This vital organ transforms drugs into forms your body can either use or eliminate, a process called biotransformation. When you swallow a pill, it travels through your digestive system and enters your bloodstream through the intestinal wall. From there, it heads directly to your liver via the hepatic portal vein, where the real work begins. The liver is responsible for metabolizing drugs, and, as a result, the organ has high exposure to toxins that may occur within them. More than 1,000 drugs and herbal compounds can cause liver damage. Doctors may sometimes use the following compounds to prevent liver injury from drugs.
How Long Does It Take For Medication to Damage the Liver?
For that reason, whenever possible, physicians prefer to use “liver-safe” medications when we know a person has liver disease. Despite being “natural” but some ingredients can be toxic to the liver. “Dietary include herbal supplements can be sold with little testing, no proof of efficacy, and no safety guarantee. Dietary supplements including herbal products are not being regulated as similar as prescribed medications or over-the-counter drugs. Patients with liver disease should restrict the daily amount of acetaminophen to 2,000 mg per day, or even less if severe liver disease is present.
Hepatotoxicity Diagnosis
Research has shown that cholesterol lowering medications are safe in people with fatty liver disease or mild hepatitis C infection, and in fact, may be beneficial to the liver by decreasing inflammation. With very rare exceptions, people that have mild liver disease can safely take most common prescription and non-prescription medications at the recommended dose. These include some medicines that you buy over-the-counter or your health care provider prescribes for you. When increased numbers of toxic breakdown products occur, this can make you more likely to get liver damage. Some medicines are directly toxic to the liver, or may cause an allergic response. If it goes on for a while, it could cause permanent liver scarring or cirrhosis.
Acetaminophen, when used as directed, is extremely safe even for people with liver disease. However, taking too much acetaminophen at once, or taking a high dose of acetaminophen continuously over several days can cause damage to the liver. People with known liver disease may be at increased risk of liver injury when certain medications are used. That means that your provider has to rule out other causes of liver disease before diagnosing you with drug-induced liver damage. Remember that medication-induced liver effects vary greatly among individuals due to genetics, existing health conditions, and lifestyle factors. What causes significant liver enzyme elevation in one person might have minimal impact on another.
Drugs that lead to a pure cholestatic reaction include anabolic steroids (eg, methyl testosterone, oxymetholone, fluoxymesterone) and contraceptive steroids. Drugs that can cause cholestatic hepatitis include erythromycin, azithromycin, ciprofloxacin, ofloxacin, ranitidine, cimetidine, phenytoin, gold salts, and terbinafine. Intrahepatic cholestasis may be accompanied by acute cholangitis and is observed in patients taking chlorpromazine, allopurinol, chlorpropamide, and hydralazine.
Lock up all drugs or chemicals in your home so children don’t eat them. They are more at risk of liver toxicity because of their small size. The exact amounts of alcohol and acetaminophen that can lead to liver damage aren’t known. High PT levels could mean liver damage, but certain blood thinners can also cause it to be elevated. If you notice any of the symptoms and have any of the things that can raise your odds of having toxic liver disease, see your doctor right away.
What is drug-induced liver injury?
Not everyone experiences the same liver effects from medications. Several individual factors can make your liver more sensitive to drug-induced stress or damage. Goldina Erowele, PharmD, is a clinical pharmacy executive and healthcare consultant specializing in medical communications, clinical strategy, and solutions.
13 Alkaline phosphatase and bilirubin levels were rarely elevated, and severe injury was rare. Indications were that rechallenging a patient with this medication could be appropriate, and in more than 80% of cases, the alanine aminotransferase (ALT) abnormalities resolved or did not reoccur. Hepatotoxicity is a known characteristic of over 1000 medications and herbal compounds, 1, 2 with drugs accounting for 20-40% of all instances of fulminant hepatic failure.
- The condition can be a temporary or long-term response to the toxins, and the compounds containing the toxic substances can be either naturally occurring or artificially manufactured.
- Learn why shortness of breath and leg swelling occur together, common causes like heart failure, and when to seek immediate medical care for these symptoms.
- Taking too much acetaminophen is what causes most cases of acute (sudden) liver failure.
