An Overview of Drug-Induced Liver Disease

Drug-induced liver disease, also called drug-induced liver injury, is damage to the liver caused by prescription or over-the-counter medications. This may result from taking a drug that is no longer considered safe or using too much of a certain drug, such as Tylenol (acetaminophen). It can also occur if you already have a liver condition.

The liver plays a critical role in processing nutrients and drugs, as well as cleaning the blood. If the liver doesn't function properly, it can lead to life threatening consequences.

This article explains what drug-induced liver damage is. It will also cover symptoms and potential causes, as well as how this condition is diagnosed and treated.

What Does the Liver Do?

The liver has many important functions:

• It acts as a filter and removes unsafe substances from the body called toxins. Toxins are either removed in urine or feces, or broken down into safer substances.
• The liver helps with many metabolic processes that help the body process energy.
• It also helps with blood clotting, which is when the blood clumps to stop bleeding.

What Is Drug-Induced Liver Damage?

Drug-induced liver injury is damage that comes from the use or overuse of medications or supplements. This condition may result from:

• Taking a certain medication that makes the liver more likely to experience damage
• Taking a specific medication and having an existing liver disease
• Taking a drug that initially tested safe, but is later found to be harmful for general use

Symptoms of Drug-Induced Liver Damage

The signs and symptoms 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
• A rash
• White colored stools

In general, symptoms can show up between five days and three months after beginning a medication.

Drugs That Can Cause Liver Damage

The liver metabolizes drugs. Certain medications and supplements have the potential to cause damage to the liver cells, the flow of bile, or both.

Below are some drugs that can have this effect on the liver, though there are others.

Acetaminophen

Acetaminophen is an over-the-counter pain relieving drug found in oral medications like Tylenol and Excedrin. It is also in creams and ointments used for muscle pain relief.

Acetaminophen overdose is one of the leading causes of drug-induced liver damage around the world. Drinking alcohol, genetic factors, and other medications you may be taking can impact the likelihood and severity of the injury.

Liver injury can begin between 24 and 72 hours after taking the medication, with symptoms showing up within two to four days after the initial ingestion.

Taking or using more than one over-the-counter or prescription drug containing acetaminophen without the guidance of your healthcare professional is not recommended because of this risk.

Anticonvulsants

Some drugs used to treat epilepsy, a condition that causes seizures, have been associated with drug-induced liver injury. These include:

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

Liver injury may occur between one to six weeks after beginning the medication.

Keep in mind that newer medications used to treat epilepsy are rarely associated with liver damage.

Antibiotics

Antibiotics are used to treat infections. Certain oral antibiotics are linked to liver damage, including isoniazid, amoxicillin-clavulanate, and azithromycin. Tetracycline, which is commonly used to treat acne, is also associated with liver damage.

In some cases, topical antibiotics applied to the skin such as clindamycin, which is used to treat acne, may also cause liver damage.

Liver damage tends to show up within weeks after using these medications.

Methyldopa

This medication, which is used to treat high blood pressure, is associated with liver injury in some cases. It is typically not recommended for use in individuals who already have a liver disorder, especially cirrhosis, which is liver scarring triggered by a long-term injury.

Liver injury may show up within two to 12 weeks after beginning this medication.

Statins

These drugs, used to treat high cholesterol, are commonly prescribed and may cause high liver enzyme levels in some people. High enzyme levels usually indicate liver damage.

Specifically, Lipitor (atorvastatin) is most commonly associated with drug-induced liver injury in this class of medication.

With statins, liver damage may be delayed. Liver injury may show up between a month and 10 years after taking this type of medication.

Other Drugs

Other medications linked to liver injury include:

• Birth control pills, which may lead to liver damage within the first few months of taking this medication
• Certain heart medications like Amiodarone, which may lead to liver injury that isn't evident until years after beginning the medication
• Certain types of anesthesia, which are used to induce unconsciousness (e.g., Halothane), which may result in liver injury within three days after use
  

Supplements

Some supplements that are linked to liver damage include:

• Anabolic steroids, a synthetic version of testosterone that stimulates muscle growth, which may result in liver injury that shows up within one to 24 months after beginning therapy
• Green tea extract, which may lead to liver injury within one to six months after starting the use of this product
• Multi-ingredient supplements, which may lead to liver damage within one to four months after using these products
• Vitamin A, which may lead to liver injury that becomes evident several months after use
• Niacin, a form of vitamin B used to treat high cholesterol, which may lead to liver damage within two days to several months after beginning use
  

Diagnosis

To diagnosis drug-induced liver damage, your healthcare provider will go over your symptoms, give you a physical exam, and review the doses of your current medications and supplements.

They will then order specific blood tests. If your tests show higher than normal levels, it may indicate liver damage.

Drug-induced liver damage is a diagnosis of exclusion, meaning that your healthcare provider relies on their clinical judgement and the ruling out other potential causes of liver disease first.

They do so by taking into account:

• When you began taking your medication
• How your liver responds when the medication is stopped
• Your specific liver injury
• Other potential causes of damage
• If the medication is linked to liver damage in others
• If the medication impacts the liver if it is started again

Treatment

Typically, the first step is stopping the medication that caused the liver damage. Depending on your specific symptoms, your healthcare provider may also recommend resting, avoiding exercise, and getting fluids through a vein.

It is also important to avoid anything else that could harm the liver such as alcohol or acetaminophen.

Most cases of drug-induced liver injury begin to improve within days to weeks after stopping the medication that led to the damage. A full recovery can be expected within two to three months. During this time, you may receive supportive care to help manage symptoms.

Summary

Drug-induced liver injury is damage triggered by the use of prescription or over-the-counter medications or supplements. Symptoms of liver damage will vary from person to person.

Your healthcare provider may order specific blood tests to diagnose this condition. Treatment typically includes stopping the medication causing the liver damage, as well as other methods to provide symptom relief.

A Word From Verywell

In some cases, liver damage from medications and supplements is avoidable. Be sure you fully understand the potential risks of the medications you are taking, even when they are prescribed by a healthcare provider. If you have any signs or symptoms of liver damage, be sure to seek medical care right away.