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The Hidden Dangers: Medications That Can Harm Your Liver

Leveraging the benefits of modern medicine is all too often a balancing act that weighs the benefits of treatment against the side effects of long-term use, many of which affect
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Medications That Can Harm Your Liver

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Medications That Can Harm Your Liver

Modern medicines can be lifesaving for many people, but there is a chance that some medications can harm your liver. It is wise for anyone taking prescription medications (as well as over-the-counter meds, supplements, or unregulated street drugs) to understand their potential side effects. Many medications taken to alleviate unpleasant symptoms can have serious  consequences on your body – especially after taking these over an extended time period.

Even short-term medications and commonplace over-the-counter medications like acetaminophen (the active ingredient in Tylenol and many other over-the-counter pharmaceutical products) can be harmful. Unfortunately, in many cases, the most serious side effects of medication will be related to one of your body’s most crucial internal organs: your liver.

The liver is responsible for naturally detoxifying the body and metabolizing the substances you consume. It can also become an unintended victim of medication toxicity. When it comes to your liver and medication, we cannot overemphasize the importance of being informed and protecting your own well-being.

Understanding the Role of the Liver in the Human Body

While a comprehensive medical knowledge of the liver’s role and function requires years of study and practice, having a basic understanding of what the liver is and does is well within anyone’s grasp. This understanding can help you make healthier, better-informed decisions about what you put in your body.

As one of your body’s most vital organs, the liver performs an impressive array of functions, most notably as a sophisticated, living filter, detoxifying your body of chemicals and metabolizing drugs and other substances.

The Role of the Liver in the Human Body

Any interference with regular hepatic operations (i.e., the many functions of a healthy liver), whether by overprescribed medications, unregulated supplements, or other disruptors, can have serious implications for your overall health.

A few of the most important things your liver does for you include:1
  • Detoxification – The liver filters toxins for removal from the body. This includes the processes that remove drugs and alcohol from the bloodstream over time, as well as the filtration of naturally produced chemicals within your body.
  • Metabolism – A healthy liver stays busy helping to convert nutrients from your diet into a form usable by your body, breaking down fats to produce energy, and regulating glucose and glycogen levels.
  • Nutrient Storage – In addition to serving as a filter, your liver can also act as a storage bank for key nutrients and minerals, such as iron.
  • Blood Health – Your liver produces important compounds that help blood clot correctly and maintain healthy blood pressure.
  • Regulation – The liver helps to regulate a wide variety of important substances in your body, from hormones to cholesterol.2,3

As impressive as this list might be, it represents only a sampling of what your liver is involved in. For all these reasons and more, liver health is a lifelong key to overall well-being.

Common Medications That Can Harm Your Liver

Medications That Damage the Liver

Now that you understand more about why the liver is such a critical part of our various internal systems, let’s explore a list of medications and medication categories that can potentially interact with this precious organ in a potentially dangerous way.

  • Alcohol – While alcohol is not a pharmaceutical medication, it is often used in an attempt to alleviate mental health symptoms, particularly PTSD, depression, and anxiety. Unfortunately, as a nervous system depressant, it can make these conditions worse, and it is not an effective method of dealing with mental health conditions. Alcohol is notorious for causing liver damage, including fatty liver, alcohol-induced hepatitis (liver inflammation), and cirrhosis (liver scarring), all of which are exacerbated when the liver breaks the alcohol down into even more damaging substances. In fact, alcohol is thought to be involved in around 50% of deaths caused by liver failure.4
  • Anticonvulsants – Whether prescribed for seizures or off-label as an antipsychotic medication used to treat bipolar disorder, anticonvulsants have the potential to cause liver damage. Examples of these drugs include carbamazepine, phenobarbital, phenytoin, and topiramate, all of which can spike liver enzymes.5
  • Antidepressants – There are multiple types of antidepressant drugs that can cause or exacerbate liver damage. In fact, one particular class of antidepressants – tricyclic/tetracyclic antidepressants – should not be taken if you have liver risk factors, including being of advanced age, alcohol use, and previous liver toxicity.6
  • Antipsychotics – Antipsychotic medications can pose a risk to the liver. Tier I liver dysfunction risks include clozapine, chlorpromazine, and olanzapine, while Tier II and III liver dysfunction risks can include drugs such as risperidone, quetiapine, and haloperidol.7
  • “Statin” Class Drugs – Common cholesterol management medicines, such as Rosuvastatin, Simvastatin, and Atorvastatin, have the potential to cause liver injury over time, even when used exactly as prescribed.
  • Antibiotics – Examples of specific antibiotic medications that have been implicated in liver issues in some patients include erythromycin and amoxicillin-clavulanate. Overuse of antibiotics, in general, has also been linked to hepatic damage by research.8
  • Arthritis Medications – Methotrexate and azathioprine, taken for treating arthritis symptoms, come with some liver-related risks.
  • Steroids – Chronic use of steroidal drugs can elevate certain liver enzymes beyond the desired levels, potentially resulting in a serious disruption to normal liver function.9
  • Over-the-Counter Pain Meds – Most notably, acetaminophen (a.k.a. Tylenol), while widely believed to be safe for occasional, as-directed use, has been proven to be hepatotoxic at high doses. Long-term use can lead to severe liver damage or serious long-term hepatic function issues in patients, particularly when used in excess or overdose.

