Treatment of Drug-induced Liver Injury in Severe Idiosyncratic Hepatotoxicity Ascribed to Flupirtine (sFILI)

Clinical Scenario

This protocol addresses severe idiosyncratic liver injury ascribed to flupirtine (sFILI) — a serious hepatotoxic reaction requiring active intervention beyond supportive care alone.

Patient Population

Patients with severe idiosyncratic drug-induced liver injury in the setting of flupirtine exposure, as characterised in a retrospective cohort study of 21 patients with confirmed sFILI.

Approach Overview

The regimen combines an intravenous hepatoprotective agent with an oral corticosteroid, with corticosteroid dosing tapered in response to biochemical markers. The complete protocol — including agents, schedule, monitoring criteria, and tapering guidance — is available via the link below.

Treatment Goal

Significant liver profile improvement within 2 weeks, with more rapid resolution compared with untreated sFILI.

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References

DOI: 10.1016/j.jhep.2019.02.014

The efficacy of NAC combined with oral prednisolone was analysed in a retrospective cohort of 21 patients with severe idiosyncratic injury ascribed to flupirtine (sFILI).
These patients received 10 g of NAC given intravenously over 24 hours for 7 days and an oral dose of 1 mg/kg prednisolone per day, with the dose tapered according to biochemical response.
The combined NAC/prednisolone treatment led to significant liver profile improvements within 2 weeks and the cases resolved more rapidly than in untreated sFILI patients.

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