Hepatotoxicity is the commonest of all adverse effects leading to drug discontinuation in 11% of patients treated with a combination of isoniazid, rifampicin, and pyrazinamide. Anti-TB drugs are one of the commonest group underlying idiosyncratic hepatotoxicity worldwide. Tuberculosis (TB) remains a major global health problem despite the availability of highly efficacious treatment for decades. World Health Organization (WHO) declared TB a global public health emergency in 1993, at a time when an estimated 7–8 million new cases and 1.3–1.6 million deaths occurred each year. In 2010, there were an estimated 8.8 million new cases reported and 1.4 million deaths including deaths from TB among HIV-positive people. In India, TB is a major public health issue with an estimated prevalence of 256 per 100,000 population and 26 per 100,000 population dying of TB. Although about 85% of TB cases are successfully treated, treatment-related adverse events including hepatotoxicity, skin reactions, gastrointestinal and neurological disorders account for significant morbidity leading to reduced effectiveness of therapy. Hepatotoxicity is the commonest of all adverse effects leading to drug discontinuation in 11% of patients treated with a combination of isoniazid, rifampicin, and pyrazinamide.