Psychotropic Drugs and the Liver

As mentioned, there are a number of medications developed to treat mental health symptoms – known as psychotropics – that can negatively affect the liver. These drugs typically fit into the anticonvulsant, antidepressant, or antipsychotic categories. While any orally-dosed drug must be processed by the liver and metabolized, there are certain medications within these categories that are especially hard on the liver or are difficult for the liver to process correctly after liver damage begins.10 These include:

Extensive First-Pass Metabolism Medications

These oral medications must not only be metabolized by the liver, but they require significant biotransformation while there. Much of the drug is lost to the liver and is not available to exert its intended effects on the body. These drugs are not recommended for those with liver damage and can cause damage over time. Examples are mostly tricyclic antidepressants like amitriptyline, amoxapine, desipramine, and nortriptyline, as well as bupropion, sertraline, venlafaxine, quetiapine, and chlorpromazine.

Extensively Protein-Bound Medications

People who have had problems with alcohol in the past or people who have experienced liver damage previously may have difficulty taking protein-bound medications. The liver must produce drug-binding proteins to effectively metabolize these medications. Without adequate levels of drug-binding proteins, metabolism can be extremely unpredictable and can drastically impact the effects of the drug on the body and mind. These drugs include many antipsychotics, benzodiazepines, aripiprazole, and fluoxetine.

The Impact of Over-the-Counter Meds on Your Liver

While powerful prescribed medicines can certainly pose a danger to your liver, over-the-counter (OTC) drugs are of special concern because they are so widely used. Beyond acetaminophen, several other OTC drugs can be harmful to the liver, as shown below.

OTC Pain Meds That May Cause Liver Damage

  • Acetaminophen

    Acetaminophen is one of the more commonly overused medicines due to its wide availability, and many people assume it’s completely safe. In reality, it is demonstrably hepatotoxic.11 The main ingredient in Tylenol (and many other popular OTC pain relief, cold and flu, headache, and menstrual pain medicines), acetaminophen is believed to be fairly safe for occasional use as directed. However, people using the medication for chronic pain issues often begin taking large, daily doses of acetaminophen that can cause serious liver problems and irreparable hepatic damage.

  • NSAIDs (Non Steroid Anti Inflammatory Drugs)

    NSAIDs are another very popular class of easily accessible pain medications. NSAIDs are the leading cause of drug-induced liver injury worldwide. Popular NSAIDs include ibuprofen© and naproxen sodium (Motrin© and Aleve©).21 

  • Aspirin

    Yes, even this tried and true pain remedy aspirin can have serious consequences for your liver. This one is of special concern to children and teens who are at risk of Reye syndrome, which is a rare but extremely serious condition that can result in damage to both the liver and the brain. Children and adolescents should not take aspirin even at very low doses. 22

Herbal Supplements and Remedies – A Caution

Herbal remedies must be correctly labeled to avoid potential adverse effects when safe agents are mixed with contaminants, or combined with unsafe agents. Research also cautions against using high dosages, especially over a prolonged period of time, and if the liver is in a compromised state. However, if adverse effects do occur, or allergic reactions occur, they will resolve when the supplement is stopped. The greatest caution is against using complex mixtures that may contain harmful ingredients, contaminants, or are mislabeled. These are actually unsafe and may harm your liver. Some examples follow.

