10 Medications That May Cause Liver Damage - GoodRx (2024)

Did you know that your liver is the largest solid organ inside your body? This football-sized powerhouse helps keep you alive and healthy. As you move throughout your day, it works hard to detoxify your blood, help with digestion, and restore your energy levels. We can’t live without it.

Your liver also plays an important role in metabolizing medications. But some medications can directly damage this vital organ, in what’s known as drug-induced liver injury (DILI).

Here, we’ll discuss 10 medications that could potentially harm your liver, what symptoms to look out for, and what you can do to prevent liver toxicity (hepatotoxicity).

1. Tylenol

Tylenol (acetaminophen) is a common over-the-counter (OTC) pain reliever and fever reducer. It’s not toxic to the liver when it’s taken occasionally and within recommended dosages. However, large doses and/or chronic use can cause liver damage.

In fact, just one large dose of Tylenol can cause liver damage. This is called Tylenol overdose, which is a medical emergency requiring immediate attention. You should call Poison Control at 1-800-222-1222 or go to the nearest emergency room if you suspect you have taken too much Tylenol.

Tylenol can also cause liver damage if it’s taken too frequently — especially over a prolonged period of time. This concern is more relevant among people who have a serious illness, alcohol use disorder, or preexisting liver issues

You can lower the risk of liver problems related to Tylenol in the following ways:

• Don’t take more than the maximum recommended amount (4,000 mg per day).

• Avoid drinking alcohol while taking Tylenol.

• Check to see if any of your OTC or prescription pain medications contain acetaminophen, so you can avoid accidentally taking it from multiple sources. Keep in mind that Tylenol is also found in many OTC cold and flu products.

2. Antibiotics, like Augmentin

Augmentin (amoxicillin/clavulanate) is a common antibiotic for respiratory, ear, and skin infections. It’s the antibiotic that’s most likely to cause liver injury — though, it’s not a very common side effect, overall.

Liver injury typically occurs within a few days to 8 weeks after starting treatment with Augmentin. This is more likely to affect men, older adults, and people who have taken Augmentin multiple times in a row. Thankfully, the damage is usually reversible and does not cause lasting effects.

3. NSAIDs, like diclofenac

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly taken for pain, inflammation, and fever. Some are available OTC, but others — like oral diclofenac (Cataflam) — are available by prescription only.

Diclofenac is one of the most likely NSAIDs to cause liver injury. In many cases, the damage is significant enough to cause elevated liver function tests (LFTs) but not enough to cause symptoms. LFTs measure liver enzymes (proteins), and increased numbers point to possible liver injury. These numbers are collected by your healthcare provider through blood tests.

Serious liver damage is more rare. But the risk is higher for women and with larger doses and/or long-term use (more than 4 weeks).

Keep in mind: Diclofenac also comes in topical forms, such as gels, creams, and patches. The risk of liver injury is lower with topical versions since a much smaller amount is absorbed into your body.

4. Amiodarone

Amiodarone (Pacerone) is a medication that’s used to treat abnormal heart rhythms. Increases in LFTs happen in up to 50% of people taking amiodarone on a long-term basis. But this usually doesn’t cause serious health problems.

In some cases, though, amiodarone can cause more substantial liver injury. This is estimated to affect up to 1% of people taking the medication. The FDA issued a boxed warning, its most serious medication warning, about this risk.

Liver injury related to amiodarone is more common in people who take the medication at higher doses and for long periods of time. Thankfully, this risk can be monitored. You’ll likely have regular LFTs while taking amiodarone to make sure your treatment doesn’t need to be adjusted.

5. Allopurinol

Allopurinol (Zyloprim) is a medication that’s used to prevent gout flares. Some people also take it to prevent certain kinds of kidney stones. And, more rarely, people with cancer take it to prevent a complication called tumor lysis syndrome.

Allopurinol can cause minor, reversible increases in LFTs in up to 6% of people who take it. This usually does not lead to any long-term problems.

Less often, allopurinol can cause liver problems as part of a broader condition called drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. DRESS syndrome is a reaction to medication that also causes fever, rash, and abnormal blood tests, among other symptoms.

Allopurinol is also associated with severe skin reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). And these conditions can also harm your liver.

