10 Medications That Can Harm the Liver
Your liver is one of the hardest-working organs in your body. It cleans your blood, helps digest food, and keeps you healthy. But did you know that some common medications can make your liver sick?
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. And while most medications are safe when taken as directed, older adults can be more sensitive to these risks, so it’s important to be aware and bring any concerns to your healthcare provider.
Older individuals are also more likely to take multiple medications — roughly 40 percent of people 65 and older regularly take five or more prescription drugs, a Lown Institute report found — raising the risk of stress and damage to the liver.
Here are 10 medications that in some instances can hurt the liver, plus ways to help protect it from damage.
1. Acetaminophen (Tylenol)
What it is: Acetaminophen is a popular over-the-counter (OTC) medication for treating mild to moderate pain and reducing fever.
Common names: Tylenol, Paracetamol (internationally)
How it affects the liver: Acetaminophen is safe if you follow the directions and take the recommended amount, but it’s easy to overdo it, since it’s found in many combination medications, such as cold and flu remedies. Taking too much acetaminophen for a headache or muscle ache can be hard on your liver and cause harm. This risk goes up if you drink alcohol or already have a history of liver problems.
Tips to lower your risk of injury: Always follow the label and don’t take more than the recommended amount. (According to the manufacturer, the daily dose limit is 3,250 milligrams (mg) for adults. However, some doctors may allow up to 4,000 mg per day.) Be sure to read the list of ingredients on all OTC medications, and talk to your healthcare provider or pharmacist before using acetaminophen if you drink alcohol or have liver problems.
2. Statins
What they are: Statins are prescription medications that lower cholesterol levels and the risk of heart disease.
Common names: Atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor)
How they affect the liver: While generally safe and well tolerated, statins can raise liver enzymes, in particular one called ALT, or alanine aminotransferase. However, increases less than three times the upper limit of normal may not require your doctor to stop statin use. And enzyme levels go back to normal once you stop the medication. In rare cases, they can cause serious liver problems, especially if you already have issues with your liver.
Tips to lower your risk of injury: Your healthcare provider may order blood tests to check your liver function while you take statins — not everyone requires one — and, if needed, make any necessary changes. Common blood tests to check liver function include:
· AST (aspartate aminotransferase): Normal range is 8 to 33 U/L
· ALT (alanine aminotransferase): Normal range is 4 to 36 U/L
· ALP (alkaline phosphatase): Normal range is 44 to 147 IU/L
· Bilirubin: Normal range of total bilirubin is 0.1 to 1.2 mg/dL
3. Amoxicillin-clavulanate
What it is: Amoxicillin-clavulanate, an antibiotic, treats a variety of bacterial infections.
Common names: Augmentin
How it affects the liver: Amoxicillin-clavulanate can sometimes harm the liver. Though the exact cause is unclear, research suggests it’s likely due to an allergic reaction caused by clavulanate. Liver problems can occur a few days to weeks after starting the medicine or even after finishing it. The risk increases with prolonged use and existing liver problems.
Tips to lower your risk of injury: Watch out for yellow skin or eyes (jaundice), tiredness, or dark-colored urine. If you notice any of these symptoms, contact your healthcare provider immediately.
4. Antiseizure medications
What they are: These medications are used to prevent and treat seizures and certain types of nerve pain.
Common names: Phenytoin (Dilantin), carbamazepine (Tegretol)
How they affect the liver: Antiseizure medications such as phenytoin (Dilantin) and carbamazepine (Tegretol) can prompt an abnormal immune response in the liver, called hypersensitivity syndrome, which can damage nearby tissues. Medications like valproic acid (Depakene) and lamotrigine (Lamictal), can also affect the liver.
Tips to lower your risk of injury: If you are prescribed these medications, your healthcare provider may perform blood tests to check your liver health. Depending on test results, your provider may adjust your dose or switch you to a different medication.
5. Methotrexate
What it is: Methotrexate is a prescription drug used to treat rheumatoid arthritis, certain cancers and autoimmune diseases.
Common names: Trexall, Rheumatrex
How it affects the liver: Methotrexate can harm the liver, especially if taken for a long time or at high doses. (People taking the drug short-term may not be affected.) It may cause liver inflammation and, over time, lead to scarring (fibrosis) or serious liver disease (cirrhosis). The risk increases if you drink alcohol or already have liver problems.