  • Kava – This plant-based supplement is popular for its gentle calming effects, and has been used for thousands of years around the world as a ceremonial beverage. Some controversy has developed over the safety profile of kava-based products. On one hand, research has documented the positive neurological effects of kava kava (Piper methysticum) classifying it as a clinical nutrient.19 The WHO published a positive review of kava beverage consumption in 2016, citing its many health benefits.20 However, there have been cases where high dosage kava extracts were associated with allergic skin reactions.18 And, there have been 3 documented case reports of suspected kava-induced (reversible) hepatitis. However, multiple animal studies cited by the WHO have shown no connection whatsoever between kava consumption even at high dosages, over months of daily use, with kava-induced hepatic toxicity. Out of caution, kava has been restricted of withdrawn across several international markets. Ongoing clinical trials are attempting to understand the anti-anxiety and anti-cancer effects better, and to determine whether adverse effects such as hepatoxicity were limited to contaminated batches, excessive consumption, the presence of mold on the raw materials, rare genetic factors affecting metabolism, concomitant use of benzodiazepines, other medications, or alcohol, and whether other contributing factors were involved.12
  • Green Tea Extract – Green tea products are widely and safely used as weight loss supplements. Research has found in rare cases of overuse or prolonged use, that green tea has been associated with mild symptoms that resolved when the supplement was stopped. With further investigation, all reports of acute liver damage were after ingesting products containing a mixture of green tea combined with other agents, or with alcohol consumption, that were known to be toxic to the liver.14
  • Chaparral – Chaparral is produced from an evergreen bush commonly found in Mexico and the southwest portions of the US. It has antioxidant properties, and is used to improve immunity and is known for many health benefits. Allergic reactions to chaparral have been clinically reported, but where more severe hepatoxicity was investigated, all cases were associated with contaminants or improper preparation.17
  • Actaea, commonly mislabeled as Black Cohosh – Black Cohosh is a flowering plant used as a health supplement for treating menopausal symptoms. Black cohosh has never been found to cause liver damage, however there are products mislabeled as “black cohosh” that are something else entirely, like Actaea, which is known to be hepatoxic. Be careful when purchasing natural health products and ensure they are high quality, pure, and correctly labeled.13
  • Comfrey – Comfrey extracts are useful in topical preparations for sprains, inflammation, and easing other physical discomfort. it should not be taken orally as it contains alkaloids that can injure the liver.15
  • Valerian Root – Valerian root has been used for centuries, safely, for its positive effects on sleep and as an antidepressant and anti-anxiety botanical. No cases have ever been found of acute liver failure or liver damage. Where symptoms of elevated liver enzymes were reported, such were mild and resolved after a short time of stopping the supplement. However, in all cases where signs of hepatoxicity were studied, the supplement taken also contained other agents. Valerian is an easily obtainable supplement used to treat insomnia, anxiety, depression, and digestive and urinary problems, and be sure to take only a purely sourced and correctly labeled product.16

Before adding any over-the-counter medication or supplement to your regimen, speak with a trusted health professional. At Alternative to Meds Center, we focus on safe and proven mental health treatments such as neurotransmitter rehabilitation, cleansing neurotoxins from the body, boosting health and healing the gut through orthomolecular medicine, the use of CBT, and other holistic treatments. We have observed that these can lead to better long-term outcomes.

Recognizing the Signs of Liver Damage

Early detection of liver issues is key to getting effective treatment. If you are concerned that your liver may be damaged from sensitivity to, or overuse of medications or supplements, there are several signs you can look out for. These include:

  • Jaundice (yellowing of the skin and eyes)
  • Excessive fatigue
  • Fever
  • Loss of appetite
  • Itching
  • Abdominal pain
  • Abdominal distension
  • Nausea, usually with vomiting
  • Unusually dark urine or feces

If you are experiencing one or more of these symptoms, make an appointment with a trusted medical professional. During your visit, be sure to give your healthcare provider a complete list of any drugs, medications, and supplements you’re taking, including any over-the-counter products.

FAQs About Medications, Liver Damage, and Liver Failure

FAQs About Medications and Liver Damage

We hope we’ve helped you to feel more empowered to look out for your hepatic health while making everyday healthcare and consumer purchasing decisions for yourself. Of course, the liver is, by its very nature, an extremely complex topic, and it’s natural that you would still have many more questions about different medications and their potential role in liver problems.

