What exactly is hepatotoxicity, and why should I be worried?

The liver is a vital organ that is responsible for many body functions, including blood cell composition, breakdown of nutrients we eat, balancing cholesterols, and ridding our body of foreign chemicals, such as alcohol and drugs.
Hepatotoxicity is damage that occurs to the liver by chemical means. Medications that we use every day can ultimately be damaging our liver!
Unfortunately, hepatotoxicity from commonly known drugs is often a cause of liver injury. It is estimated as many as 1000 drugs can be blamed for some form of liver damage.
The liver’s role in detoxification makes it especially vulnerable to damaging substances. Liver cells, hepatocytes, can be injured by various pathways depending on the type of drug being metabolized. Reactive particles can destruct the cellular components of the hepatocytes, leading to cell death. Other metabolites alter liver enzymes responsible for drug metabolism leading to toxicity. Drug fragments can also bind to liver proteins initiating an autoimmune attack on the liver tissue.
Effects of hepatotoxicity can be seen throughout the body. General symptoms include: nausea, vomiting, upper right stomach pain, loss of appetite, brown urine, and yellowing of the skin and eyes (jaundice.) It is important to note these changes early and notify the health-care provider immediately if they are experienced. Early intervention is the safest way to limit damage to the liver!
Who is at risk for hepatotoxicity? EVERYONE! It may be a patient you are monitoring, a family member you are educating, or yourself. Concerns extend far beyond high dosages of prescription medications. Hepatotoxicity can result from combining multiple drugs, alcohol consumption with medications, genetic predispositions, age-related metabolism rates, and underlying diseases. Over-the-counter products, such as Tylenol, and herbal remedies, that are often considered “safe”, play a HUGE role in liver damage.
The key to lowering your risk is EDUCATION. Knowledge about hepatotoxicity is critical to keeping EVERYONE safe.

Kaplowitz, N. (2004). Drug-induced liver injury. Clinical Infectious Diseases: An Official Publication Of The Infectious Diseases Society Of America, 38 Suppl 2S44-8.

More information on hepatotoxicity, like specific symptoms to look out for can be found here: http://www.liverdisordersfocus.com/articles/liver-disorders/drug-induced-liver-damage.php

Friday, October 23, 2009

Antiobiotics Fighting Germs: Are They Also Fighting Your Liver?

Antibiotics are one of the most prescribed medications; however, they are also one of the top medications known to cause liver damage. The damage that can result can drastically increase the cost of your healthcare during the treatment of infections!

Hepatotoxicity from these drugs have been known since the 60s when erythromycin was found to have serious effects on the liver in adult patients. Today, a wide variety antibiotics are known to cause liver toxicity including those used to treat staph infections and many penicillins.

How do you know you are at risk while taking an antibiotic? Ask your healthcare provider or pharmacist about potential side effects of your medication. Of course, alcohol use and taking other medications known to alter liver action increases your risk for developing problems. Patients at either end of the age spectrum, either young children or elder adults, are also at an increased risk of problems.  Other diseases, such as HIV, AIDS, hepatitis, tuberculosis, and malnutrition, can also increase your risk for developing liver damage with antibiotics.

What is the solution to the problem? EDUCATION for patients is the best way to prevent serious liver damage. Know your risks and take caution when starting an antibiotic treatment.  It has been suggested that baseline liver function tests before treatment is key to monitoring changes in the liver.  This is a drastic measure that should be utilized in specific situations where infection and the medications used to treat it both play major roles in liver injury (e.g. tuberculosis and hepatitis treatments.)

Had you ever heard of liver damage from antibiotics? Can we do more to protect people from liver injury with antibiotic use?

Ybarra, J. (2007). Drugs that harm bugs...and the liver?. Drug Formulary Review, 3-4. http://libproxy.uta.edu:2066/

For more infomation on this topic, please visit:


  1. Very Interesting with great, Helpful information! Never knew half of the information on here!--Misty Howe

  2. This article definitely hit home with me. Back in 2002 i had a failed PPD test and was told i had a dormant form of tuberculosis in my system. One of the treatments for this was to take a really strong antibiotic that could damage my liver and would not guarantee that the tuberculosis would stay dormant. After sitting down with several doctors and weighing all of the risks i decided it was not worth the possible harm that could be caused to my liver and decided not to take the medication. It just shows you that you have to way all of your options before taking any prescription drugs...... Joe Arnold

  3. This is a very interesting article. As a military officer, I try to take as few medications as possible. Now I know that I was doing the right thing (besides all the shots and vaccines we have to take). Thanks for the article.

