Liver Damage from Medication (Drug-Induced Liver Disease)

Some drugs can cause a type of liver damage known as drug-induced liver disease, or drug-induced liver injury. These drugs include both prescription and over-the-counter (OTC) medications.

Taking a drug that is no longer considered safe or using too much of a certain drug, such as Tylenol (acetaminophen), can hurt your liver. If you have a liver condition, taking certain medications can be risky.

This article will go over what drug-induced liver damage is. You will learn about the symptoms and how the condition is diagnosed and treated, as well as types of drugs that cause liver damage.

Causes of Acute Liver Failure

The liver plays an important role in processing nutrients and drugs, as well as cleaning the blood. If the liver isn't working well, it can lead to serious, even life-threatening, health problems.

Drug-induced liver injury is damage that happens from the use or overuse of medications or supplements.

Causes of drug-induced liver damage include:

• Taking a medication that makes the liver more likely to get damaged
• Having liver disease already and taking medications that can damage the liver
• Taking a drug that was considered safe but is now considered harmful to use

Risk Factors for Drug-Induced Liver Injury

Having certain medical conditions increases your risk for liver damage from medication or other causes.

These conditions include:

• Hepatitis
• Wilson's disease
• Celiac disease
• Epstein-Barr virus
• Herpes simplex virus
• Alcohol use disorder
  

Early Signs of Liver Damage from Medication

Paying close attention to the symptoms in your body is one way to know if your liver is damaged from medicine. The early signs of liver damage or injury from medications may include:

• Stomach pain
• Fever
• Diarrhea
• Dark urine
• Jaundice, a condition that occurs when a substance called bilirubin builds up in the blood and causes the skin and whites of the eyes to appear yellow
• Nausea and vomiting
• Severe fatigue or sleepiness
• Rash
• White-colored stools

Complications

The liver has many important functions. If it's not working well, it can lead to problems throughout the body.

Here are a few examples of the health complications you may experience if you develop liver damage from medication use:

• Filtration: The liver removes unsafe substances (toxins) from the body. Toxins are either passed out of the body in urine or feces, or broken down into substances that are safer. If the liver is not working well, these toxins can build up.
• Metabolism: The liver is part of many metabolic processes that help the body process energy. If a person's liver isn't working, these processes won't work well.
• Blood clotting: The liver also helps blood cells clump together to stop bleeding (blood clotting). A person who doesn't have a healthy liver is at risk for bleeding problems.

What Drugs Cause Liver Damage?

One of the liver's most important jobs is breaking down and processing (metabolizing) drugs.

However, certain medications and supplements have the potential to cause damage to the liver cells, the flow of bile, or both.

Acetaminophen: Leading Cause of Liver Failure

Acetaminophen is an over-the-counter (OTC) pain-relieving drug that is found in Tylenol and Excedrin. It is also used in creams and ointments that are used for muscle pain relief.

Taking too much acetaminophen is what causes most cases of acute (sudden) liver failure. Drinking alcohol, genetic factors, and the other medications you are taking can add to the risk of injury to your liver.

Acetaminophen damage can start between 24 hours and 72 hours after taking the medication. The symptoms usually show up two to four days after you first take it.

Taking or using more than one OTC or prescription drug containing acetaminophen without the guidance of a healthcare provider is not recommended because of this risk.

If you think you have taken too much acetaminophen, get emergency medical care right away.

Anticonvulsants

A few drugs that are used to treat epilepsy (a seizure disorder) can injure the liver.

However, many of these medications are older. Newer medications that are used to treat epilepsy are rarely associated with liver damage.

Antiseizure drugs that may cause liver damage include:

• Depakene (valproic acid)
• Dilantin (phenytoin)
• Felbatol (felbamate)

Liver injury from these drugs can occur between one to six weeks after you start taking the medication.