What Medications Are Harmful to the Liver?

There is a substantial list of common medications and supplements that can be implicated in poor liver health or even liver failure, especially when used at high dosages, or over long periods of time. That being said, it’s important to understand that what we’ve talked about above is not a complete list of the medications that can potentially interact with or do harm to your liver. The liver works as a sort of front-line “filter” organ to metabolize substances and remove toxins. Special care should be taken in managing medication use, especially where the liver is already compromised.

Which Medications Can Cause Elevated Liver Enzymes?

There are many drugs that can affect the level of various crucial liver enzymes. A few specialized drugs might do this deliberately, by the nature of their therapeutic mechanism, but many others will increase liver enzyme levels as an unwanted side effect. “Statin” type cholesterol medicines and various types of steroids are two common examples of this.

What Medication Is Bad for Fatty Liver?

Fatty liver is a condition that can be caused by overeating, overconsumption of alcohol, or a type of liver malfunction wherein your system fails to break down fats adequately. Overconsumption of many different prescription psychotropic, healthcare medications, and OTC drugs, including acetaminophen, can contribute to fatty liver, or harm your liver in other ways, especially when used in excess.

How Do I Know If My Medication Is Affecting My Liver?

In addition to symptoms such as jaundice, fatigue, vomiting, itching, etc., regular blood tests are a good way to monitor the levels of key liver enzymes. Standard blood work available at any medical lab will give you insights into your levels of alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), alanine transaminase (ALT), and other important enzymes that can work quite well as markers of overall liver health.

Can Liver Damage From Medication Be Reversed?

In mild cases, simply ceasing the use of the problematic drug or supplement can, in time, allow the injury to heal. Some medications that can harm your liver may be able to be gradually reduced but only under medical oversight. However, severe cases may require long-term treatments and permanent lifestyle changes may help to manage the symptoms of hepatic damage. In worst-case scenarios such as overconsumption of alcohol, the damage caused by cirrhosis, liver scarring caused by long-term toxicity, may not be completely reversible.

In general, it’s important to remember that the liver is crucial to many core bodily functions and that you’re only born with one of them, so try to treat it that way. While it can be a challenging long-term prospect to recover from serious liver damage, it may not be too late to start making healthier choices.

How Do You Keep Your Liver Healthy While Taking Medication?

While protecting the liver is extremely important, some medications may be essential to treat certain disorders. If you need to take meds or supplements, there are many things you can do to protect your liver health. Start by eating a healthy diet, ensuring you are not being overprescribed, and closely monitoring your medicine intake to avoid accidental double dosing. Also consider transitioning to natural alternatives that will not harm your liver.

Best Practices for Liver Health Include Being Informed

Medications may play an important role in modern healthcare practices, but it remains of paramount importance for consumers to be aware of their side effects. By researching potential risks, consulting with trusted healthcare providers, and using regular check-ups and bloodwork to get a comprehensive picture of your health, you can monitor the potential risks of taking medications that may harm your liver.

About Alternative to Meds Center

Alternative to Meds Center

If you are concerned about taking medication that you believe may harm your liver or your overall health, Alternative to Meds Center can offer powerful, sustainable help.

Located in the serene spiritual haven of Sedona, AZ, the Alternative to Meds Center is a fully licensed inpatient treatment facility dedicated to holistic, integrative solutions for those in need of addiction treatment, medication detoxification, and holistic-based mental health services.

We are proud to provide a fresh perspective on substance use disorder, medication and environmental toxicity, and mental health treatment: one that emphasizes compassion, embracing the healing power offered by various natural methods, and addressing each individual’s unique needs. From safe, monitored medication tapering services to holistic practices like qigong, yoga, and -orthomolecular medicine, Alternative to Meds Center offers an open-minded and forward-thinking, yet always evidence-based, approach to well-being and recovery. Please reach out to our compassionate staff at your earliest convenience for any other questions you may have about the services we provide.

For Liver Health

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This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Medical disclaimer

This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. Never start, stop, or change a prescription medication without consulting a qualified healthcare professional who understands your medical history. If you are experiencing an immediate medical or safety emergency, call 911.