Hepatotoxicity: Drug-Related Liver Damage — What You Need to Know

Hepatotoxicity means the liver has been harmed by a drug, supplement, or chemical. The liver clears medicines and toxins, so it’s exposed to a lot. Most drugs are safe for most people, but some can injure the liver—sometimes quickly, sometimes slowly. Knowing the common signs and how to reduce risk can keep you out of an emergency room.

Common drugs that can hurt the liver

Some well-known medicines are linked to liver damage. Acetaminophen (paracetamol) is the top cause of acute liver failure when people take too much or combine it with alcohol. Certain antibiotics, like isoniazid, and antiseizure drugs such as phenytoin can also cause problems. Antifungals like terbinafine (Lamisil) have a small but real risk of severe liver injury. Methotrexate, used for cancer and autoimmune disease, may cause long-term liver harm. Even some herbal supplements—kava, high-dose green tea extract, and others—can injure the liver.

Statins and many common medicines are generally safe, but rare reactions happen. Risk depends on dose, other medicines, alcohol, pre-existing liver disease, and individual genetics.

How to spot hepatotoxicity and what to do

Watch for new symptoms when starting a medication: yellowing of the skin or eyes (jaundice), dark urine, pale stools, severe nausea, persistent stomach pain, extreme fatigue, or unexplained itching. These are warning signs—don’t ignore them. Simple blood tests (ALT, AST, alkaline phosphatase, bilirubin) tell whether the liver is inflamed or not working well.

If you notice symptoms, stop the suspected drug only if your prescriber or a poison center tells you to—some medicines require a supervised taper. Seek medical care right away if you have jaundice, confusion, or severe abdominal pain. Early detection often prevents lasting damage.

To lower your risk: always follow dosing instructions, avoid mixing alcohol with potentially hepatotoxic drugs, tell every provider and pharmacist about all your medicines and supplements, and ask if a new drug needs liver monitoring. For long-term therapies known to affect the liver, your clinician will usually check blood tests before and during treatment.

If you have liver disease, pregnancy, or take multiple medicines, mention that before a new prescription. Pharmacies and drug guides often note liver-related warnings—read them and ask questions. Reporting side effects to your doctor or local health agency helps catch rare problems faster.

Knowing the main culprits, spotting early signs, and acting quickly gives you the best chance to avoid serious harm. If you’re worried about a specific drug, check its safety profile, discuss alternatives with your clinician, and make a simple plan for monitoring. Your liver does a lot—treat it like the valuable filter it is.