- For that reason your physician may obtain a baseline liver panel prior to starting a medication to be sure that it is normal.
What Is Toxic Liver Disease, or Hepatotoxicity?
Experienced in leading software and clinical development teams, contributing to patents, launching health-related products, and turning diagnostics into actionable tools. Learn why kidney issues cause excessive thirst, including causes like chronic kidney disease, diabetes insipidus, and electrolyte imbalances, plus treatment options. Currently, no specific tests are available for diagnosing DILI, so doctors may use different diagnostic criteria when confirming the condition. The primary cause of Medications Affecting Liver DILI is whichever drug has injured the liver, but the process varies depending on whether the condition is intrinsic or idiosyncratic. As a result, it is the area that the toxins within drugs most affect.
Ultrasonography is effective to evaluate the gall bladder, bile ducts, and hepatic tumors. Imaging studies are used to exclude causes of liver pathology, after which a diagnosis can be made. Performing laboratory tests to assess and diagnose the effects of the suspected medication is essential. Massive necrosis is an extension of submassive necrosis and manifests as fulminant failure. If the clinician is not familiar with the drug or if any question remains about the safety of continuing a drug, consultation with a hepatologist should be considered. A.D.A.M., Inc. is accredited by URAC, for Health Content Provider ().
What liver enzyme levels indicate medication-related damage?
- Blood tests can usually detect evidence of liver damage before symptoms develop.
- Internationally, data on the incidence of adverse hepatic drug reactions in the general population remain unknown.
- The interval of developments is usually less than 4 weeks and may be as long as 8 weeks.
- However, excessive doses deplete glutathione stores, allowing NAPQI to damage liver cells directly.
For those taking potentially hepatotoxic medications long-term, establishing baseline liver values before starting treatment and monitoring regularly helps detect problems early. If you’re interested in comprehensive liver health monitoring, regular testing can provide peace of mind and early detection of any issues. Taking proactive steps to support your liver health can minimize medication-related stress and reduce your risk of drug-induced liver injury.
Causes of Acute Liver Failure
Maintaining a healthy weight reduces fatty liver disease risk, which can compromise drug metabolism. Regular exercise improves liver blood flow and helps maintain healthy enzyme levels. Amiodarone 20, 21, 22, 23, 24 causes abnormal liver function test results in 15-50% of patients. The spectrum of liver injury is wide, ranging from isolated asymptomatic aminotransferase elevations to a fulminant disorder. Hepatotoxicity usually develops more than 1 year after starting therapy, but it can occur in 1 month.
When to Seek Medical Attention
It includes some of the most common prescription and over-the-counter (OTC) drugs that can cause liver damage. If you’re not sure if a medication or supplement is safe to use or use with other medications you’re taking, talk to your healthcare provider. Work closely with your healthcare provider to find the right balance between therapeutic benefit and liver safety. Don’t discontinue medications without medical guidance, as abrupt cessation can sometimes be more dangerous than continued use. Instead, focus on regular monitoring, supporting your liver through healthy lifestyle choices, and maintaining open communication about any concerns or symptoms you experience. With the right approach, you can protect your liver health while still receiving the medications you need for optimal wellness.
Hepatic dysfunction, including jaundice, hepatic cholestasis, and acute cytolytic hepatitis, have been reported. A positive dechallenge is a 50% fall in serum aminotransferase levels within 8 days of stopping the drug. A positive dechallenge is very helpful in cases of use of multiple medications. Drugs that result in massive necrosis are propylthiouracil, INH, phenytoin, phenelzine, sertraline, naproxen, diclofenac, kava kava, and ecstasy. The only specific treatment for most cases of liver damage caused by taking a medicine is to stop taking the medicine that caused the problem.
Serum ALT may rise and fall quite rapidly, and waiting a week or two before obtaining confirmation of elevations may lead to a false conclusion that the initially observed abnormality was spurious. Of greater concern, delay in retesting may allow progression to severe worsening if the initial abnormality was the herald of a severe reaction to follow. The need for prompt repeat testing is especially great if the ALT is much greater than three times the upper limit of normal or total bilirubin level is greater than two times the upper limit of normal.
