What medications result in liver problems?
Drug-induced liver injury (DILI) is a condition that can result from toxins within drugs, causing liver damage. More than 1,000 different drugs, including prescription and nonprescription medications, antibiotics, cardiovascular drugs, central nervous system agents, chemotherapy drugs, herbal supplements like green tea extract, and dietary supplements like anabolic steroids, can potentially cause liver damage.
Preventing DILI
The best prevention is careful medication management and avoidance of hepatotoxic exposures. This includes limiting medication use to only when necessary, avoiding unnecessary polypharmacy, strictly following prescribed dosages and instructions, and caution with herbal supplements and natural products, since they may also cause liver damage. It's advisable to consult healthcare professionals before using these supplements.
Other preventive measures include avoiding alcohol consumption while taking medications known to affect the liver, such as acetaminophen, protecting oneself from exposure to toxic chemicals at work or home, and keeping all medicines and chemicals out of children's reach with proper storage.
Diagnosing and Treating DILI
If a doctor suspects that a person has DILI, they will recommend immediately stopping the use of the drug likely responsible for the damage. Treatment mainly involves supportive care tailored to the severity of liver injury, and in some cases, the use of specific antidotes or protective agents.
For instance, N-acetylcysteine (NAC) is a specific antidote for acetaminophen overdose. Emerging evidence suggests certain agents like rosmarinic acid (RA) may protect against acetaminophen-induced liver injury by enhancing antioxidant capacity and inhibiting cell death pathways. In some cases, ursodeoxycholic acid (UDCA) has been shown to help restore liver function after DILI.
In some cases where the liver damage presents as autoimmune hepatitis, doctors may prescribe glucocorticoid therapy. Autophagy, a mechanism that enables cells to respond to stress, can be controlled to potentially reduce or prevent DILI.
Understanding DILI
DILI can be either intrinsic or idiosyncratic. Intrinsic DILI is easier to predict and avoid, as it depends on the dosage, with a short latency period. Paracetamol, also known as acetaminophen, causes the highest number of intrinsic DILI cases.
Idiosyncratic DILI, on the other hand, is harder to control, has a long latency period, and is dependent on individual risk factors. Genetic and environmental factors, such as pre-existing conditions, inflammation, and alterations in gut microbiota, can increase the risk of DILI, particularly for idiosyncratic DILI.
Any previous reactions to drugs can also influence the risk of DILI. Symptoms of DILI can be acute or chronic, with many people not experiencing any symptoms. Common symptoms include jaundice, weakness, abdominal pain, dark stool, dark urine, nausea, and pruritis (itchy skin).
The U.S. Food and Drug Administration maintains a searchable database of medicines and herbal compounds that can damage the liver. For more information, visit their website.
- To minimize the risk of drug-induced liver injury (DILI), especially for idiosyncratic DILI which can be influenced by genetic and environmental factors, it's advisable to be cautious when using herbal supplements like green tea extract and dietary supplements like anabolic steroids, since they may also cause liver damage.
- In the case of chronic diseases or medical-conditions requiring chronic medication use, maintaining a healthy nutrition and adhering to a health-and-wellness lifestyle, in addition to careful medication management, can potentially reduce the risk of DILI and liver damage.
- While science has made strides in understanding the underlying mechanisms of DILI, such as the role of autophagy in reducing or preventing DILI, more research is needed to develop effective therapies for chronic DILI cases, especially those caused by idiosyncratic DILI.
