected

Marjorie Bunch; Shilpa Klocke; Nicole Woodrich; Alfred Sidney Barritt; Sara Eyal

doi:10.1177/15357597251403348

Antiseizure Treatments and Liver Injury: Expect (and Prevent) the Unexpected

Marjorie Bunch
, Shilpa Klocke
, Nicole Woodrich
, Alfred Sidney Barritt
, Sara Eyal^*

^*Corresponding author for this work

School of Pharmacy

Research output: Contribution to journal › Review article › peer-review

Abstract

Drug-induced liver injury remains a major concern in the pharmacological management of epilepsy. Antiseizure medication (ASM)-related liver injury has multiple phenotypes, and in the majority of cases it is “idiosyncratic,” involving hypersensitivity reactions. Awareness of drug- and patient-related risk factors can help direct treatment selection, monitoring, and ASM discontinuation, when necessary. This article examines the typical patterns of ASM-induced liver injury, from mild elevations of hepatic enzymes to life-threatening conditions. We also discuss risk factors, means for preventing liver injury in people with epilepsy treated with ASMs, and emerging biomarkers.

Original language	English
Journal	Epilepsy Currents
DOIs	https://doi.org/10.1177/15357597251403348
State	Accepted/In press - 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Keywords

DRESS
SJS/TEN
antiseizure medications
drug-induced liver injury
hepatotoxicity
hypersensitivity reactions
liver tests

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10.1177/15357597251403348

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title = "Antiseizure Treatments and Liver Injury: Expect (and Prevent) the Unexpected",

abstract = "Drug-induced liver injury remains a major concern in the pharmacological management of epilepsy. Antiseizure medication (ASM)-related liver injury has multiple phenotypes, and in the majority of cases it is “idiosyncratic,” involving hypersensitivity reactions. Awareness of drug- and patient-related risk factors can help direct treatment selection, monitoring, and ASM discontinuation, when necessary. This article examines the typical patterns of ASM-induced liver injury, from mild elevations of hepatic enzymes to life-threatening conditions. We also discuss risk factors, means for preventing liver injury in people with epilepsy treated with ASMs, and emerging biomarkers.",

keywords = "DRESS, SJS/TEN, antiseizure medications, drug-induced liver injury, hepatotoxicity, hypersensitivity reactions, liver tests",

author = "Marjorie Bunch and Shilpa Klocke and Nicole Woodrich and Barritt, \{Alfred Sidney\} and Sara Eyal",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).",

year = "2026",

doi = "10.1177/15357597251403348",

language = "אנגלית",

journal = "Epilepsy Currents",

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AU - Klocke, Shilpa

AU - Woodrich, Nicole

AU - Barritt, Alfred Sidney

AU - Eyal, Sara

N1 - Publisher Copyright: © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2026

Y1 - 2026

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AB - Drug-induced liver injury remains a major concern in the pharmacological management of epilepsy. Antiseizure medication (ASM)-related liver injury has multiple phenotypes, and in the majority of cases it is “idiosyncratic,” involving hypersensitivity reactions. Awareness of drug- and patient-related risk factors can help direct treatment selection, monitoring, and ASM discontinuation, when necessary. This article examines the typical patterns of ASM-induced liver injury, from mild elevations of hepatic enzymes to life-threatening conditions. We also discuss risk factors, means for preventing liver injury in people with epilepsy treated with ASMs, and emerging biomarkers.

KW - DRESS

KW - SJS/TEN

KW - antiseizure medications

KW - drug-induced liver injury

KW - hepatotoxicity

KW - hypersensitivity reactions

KW - liver tests

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JF - Epilepsy Currents

ER -

Antiseizure Treatments and Liver Injury: Expect (and Prevent) the Unexpected

Abstract

Bibliographical note

Keywords

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