6. Anti-seizure medications, like phenytoin

Anti-seizure medications top many lists as potential causes of liver injury. Phenytoin (Dilantin) is one of the most common causes of DILI and liver failure. But the occurrence of liver damage related to the medication is still pretty rare overall; it happens in less than 1 in 1,000 people taking phenytoin.

Liver injury typically occurs 2 to 8 weeks after starting treatment with phenytoin. Almost all phenytoin hepatotoxicity cases happen as part of broader medication reactions that affect the whole body, such as anticonvulsant hypersensitivity syndrome (AHS), DRESS, SJS, and TEN. However, most cases of this type of liver injury resolve within 1 to 2 months of stopping treatment with phenytoin.

Other anti-seizure medications that have been connected to liver problems are valproic acid (Depakene), carbamazepine (Tegretol), and lamotrigine (Lamictal).

7. Isoniazid

Isoniazid is an antibiotic that’s effective at preventing and treating tuberculosis. But it’s one of the top 10 most likely medications to cause DILI in multiple countries. Increased LFTs can affect up to 20% of people taking isoniazid. But only about 1% of people taking the medication experience actual liver injury.

Most cases of isoniazid-related liver problems are mild and/or resolve within 1 week of stopping treatment with the medication. But isoniazid also has a boxed warning regarding the risk of severe liver inflammation.

The risk of liver failure related to isoniazid is higher for women, Black people, and people with existing liver problems. It’s also higher for older adults and people who drink alcohol daily.

8. Azathioprine

Azathioprine (Imuran) is a medication that intentionally suppresses the immune system. It’s commonly taken after an organ transplant and for the treatment of an autoimmune condition.

Azathioprine can cause a few types of liver injury. These range from mild, reversible increases in LFTs to long-term injuries that can develop 1 to 5 years after starting treatment with azathioprine. Liver toxicity related to azathioprine is most common in people who have received a transplant.

Stopping treatment with azathioprine will usually resolve these issues. But your healthcare provider will likely routinely monitor your liver health while you’re taking the medication.

9. Methotrexate

Methotrexate is most often used to treat cancer and autoimmune conditions. But it does have a boxed warning regarding the risk of liver toxicity. The degree of injury varies depending on the dose and length of treatment.

High doses of methotrexate given through an IV can cause large increases in LFTs. But since high doses aren’t given routinely, liver enzymes tend to normalize quickly without symptoms. These doses are also usually administered in a controlled medical setting.

Lower, daily doses of oral methotrexate aren’t as likely to cause large LFT changes. Though, they may put people at risk for developing fatty liver disease or liver scarring. This is more common in people who already have risk factors for these conditions, such as excessive alcohol use or obesity.

10. Other cancer medications

Many cancer medications —including chemotherapy, targeted therapies, and hormonal agents — can cause liver issues.

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are two examples. These medications, called immune checkpoint inhibitors (ICIs), allow the immune system to better identify cancer cells. But sometimes they prompt the immune system to create an exaggerated response and attack healthy cells. This causes liver inflammation in up to 6% of people receiving treatment with ICIs.

Can supplements cause liver damage?

Yes, there are a few potential supplements that cause liver damage. In fact, studies show that supplements account for up to 20% of liver injury cases in the U.S.

Dietary supplements linked to liver injury include:

• Bodybuilding supplements containing anabolic steroids

• Weight-loss supplements containing green tea extract

• Certain vitamins when taken long term and at high doses, such as niacin (up to 3,000 mg per day taken for several months)

• Herbal products like ginseng and black cohosh

• Multi-ingredient nutritional products, such as Hydroxycut, Slimquick, and Herbalife

Keep in mind: Not all supplements are linked to liver injury. Check with your healthcare team or pharmacist prior to taking a supplement to make sure it’s appropriate for your situation.

What are some symptoms of liver damage?

Liver damage doesn’t always come with symptoms. You may not know your medication is affecting your liver until blood work reveals abnormal LFTs. But, if you do develop liver symptoms, they can include:

• Abdominal pain or tenderness

• Abdominal swelling or distention

• Dark urine

• Nausea or vomiting

• Unexplained weight loss

• Yellowing of the skin and eyes (jaundice)

If you’re taking a medication that carries a risk of liver-related side effects and you develop symptoms of liver inflammation that last more than a day, you should let your healthcare team know immediately. They will likely assess your LFTs and decide if you need to stop taking the medication. If you aren’t sure if a medication carries these risks, feel free to check in with your pharmacist.