Antibiotics

Antibiotics are medications that are used to treat bacterial infections. Certain oral and topical antibiotics are linked to liver damage, including:

• Isoniazid
• Metronidazole
• Amoxicillin-clavulanate
• Azithromycin
• Tetracycline
• Clindamycin

Liver damage from these antibiotics usually shows up within weeks of taking them.

Methyldopa

Methyldopa is a medication that is used to treat high blood pressure (hypertension).

Since methyldopa has been linked to drug-induced liver damage, it is typically not recommended for people who already have liver disease, especially scarring that comes from a long-term injury (cirrhosis).

Liver injury may show up within two to 12 weeks after starting methyldopa.

Statins

Statins are common medications that treat high cholesterol. People who are taking statins may have high liver enzyme levels on a blood test, which can be a sign of drug-induced liver damage.

Lipitor (atorvastatin) is the statin that is most commonly associated with drug-induced liver injury.

Liver injury from statins does not happen right away—it can take a month to up to 10 years for the damage to show up.

Other Drugs

There are also other common medications that may affect your liver, including:

• Birth control pills (oral contraceptives)
• Amiodarone (a medication to treat heart arrhythmias)
• Certain types of anesthesia

The time it takes for these drugs to damage the liver varies. For example, liver damage related to birth control may not show up for weeks or months, but damage from anesthesia can happen in just a few days.

Supplements

There are also supplements that can damage the liver. Many of these are available without a prescription and can be purchased OTC at pharmacies, health stores, and online.

Supplements that may cause liver injury include:

• Anabolic steroids: These supplements are a synthetic version of the hormone testosterone that stimulates muscle growth. Liver injury from the supplements usually shows up within one to 24 months after starting them.
• Green tea extract: This herbal supplement can lead to liver injury within one to six months after starting it.
• Multi-ingredient supplements: Products that have more than one ingredient in them can cause liver damage within one to four months after starting them—it depends on what's in them and what the doses are.
• Vitamin A: This vitamin supplement can damage the liver after several months of use.
• Niacin: This supplemental form of vitamin B is used to treat high cholesterol. It can lead to liver damage within two days to several months after starting it.
  

How Do You Know if Your Liver Is Damaged From Medicine?

Before they can diagnose you with drug-induced liver damage, your healthcare provider will need to talk to you about your symptoms, do a physical exam, and ask you about any medications and supplements you take.

They can order blood tests to see how your liver is working. If your tests show higher than normal levels, it may indicate liver damage.

Drug-induced liver damage is a diagnosis of exclusion. That means that your provider has to rule out other causes of liver disease before diagnosing you with drug-induced liver damage.

Here are the key pieces of information your provider will consider when making a diagnosis:

• When you began taking the medication
• How your liver responds when you stop taking the medication
• If the medication affects the liver when it's started again
• Your specific liver injury
• Other potential causes of liver damage
• If the medication has been linked to liver damage in other people

Treatment

If your liver has been damaged by a drug, the first step is for you to stop taking it, if possible.

Depending on your symptoms and the severity of the damage to your liver, your provider may also want you to rest, avoid exercise, and get fluids through a vein (IV).

Most cases of drug-induced liver injury will start to get better within days to weeks of stopping the medication.

It usually takes two to three months to make a full recovery. During this time, you may get supportive care to address your symptoms.

Managing the condition for the long term means you'll have to avoid anything that could harm the liver such as using alcohol or taking acetaminophen.

Summary

Drug-induced liver injury is damage that is triggered by the use of prescription or over-the-counter (OTC) medications or supplements.

Symptoms of liver damage will vary from person to person. They may show up soon after you start taking a medication, but not always. Liver damage from medications may take months or years to become apparent.

Your healthcare provider can order blood tests to check your liver function for damage. Once they have ruled out other causes of liver damage, they will diagnose you with drug-induced liver injury.

If your liver has been damaged by a medication, you'll need to stop taking it and avoid any other things that could hurt your liver, like alcohol.