The liver is an organ
that is the immediate target of medications and toxins taken orally. Blood from
the intestine along with absorbed nutrients, medications and toxins are taken
by the portal vein to the liver. The liver then detoxifies the harmful
substances so that they do not reach the other parts of the body.
Unfortunately, this process can also take its toll on the liver, resulting in
‘The liver that detoxifies toxins can itself get damaged by medications, herbal and dietary supplements. Commonly used acetaminophen drug, antibiotics like amoxicillin, erythromycin and anti-epileptic drugs like phenytoin are hepatotoxic.’
drugs are known to be toxic to the liver, depending on their chemical
These need not only be allopathic medications; even herbal medications and
dietary supplements that are often overlooked can cause liver damage.
people suffer from liver injury with a drug due to an allergic reaction.
reactions are difficult to predict - they can affect just any one at any time -
and are therefore almost impossible to prevent.
Drugs that are mentioned
in the article as hepatotoxic vary from over-the-counter medications to
medications used for serious conditions. They include:
- Acetaminophen - It is a
common fever-reducing medication and painkiller. The drug is extremely
safe and unlike several other over-the-counter painkillers, is even recommended
in patients prone to stomach ulcers. However, the patients should be
warned to restrict to the maximum recommended dose since a high dose can
damage the liver
- Antibiotics - Commonly used
antibiotics like amoxicillin clavulanate, fluoroquinolones, erythromycin,
minocycline, azithromycin and trimethoprim-sulfamethoxazole.
- Anti-epilepsy drugs like phenytoin and carbamazepine.
When we come across the
terms herbal or dietary supplements, we presume that anything natural is
completely safe. Not necessarily. Herbal
and dietary supplements, including those used for bodybuilding have caused
. Since such supplements contain multiple ingredients, it is
sometimes difficult to pinpoint a single substance that has caused the liver
damage. The author mentions that herbal
products that have been associated with liver damage include green tea extract,
Senna glycosides, Centella asiatica,
greater celandine, isabgol, and Venencapsan
It is also important to
remember that drug-induced liver disease is extremely rare. The author points out that some people may
have a higher risk of developing liver disease. These include:
Diagnosing Drug-Induced Liver Injury
- Older or younger
- Females as
compared to males (pregnancy also increases the risk)
- Those with
pre-existing liver disease, smokers and alcohol consumers
A drug-induced liver
injury is diagnosed based on
- The medical
history of the patient who indicates the appearance of certain symptoms
within up to 6 months of intake of a medication
examination which may reveal signs of liver injury like jaundice
- Laboratory tests
like blood tests, urine tests and stool tests
It is also important to
rule out other possible causes of liver damage like hepatitis B
and hepatitis C
drug-induced liver injury often recover on withdrawal of the liver-damaging
medication. Corticosteroids may be required in some cases. Paracetamol toxicity
requires treatment with N-acetyl cysteine. Severely damaged livers may also
require liver transplantation.
- Lisi DM. Drug-Induced Liver Injury: An Overview. US Pharm. 2016;41(12):30-34.