Tips to lower your risk of injury: If prescribed, your healthcare provider may test your liver with blood work and adjust your medication if needed. Discuss your treatment plan with your doctor, and avoid alcohol while taking this medication.
6. Nonsteroidal anti-inflammatory drugs (NSAIDs)
What they are: NSAIDs are over-the-counter medications used to treat pain, inflammation and fever.
Common names: Ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac (Voltaren)
How they affect the liver: NSAIDs are usually safe for short-term use. However, taking them for a long time or at higher doses can put stress on the liver and, in some cases, cause liver damage. People with liver conditions or those taking multiple medications that affect liver function are at higher risk.
Tips to lower your risk of injury: Before using NSAIDs, check with your healthcare provider. They may recommend starting with the lowest dose for the shortest time or may suggest an alternative.
7. Certain herbal and dietary supplements
What they are: Herbal and dietary supplements are often marketed for various health benefits, but some can cause damage to the liver. Kava and black cohosh are two examples.
Common names: Kava (Piper methysticum), black cohosh (Cimicifuga racemosa)
How they affect the liver: Kava is used for anxiety and insomnia and has been associated with serious liver damage, though the exact cause is unclear. Black cohosh, often used for menopause symptoms, has been linked to liver problems such as a rise in liver enzymes and liver failure. More than 30 cases of liver injury linked to these supplements have been reported in the U.S.
Because the U.S. Food and Drug Administration (FDA) does not regulate or approve herbal or dietary supplements in the same way it does with other medications, ingredients in marketed products can vary, and some may contain harmful substances.
Tips to lower your risk of injury: Be a savvy consumer and know that “natural” doesn’t always mean safe. Always talk to your doctor before using supplements, and avoid using these supplements if you have existing liver problems.
8. Antifungal medications
What they are: Antifungals are a class of medications used to treat fungal infections in the skin, lungs, and nails.
Common names: Fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral)
How they affect the liver: Antifungal medications like fluconazole and ketoconazole can harm the liver, but keep in mind these medications are often prescribed for short-term use. The effects can range from a mild rise in liver enzymes (which is generally not concerning and can be monitored), to inflammation and even liver failure in rare cases. Watch out for yellowing skin or eyes, tiredness or dark urine.
Tips to lower your risk of injury: If you notice these symptoms, contact your healthcare provider immediately. They may order blood tests and, if necessary, adjust your medication.
9. Amiodarone
What it is: Amiodarone is a prescription for treating and preventing life-threatening irregular heartbeats (arrhythmias).
Common names: Cordarone, Pacerone
How it affects the liver: Amiodarone can damage the liver, affecting up to 1 percent of people who take it every year. It can raise liver enzyme levels or, in rare cases, lead to liver scarring. The FDA has issued a boxed warning about the risk of liver injury with this medication.
Tips to lower your risk of injury: Your healthcare provider will check liver enzyme levels before starting the medication and during treatment.
10. Isoniazid
What it is: Isoniazid is an antibiotic used for treating tuberculosis (TB) and, in some cases, preventing it.
Common names: INH, Nydrazid, Rifater
How it affects the liver: Isoniazid is broken down by the liver and can cause liver damage. It causes mild inflammation to serious liver injury — especially in older adults, those with liver conditions, or those who drink alcohol. It also has an FDA-boxed warning about liver inflammation risk, particularly when combined with certain medications.
Tips to lower your risk of injury: Your healthcare provider may check the health of your liver with lab tests. Contact your doctor immediately if you experience nausea, vomiting, yellow skin or eyes, or dark urine.
Risk factors for liver damage
Some factors can raise the risk of liver damage from medications, including:
· A history of liver issues
· Frequent alcohol use
· Taking multiple medications
Working closely with your healthcare provider and pharmacist can help protect your liver. They may check your liver health and adjust your treatment if needed, says Jessica Njoku, a pharmacist with Harris Health System in Houston.
To help protect your liver, take your medications exactly as prescribed, Ikezuagu says, and never change your dose without talking to your healthcare provider first. What’s more, be sure to talk to your doctor before mixing prescription drugs, over-the-counter medications and supplements.
By Goldina Erowele
Goldina Erowele, PharmD, is a clinical pharmacy executive and healthcare consultant specializing in medical communications, clinical strategy, and solutions.
Dr. Merle Myerson is a board-certified cardiologist with specialties in sports medicine, lipids, women’s health, and prevention of cardiovascular disease.