  4. Joe,
    It is true that tuberculosis medication can be very damaging. They require you to consciously think about everything you consume (alcohol, Tylenol, foods, etc.) Sometimes they require drastic lifestyle changes. You seem pretty informed, but here is a website if you decide to know more about your situation:

    The key here is to weigh the benefits of the antibiotics with the risks. Sometimes you need the medications, but, as I stated before, you must know your risks and be conscious of what you consume. It may require you to change your lifestyle for a short period of time. Always be aware of any changes signalling hepatotoxicity while you are taking these medications. Talk with your health-care provider or pharmacist to truly know the benefits and risk before ruling out any antibiotic therapy.

  5. Is the damage that occurs in the Liver permanent? My daughter took very high powered antibiotics during her 1st year of life for ear infections. Should I be concerned with any lingering damage?

  6. If your daughter did not show signs of liver toxicity (jaundice, nausea, stomach pains, brown urine), it is very unlikely that she has any damage from that therapy. Chronic conditions that harm the liver, such as hepatitis viruses and alcoholism, can cause scar tissue to form in the liver that cannot be reversed. However, our livers are amazing at repairing temporary damage! Talk with your child's healthcare provider if you have any specific concerns about medications she is currently taking that may be affected by this. Here is a brochure from the American Liver Foundation that has more information on the liver and medications:

  7. Marian,

    Here is another site that has tons of pediatric information! This particular link goes straight to acetominophen concerns with children; however, there are additional resources about infections and other medications, as well. Please let us know if you have any other concerns we can research for you!


Hepatotoxicity: Where We've Been, Where We Are, Where We're Going


Hepatotoxicity dates back to nearly 100 years. Just recently, they have discovered that some of the most common drugs can cause liver injury. These drugs are currently well known to the public and used by a majority of the population. The drugs in question are known as non-steroid anti-inflammatory drugs (NSAIDS), statins, anti-diabetics, and acetaminophen.

- Acetaminophen was known to cause liver damage in 1943, if not taken in therapeutic range. Even when taken appropriately, can cause hepatotoxicity if taken with other medications.
- The anti-diabetic drug, troglitazone, was the first drug to bring light to hepatotoxicity and the long-term causes it can have on the liver.


Hundreds of articles exist on the effects of drugs on the liver. The drug industry has been hit hard with removal of drugs from the market that cause liver damage. Liver hepatotoxicity is one of the most common reasons that drugs are withdrawn from the public's use. Even doses in the therapeutic range, have been known to cause toxicity of the liver. Although these drugs were known to work effectively, they were shown to cause severe liver damage, liver transplant, or death.

In 2006, the FDA added guidelines to follow if the immune system falls below a certain range. Liver enzymes should be tested in order to keep patients safe. This is currently the only way to diagnosis liver hepatoxicity, at least the most efficient way.

Recently, the public has become aware of acetaminophen related hepatotoxicity. One controversy on OTC drugs is the drug-drug interactions. The public is not as educated as they should be on the ease of overdosing on OTC drugs. As healthcare professionals, it should be an important goal to educate patients on liver safety.


Drug companies will have a never-ending battle with regulating the side effects of drugs. It could be considered a catch 22, drugs can dramatically improve ones life and at the same time be a silent killer. The FDA has taken steps to educate the public on these drugs, but the warnings do not seem to be eye catching enough.

Studies show that there is a possible genetic link to drug induced liver injury. Science Daily (2009) studies show that acetaminophen is toxic if taken in high doses, but a link exists showing that toxicity is more likely due to genetics. The study suggests that finding the genetic marker will help create safer drugs in the future. Studies also suggest that some patients become more susceptible due to their environmental factors.

Current preclinical and clinical liver safety testing does an excellent job in keeping the public safe from drugs capable of causing various forms of liver injury.

In any case, the FDA will constantly be on alert for drugs and their contraindications for hepatotoxicity. Healthcare professionals will need to be aware of the ever-changing revisions to drugs and safety changes.


Lucena, M., García-Cortés, M., Cueto, R., Lopez-Duran, J., & Andrade, R. (2008). Assessment of drug-induced liver injury in clinical practice. Fundamental & Clinical Pharmacology, 22(2), 141-158. http://search.ebscohost.com/

Watkins, P. (2005). Idiosyncratic liver injury: challenges and approaches. Toxicologic Pathology, 33(1), 1-5. http://search.ebscohost.com/

Fontana R, Watkins P, Bonkovsky H, et al. Drug-Induced Liver Injury Network (DILIN) prospective study: rationale, design and conduct. Drug Safety: An International Journal Of Medical Toxicology And Drug Experience [serial online]. 2009;32(1):55-68. Available from: MEDLINE

Ipswich, MA. Accessed October 16, 2009.Lee W, Senior J. Recognizing drug-induced liver injury: current problems, possible solutions. Toxicologic Pathology [serial online]. 2005;33(1):155-164. Available from: MEDLINE, Ipswich, MA. Accessed October 16, 2009.009.