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Medications and the Liver
Medications and the Liver: Overview
- How do medications impact the liver?
One of the main functions of the liver is to break down substances that we ingest, including medications and dietary supplements.
Certain medications and supplements may harm the liver in high doses. People with existing liver disease may be more sensitive to these medications and supplements.
When new medications are developed, they are tested for safety prior to being approved by the Food and Drug Administration (FDA). For this reason, the majority of FDA-approved medications are safe, even for people with liver disease. Dietary supplements, however, are not regulated by the FDA for safety or effectiveness.
Patients should talk to their healthcare providers about all medications and dietary supplements they take.
Symptoms
- What are symptoms of liver damage?
In most cases, substantial liver damage can occur before symptoms appear. Typical symptoms of liver damage may include:
- Nausea
- Lack of appetite
- Abdominal pain, especially in the right upper area of the abdomen
- Generalized itching
- Dark urine and jaundice (yellow discoloration of the eyes and skin)
Diagnosis
- How is liver damage diagnosed?
Blood tests can usually detect evidence of liver damage before symptoms develop.
When a medication or dietary supplement known to possibly cause liver damage is used, your healthcare provider may recommend that blood tests be checked to detect evidence of liver disease before symptoms appear.
Alternatively, elevated liver blood tests may prompt your healthcare provider to take a closer review of your medications and dietary supplements. This would be to ensure you are not accidentally damaging your liver with certain medications and dietary supplements.
The most common liver blood tests include the following:
- AST (aspartate aminotransferase)
- ALT (alanine aminotransferase)
- AP (alkaline phosphatase)
- Bilirubin
There are many other causes of elevated liver blood tests besides medications and dietary supplements. For that reason, your physician may obtain baseline liver blood tests prior to starting a medication.
Risk Factors
- What are common medications that cause liver damage?
Acetaminophen or Tylenol® is one of the best-known medications that can damage the liver. This medication is widely available without prescription. It is present in many cold and flu remedies, as well as in pain medications. Most pain medications that are labeled as “non-aspirin” have acetaminophen as its main ingredient.
Acetaminophen, when used as directed, is extremely safe, often even for people with liver disease. However, taking too much acetaminophen at once, or taking a high dose of acetaminophen over several days can cause damage to the liver.
Healthy individuals should not take more than 1,000 mg of acetaminophen per dose and should not take more than 4,000 mg in one day. In addition, even healthy persons should avoid taking 3,000 mg of acetaminophen daily for more than 3 to 5 days.
Patients with liver disease should restrict the daily amount of acetaminophen, often to 2,000 mg per day in cirrhosis.
It is important that you read the labels of all prescription and over-the-counter medications that you take. Often, acetaminophen may be present and it can be easy to accidentally exceed the safe limit dose of acetaminophen.
People who drink alcohol regularly or in large amounts at a time are at higher risk of developing severe liver damage from acetaminophen. Increased alcohol use can change the way the liver breaks down certain medications. In the case of acetaminophen, alcohol use can cause the buildup of a toxic byproduct of acetaminophen in the liver that can damage the liver. People who drink alcohol regularly should not take acetaminophen.
- Can cholesterol lowering medications impact the liver?
Cholesterol lowering medications commonly known as “statins” are used in millions of people with an excellent safety record and little evidence of liver damage, even when used in people with liver disease.
Sometimes, people to develop minor elevations in liver blood tests soon after starting these medications. In the majority of cases, these elevations are less than 3 times over the normal level and return to normal despite continued use of the medication.
- Can supplements and herbs impact the liver?
Dietary supplements include vitamins, herbal products, some weight loss products, and supplements for muscle growth. They are not regulated by the FDA, unlike prescribed medications and over-the-counter drugs.
Despite often being “natural,” dietary supplements may contain ingredients that can be toxic to the liver, especially in high, concentrated doses.
Some dietary supplements that are known to sometimes cause liver damage include the following:
- Chaparral
- Kava
- Skullcap
- Turmeric
- Green tea extract
- Vitamin A
- What medications do people with liver disease use?
With rare exceptions, people with mild liver disease can safely take most common prescription and non-prescription medications at the recommended dose.
Having mild liver disease often does not increase the risk that a given medication will be toxic to the liver.
However, if a person with pre-existing liver disease develops liver injury from a medication, the resulting liver damage may be more severe than would occur in an otherwise healthy person with the same reaction.
For that reason, when possible, healthcare providers often prefer to use “liver-safe” medications for patients with known liver disease.
People with more severe types of liver disease such as cirrhosis often must be more careful regarding the types and dose of medications they take.
- How do you minimize the risk of liver injury from medications?
- Always keep a list of all the prescription and non-prescription medications you take, including herbs, vitamins and supplements. Bring this list with you to every medical appointment.
- If you have several healthcare providers prescribing medications for you, be sure all of them are updated on your current list of medical conditions, medications, and dietary supplements.
- When using non-prescription medications, be sure to read the label carefully and never exceed the recommended amount. It is a good idea to discuss non-prescription medications with your healthcare provider before starting them.
- If you are taking several medications, be sure the ingredients are not the same. Otherwise, you may risk taking an accidental overdose.
- If you drink a significant amount of alcohol daily or drink large amounts at a time, avoid or restrict the use of acetaminophen.
- If you have liver disease, make sure that your healthcare provider is aware of your diagnosis and the severity of your liver disease.
- If you have advanced liver disease such as severe cirrhosis, it is a good idea to consult with your liver specialist before starting new medications.
Author(s) and Publication Date(s)
Jorge L. Herrera, MD, FACG, University of South Alabama College of Medicine, Mobile, AL – Published November 2007. Updated December 2012.
Alisa Likhitsup, MD, MPH, University of Michigan, Ann Arbor, MI – Updated August 2022.
Claire Faulkner, MD, MPH, Boston University Medical Center, Boston, MA – Updated April 2026.