What Types of Drugs Can Be Toxic to Your Liver?

Your liver is the largest solid organ in your body. It performs hundreds of essential tasks such as:

• filtering toxins out of your blood
• removing old blood cells
• creating bile, a fluid that helps break down fats
• storing sugar in the form of glycogen
• storing some vitamins

Liver injury is the most commonTrusted Source complication that leads to drugs failing to receive FDA approval or being removed from the marketplace.

Many types of over-the-counter and prescription drugs can be toxic to your liver. Damage can be mild and reversible or severe and possibly life threatening.

Read on to learn more about how some drugs can damage your liver, how to recognize symptoms of liver damage, and which drugs are most likely to be toxic to your liver.

What makes a drug toxic to the liver?

Drug-induced liver injury is the most commonTrusted Source cause of sudden liver failure in the United States and Europe. Liver toxicity is dose-dependent, meaning that higher doses are more likely to cause damage.

Some drugs are only known to cause liver damage at very high doses, whereas some can cause damage even at recommended dosages.

Drugs can cause three patternsTrusted Source of liver damage:

• Cholestatic: Injury results from the destruction of bile ducts and accumulation of bileTrusted Source. It tends to mimic bile duct obstruction or gallstones.
• Hepatocellular: Injury results from damage to cells called hepatocytes and causes symptoms similar to viral hepatitis. Hepatocytes make up 70% to 85%Trusted Source of your liver volume and perform most of your liver’s functions.
• Hepatocellular-cholestatic: Liver damage has features of both cholestatic and hepatocellular injury.

Most liver damage caused by medication is minor and temporary, but some people can develop serious liver diseases such as cirrhosis or liver failure. Liver failure can be life threatening and may need to be treated with a liver transplant.

People with drug-induced hepatocellular injury are 2 to 3 timesTrusted Source more likely to need a liver transplant than people with cholestatic injury.

What types of drugs can cause liver damage?

Many types of drugs can cause liver damage. In a 2016 studyTrusted Source published in the International Journal of Molecular Sciences, researchers found at least one report of liver toxicity in 53% of drugs in the National Institutes of Health’s LiverTox database.

In North America and Europe, the most common cause of toxic hepatitis is acetaminophen (Tylenol). Acetaminophen is harmlessTrusted Source at low doses but can cause life threatening liver damage in high amounts.

Liver toxicity from acetaminophen usually occurs in suicide attempts at doses higher than 7.5 gramsTrusted Source, and most often over 15 grams.

The researchers also found that more than 100 cases of liver injury were reported in the following medications:

• Antimicrobial drugs:
  • efavirenz
  • erythromycin
  • flucloxacillin
  • didanosine
  • interferon alpha/Peginterferon
  • nevirapine
• Antibiotics:
  • sulfamethoxazole/Trimethoprim
  • sulfazalazine
  • sulfonamides
  • amoxicillin-clavulanate
  • minocycline
  • telithromycin
  • nitrofurantoin
• Antifungal drugs:
  • ketoconazole
• Antiepileptic drugs:
  • carbamazepine
  • valproate
  • phenytoin
• Antineoplastic:
  • thioguanine
  • floxuridine
  • flutamide
• Antituberculosis drugs:
  • pyrazinamide
  • rifampin
  • isoniazid
• NSAIDs:
  • nimesulide
  • sulindac
  • ibuprofen
  • diclofenac
• Immunosuppressive agents:
  • infliximab
  • azathioprine/6-Mercaptopurine
  • methotrexate
  • gold salts
• Arrhythmia medications:
  • amiodarone
  • quinidine
• Antihypertensive medications:
  • methyldopa
  • hydralazine
• Lipid-lowering agents:
  • atorvastatin
  • simvastatin
• Bodybuilding drugs:
  • anabolic steroids
• Gout prophylaxis:
  • allopurinol
• Chemotherapy:
  • busulfan
• Other drugs:
  • estrogens and oral contraceptivesTrusted Source
  • chlorpromazine (phenothiazine antipsychotics)
  • dantrolene (muscle relaxant)
  • disulfiram (substance abuse agent)
  • halothane (anesthetic)
  • interferon beta (multiple sclerosis)
  • ticlopidine (platelet inhibitor)
  • propylthiouracil (antithyroid)

Herbal supplements

Many people assume that herbal supplements are safe if they’re marketed as natural. However, many of these supplements can cause liver damage. Some herbal supplements linked to liver damage include:

• germander
• black cohosh
• kava extract
• green tea extract

Symptoms of liver toxicity

Symptoms of liver toxicity are similar to other liver diseases. They can include:

• jaundice
• dark urine
• fatigue
• weakness
• nausea
• poor appetite
• abdominal pain
• fever
• rash
• itching

Weakness and fatigue are prominent symptoms of hepatocellular injury. Jaundice and itching are typical symptoms of cholestatic injury.

It’s important to stop taking the medication as soon as possible after you develop symptoms.

When to get medical attention

Contact your doctor as soon as possible if:

• you develop potential symptoms of liver injury after starting a new medication
• you develop any new symptoms
• your symptoms don’t get better after stopping the medication

If your symptoms develop after taking high doses of acetaminophen, get immediate emergency attention.

What are the risk factors for liver toxicity?

According to researchTrusted Source, you may be at an increased risk for developing drug-induced liver toxicity if you:

• are an older adult
• are born female
• are of African American descent
• consume a high level of alcohol over a long period of time, while using some types of drugs
• have certain genes

There’s debate about whether people with preexisting liver disease develop drug-induced liver illness more frequently. It has been found that they have a higher death rateTrusted Source.

How is liver toxicity diagnosed and treated?

There are no specific testsTrusted Source to diagnose drug-induced liver toxicity. To make a diagnosis, your doctor will consider your medical history and any drugs you’re taking. They’ll likely recommend blood tests to look for signs of liver damage and rule out other conditions. These tests often include:

• serum bilirubin test
• alanine aminotransferase test (ALT)
• aspartate aminotransferase test (AST)

Treatment for liver injury

In most cases, the only specific treatment needed is to stop taking the medication. High doses of acetaminophen need to be treated in the emergency room.

If you have severe symptoms of liver damage, it’s important to avoid:

• heavy exercise
• alcohol
• acetaminophen
• other substances that harm the liver

What can you do to lower your risk of liver damage when taking certain drugs?

You can reduce your chance of developing liver injury by closely following your doctor’s instructions for prescription medications and following the medication instructions for over-the-counter drugs. Your risk of developing toxicity increases at higher medication dosages.

Other things you can do include:

• talking with your doctor before you start taking herbal or dietary supplements
• telling your doctor about all the medications and supplements you’re currently taking
• closely reading the warnings and instruction information that comes with your medication
• reducing the use of nonessential medications
• visiting your doctor for regular checkups
• going to all your scheduled follow-ups

The bottom line

Many types of medications can cause liver injury. The most common cause of drug-induced liver injury in the United States is acetaminophen, usually at doses over 7.5 grams.

Common initial symptoms of drug-induced liver injury include jaundice, fatigue, and weakness. It’s important to contact your doctor right away if you develop signs of liver injury after starting a new medication. Usually, with mild cases, stopping the medication is the only treatment that’s necessary.