Your provider will do a physical exam to check for an enlarged liver and abdominal tenderness in the right upper part of the belly area. A rash or fever may be part of some medicine reactions that affect the liver. Some medicines can cause hepatitis with small doses, even if the liver breakdown system is normal. It’s possible, depending on the cause of your liver toxicity, how serious it is, and how quickly you treat it. If alcohol or acetaminophen is the cause of the toxicity and if you stop the exposure quickly, you can often reverse it within a few weeks or months.
Painkillers and fever reducers that contain acetaminophen are a common cause of liver injury, particularly when taken in doses greater than those recommended. People who drink alcohol to excess are more likely to have this problem. If there is reason to think an acetaminophen overdose caused your liver disease, quickly go to the hospital to get this drug. Your doctor will give you a physical exam, and go over your symptoms and medical history. Tell your doctor if you use any drugs or herbal supplements, drink alcohol, or use any chemicals at work. Most cases of drug-induced liver injury will start to get better within days to weeks of stopping the medication.
- Dr. Milinkovic initially joined SiPhox Health to spearhead the health coaching initiative and has been a key contributor in the development and launch of the Heart and Metabolic program.
- Prolonged therapy with methotrexate, INH, ticrynafen, perhexiline, enalapril, and valproic acid may lead to cirrhosis.
- People who are taking statins may have high liver enzyme levels on a blood test, which can be a sign of drug-induced liver damage.
- Both prescription and nonprescription drugs can cause drug-induced liver injury (DILI).
- If the liver toxicity is severe enough, you may need a liver transplant.
- Regular alcohol use induces certain CYP450 enzymes, potentially accelerating the breakdown of some medications while simultaneously depleting glutathione stores needed for detoxification.
Initial testing should include a complete blood count (CBC), a basic metabolic profile, a hepatic function panel, and urinalysis. If you have a mild case of liver hepatotoxicity, it’s likely to get better within weeks or months. But if the damage is chronic, or goes on for a while, it can lead to more serious damage like cirrhosis or liver failure. Your chances of serious liver damage also go up if you have another condition such as MASLD or hepatitis.
Hepatotoxicity FAQs
- DILI can be intrinsic, meaning that it results from too high a dosage, or idiosyncratic, which occurs due to a combination of risk factors.
- Most pain medications that are labeled as “non-aspirin” have acetaminophen as its main ingredient.
- It’s a condition known as drug-induced liver injury, explains Udoka Ikezuagu, M.D., a hospitalist at Loma Linda University Medical Center in Murrieta, California.
- Keep a medication diary noting when you started each drug, dosages, and any symptoms you’ve experienced.
- Drinking alcohol, genetic factors, and the other medications you are taking can add to the risk of injury to your liver.
- The spectrum of liver injury is wide, ranging from isolated asymptomatic aminotransferase elevations to a fulminant disorder.
Understanding why medications affect your liver so strongly empowers you to take a more active role in your healthcare. Classify drug-induced liver injury (DILI) as hepatocellular, cholestatic, or mixed according to the pattern of elevation of liver enzymes based on the first set of laboratory tests available. However, knowledge of the most commonly implicated agents and a high index of suspicion are essential in diagnosis.
Risk factors
It is usually predictable and dose dependent and has a direct hepatotoxic effect. Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease the severity of hepatotoxicity if the drug is discontinued. Knowledge of the commonly implicated agents and a high index of suspicion are essential in diagnosis. No specific antidote is available for the vast majority of hepatotoxic agents. Emergency liver transplantation has utility in the setting of drug-induced fulminant hepatic injury.
Chlorpromazine should be administered with caution to persons with liver disease. History must include dose, route of administration, duration, previous administration, and use of any concomitant drugs, including over-the-counter medications and herbs. Knowing whether the patient was exposed to the same drug before may be helpful.
Causes of Acute Liver Failure
This can happen only if you don’t have another disease and your liver is otherwise healthy. Your doctor will run a battery of labs to see if your liver is affected by hepatotoxicity. Generally, these labs will measure certain enzymes and proteins in your blood. If levels aren’t in the normal range, it could be a sign of liver hepatotoxicity. This depends on several factors, including the drug involved and a person’s individual health situation. In general, the symptoms of liver damage from medication can show up between five days and three months after you start taking a drug.
Read and follow all instructions and warnings for any chemicals you use, at home or on the job. Keep all chemicals and medications locked up in your home so that children or pets can’t eat them by mistake. Losing about 5% of your body weight could make a difference in reducing fat in your liver. A 7% to 10% loss of body weight could decrease inflammation around your liver. Aim to lose about 1 to 2 pounds a week until you reach your ideal weight.
Clinical and Pathologic Manifestations of Drug-Induced Liver Disease
The most common biochemical abnormality is elevation of the alkaline phosphatase level, usually without hyperbilirubinemia. Men and older patients are more prone to these adverse effects. The interval of developments is usually less than 4 weeks and may be as long as 8 weeks. Fever, rash, and eosinophilia may be observed in as many as 30% of individuals, but these findings do not define the disorder. Acute intrahepatic cholestasis is divisible into two broad categories, (1) cholestasis without hepatocellular injury (bland jaundice or pure cholestasis) and (2) cholestasis with variable hepatocyte injury.
Recreational drugs
Intense aerobic exercise is shown to decrease inflammation and fat in the liver. But always check with your doctor before you start a new exercise plan. Depending on your symptoms and the severity of the damage to your liver, your provider may also want you to rest, avoid exercise, and get fluids through a vein (IV).
The Liver’s Central Role in Drug Metabolism
Focal nodular hyperplasia and hepatocellular adenomas have been well described since the advent of oral contraceptive steroids. Many agents are linked to malignant hepatic neoplasms, including angiosarcoma from vinyl chloride and thorium dioxide. Other drugs include sulfonamides, salicylates, sulfonylureas, and quinidine. This tolerance has also been observed in 25-50% of the patients taking drugs such as methyldopa or phenytoin, and it has been especially well described with INH.
Drug-Induced Hepatotoxicity
This means it’s harder to predict how they’ll affect the liver at any dose. This includes drugs like like some kinds of antibiotics, herbal supplements, and other common Medications Affecting Liver medications. If you have existing liver conditions like fatty liver disease, hepatitis, or cirrhosis, your liver’s capacity to handle medications decreases substantially. Even mild liver dysfunction can alter drug metabolism, potentially leading to accumulation and toxicity.
There are currently no tests available for diagnosing DILI specifically, so the process of elimination plays a large role in the diagnosis. However, certain biomarkers within the body may support a diagnosis. The condition is particularly challenging to diagnose when the cause is a herbal or dietary supplement. This is because people are less likely to be aware of toxic substances within the compound, and it is harder to establish a link between the cause and condition. DILI can be difficult to diagnose, as many people do not experience symptoms. When symptoms do occur, the condition appears similar to other disorders relating to the liver and nearby organs.
Liver damage from these antibiotics usually shows up within weeks of taking them. If you think you have taken too much acetaminophen, get emergency medical care right away.