The liver is one of the body’s most vital organs, responsible for detoxification, metabolism, and filtering harmful substances from the bloodstream. However, the liver is also highly susceptible to damage from various medications, especially when these are used over long periods or taken incorrectly. Drug-induced liver injury (DILI) accounts for a significant proportion of acute liver failure cases worldwide. While many medications are generally safe when taken as prescribed, misuse, overuse, or interactions with other drugs can elevate the risk of liver toxicity.
In this article, we will explore some of the most common medications known to potentially cause liver damage, why this happens, and how to minimize the risks. It’s crucial for both patients and healthcare providers to be aware of these risks to protect liver health and avoid preventable complications.
Acetaminophen (Paracetamol)
Acetaminophen, also known as paracetamol in many countries, is one of the most commonly used over-the-counter pain relievers and fever reducers. While it is considered safe when used at recommended doses, it is also the leading cause of acute liver failure in the United States.
Signs of toxicity may include:
- Nausea and vomiting
- Abdominal pain (particularly in the upper right side)
- Jaundice (yellowing of the skin and eyes)
- Confusion or drowsiness
Prevention tips:
- Never exceed 3,000–4,000 mg per day unless instructed by a physician.
- Be cautious of combination medications (like cold or flu remedies) that may also contain acetaminophen.
- Avoid alcohol while using acetaminophen, as it increases the risk of liver damage.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs such as ibuprofens, naproxen, and diclofenac are widely used for pain relief, inflammation, and fever. While effective, long-term or high-dose use of these drugs can harm the liver in some individuals.
Signs of NSAID-related liver injury:
- Fatigue
- Loss of appetite
- Dark urine or pale stools
- Elevated liver enzymes on blood tests
Prevention tips:
- Use the lowest effective dose for the shortest time necessary.
- Regularly monitor liver function if NSAIDs are used long-term.
- Avoid combining multiple NSAIDs or using them with alcohol.
Statins
Statins, such as atorvastatin, simvastatin, and rosuvastatin, are widely prescribed to lower cholesterol and reduce cardiovascular risk. While statins are generally well-tolerated, they have been associated with mild to moderate elevations in liver enzymes.
Monitoring for liver health:
- Liver function tests (LFTs) are often performed before starting statins and periodically thereafter.
- Patients rarely experience symptoms unless the damage is severe, so routine testing is crucial.
Prevention tips:
- Inform your doctor of any history of liver disease before starting statins.
- Report any unusual fatigue, yellowing of the skin, or abdominal pain.
- Avoid excessive alcohol intake while on statins.
Antibiotics
Certain antibiotics, especially when used over a long period, have been associated with liver injury. These include amoxicillin-clavulanate, isoniazid, rifampin, erythromycin, and nitrofurantoin.
Why it’s risky:
- Amoxicillin-clavulanate (a common antibiotic for respiratory and sinus infections) is the leading cause of antibiotic-related liver injury, particularly in older adults.
- Isoniazid and rifampin, used to treat tuberculosis, have well-known hepatotoxic potential.
- Nitrofurantoin, commonly prescribed for urinary tract infections, can cause chronic active hepatitis when used long-term.
Symptoms of antibiotic-induced liver injury:
- Fever and rash (signs of hypersensitivity)
- Fatigue and jaundice
- Elevated liver enzymes
Prevention tips:
- Only use antibiotics when necessary and for the prescribed duration.
- Discuss any history of liver disease with your healthcare provider.
- Report side effects promptly, especially if you’re on long-term antibiotic therapy.
Herbal Supplements and Over-the-Counter Products
Many people assume that natural products are inherently safe, but several herbal supplements have been linked to liver damage. These include kava, comfrey, black cohosh, green tea extract (in high doses), and certain weight-loss or bodybuilding products.
Red flags include:
- Rapid onset of jaundice or fatigue after starting a new supplement
- Unexplained changes in liver enzymes
- Acute liver failure in extreme cases
Prevention tips:
- Research any supplement before use and buy from reputable sources.
- Avoid products with vague ingredient labels or proprietary blends.
- Inform your doctor about all supplements and non-prescription drugs you take.
Final Thoughts
While medications play an essential role in managing health conditions, it’s important to be aware that some can affect liver function, especially when misused or used for extended periods. The liver’s central role in drug metabolism makes it particularly vulnerable to injury from both prescription and over-the-counter drugs, as well as herbal products.
To protect your liver:
- Always follow prescribed dosages.
- Avoid unnecessary medications and supplements.
- Get regular liver function tests if you’re on long-term medications.
- Inform your healthcare provider about all substances you use, including alcohol and over-the-counter products.
