Drug-induced liver injury (DILI)

happens when a medication or supplement damages the liver. You don't need to be on chemotherapy or complex drugs — common pills can cause it. Acetaminophen overdose is the top cause of acute liver failure in many countries, but antibiotics (like amoxicillin‑clavulanate), antiepileptics (phenytoin), antifungals (terbinafine), isoniazid, methotrexate, and some herbal supplements also rank high.

Symptoms often start vague:

Fatigue, nausea, loss of appetite, dark urine, and yellowing of the skin or eyes (jaundice). Sometimes pain appears under the right rib cage. Symptoms can show within days or months of starting a drug; timing varies by medicine. Lab tests reveal elevated liver enzymes (ALT, AST), alkaline phosphatase, and bilirubin. If you have new symptoms or abnormal labs after starting a medicine, tell your provider.

How doctors figure it out:

They review your full medication and supplement list, check timing, run blood tests and imaging to rule out other causes, and sometimes stop the suspected drug to see if labs improve. There’s no single test that proves DILI — diagnosis is often one of exclusion. In severe cases a liver biopsy may help.

What to do right away: stop the suspected drug and call your doctor or go to the ER if you have jaundice, persistent vomiting, confusion, or bleeding. For acetaminophen overdose, N‑acetylcysteine (NAC) is an effective antidote if given early. Other treatments are supportive — fluids, monitoring, and addressing complications. Some patients need referral to a liver specialist or even liver transplant evaluation if liver failure develops.

Lowering your risk: keep a current list of every prescription, OTC drug, and supplement. Avoid combining multiple liver‑metabolized drugs when possible, and limit alcohol while on potentially liver‑harmful medicines. Take acetaminophen at or below recommended doses and be careful with products that contain it. For long‑term drugs known to affect the liver, your doctor may order periodic liver tests.

Who’s at higher risk? Older adults, people with preexisting liver disease, genetic differences in drug metabolism, and those taking several medications. Also pay attention to herbal supplements — some are linked to severe liver injury.

When can a drug be restarted? That depends. If liver tests normalize and the suspected drug has clear benefits, a doctor may consider re‑challenge under close monitoring, but this is risky and usually avoided for drugs that likely caused severe liver injury.

If you read our site, check related posts about Lamisil (terbinafine) and Dilantin (phenytoin). Both medicines can affect the liver and are discussed in more detail in those articles. If you suspect DILI, act fast — stopping the drug early often prevents worse damage.

Also, report suspected drug liver harm to your country's drug safety agency and your prescriber. Keep copies of lab results and dates you started and stopped medicines. If you have ongoing liver enzyme elevations, ask about alternate drugs or dose changes. Small steps—tracking meds, avoiding alcohol, and timely testing—cut risk and keep your liver working.

If unsure, call your clinic — early action saves liver health. Stay informed.