Underestimated Side Effects: Liver Damage from Medications

By SWA

Introduction

Medications are essential tools in modern medicine, helping to treat infections, manage chronic diseases, and alleviate pain. However, many people are unaware that a wide range of drugs can have unintended consequences on the liver. Liver damage from medications is more common than often assumed—and frequently goes undetected.

Liver: A Silent Victim of Medication Side Effects

According to the German Society for Digestive and Metabolic Diseases (DGVS), approximately one in ten drug-related side effects affect the liver. A recent study published in the journal Gastroenterology revealed that medications can cause liver injuries more frequently than previously thought, and many such cases remain unrecognized.

The DGVS warns that even commonly used drugs—particularly fever reducers and antibiotics—can significantly impact liver health. Among the most frequently implicated are:

  • Antibiotics (especially the combination of amoxicillin and clavulanic acid, responsible for 22% of cases),

  • Paracetamol (acetaminophen), particularly in overdose or in patients with pre-existing liver conditions,

  • NSAIDs (non-steroidal anti-inflammatory drugs),

  • Statins (used to lower cholesterol),

  • Certain antidepressants,

  • Antiepileptic drugs, and

  • HIV medications.

How Medication Harms the Liver

The liver is the body's primary detoxification organ, metabolizing most drugs that enter the bloodstream. However, during this process, some medications or their byproducts can damage liver cells or interfere with bile flow.

These effects might be directly toxic, immune-mediated, or a result of interactions with other substances. Some damage occurs only at high doses or with long-term use, while others may happen unpredictably—even at therapeutic doses.

Recognizing Liver Damage: The Role of Liver Enzymes

Liver damage is often silent in its early stages. Therefore, blood tests measuring liver values are crucial for early detection. These laboratory values help assess liver cell health, bile flow, and the liver’s ability to perform essential functions.

Key Liver Values Explained:

  • ALT (GPT – Alanine Aminotransferase):
    A highly specific marker for liver cell damage. Elevated levels indicate leakage from damaged liver cells into the bloodstream.

  • AST (GOT – Aspartate Aminotransferase):
    Also signals liver damage, though it's less specific than ALT because AST is also found in muscles and the heart.

  • GGT (Gamma-Glutamyl Transferase):
    Sensitive to bile duct damage and alcohol-related liver disease.

  • AP (Alkaline Phosphatase):
    Elevated levels may point to bile flow obstruction or, less commonly, bone disease.

  • Bilirubin:
    A breakdown product of red blood cells processed by the liver. High levels can signal impaired liver function or bile flow issues.

  • Albumin:
    A protein produced by the liver. Low levels may reflect reduced liver synthetic capacity.

What Do Abnormal Liver Values Mean?

Liver values are typically reported in U/L (units per liter), but the normal ranges vary depending on gender, lab, and health status. Therefore, interpretation should always be left to a medical professional.

  • Elevated ALT, AST, and GGT: Suggest liver cell damage or bile duct issues.

  • Elevated AP and Bilirubin: May indicate bile duct obstruction or liver cell dysfunction.

  • Low Albumin: May reflect decreased liver function, especially in chronic liver diseases.

Not all deviations from the norm are cause for alarm. However, persistent or significant abnormalities should prompt further testing—such as ultrasound imaging or a review of medications.

Prevention: What Can Patients Do?

  1. Be medication-aware: Always follow dosing instructions and avoid combining drugs (especially painkillers) without consulting a doctor.

  2. Monitor liver values: Those on long-term medications—such as statins, antiepileptics, or HIV treatments—should have their liver function regularly tested.

  3. Avoid self-medication, particularly with over-the-counter drugs like paracetamol or NSAIDs.

  4. Inform healthcare providers of all medications, including supplements and herbal remedies, as these can also affect liver health.

Conclusion

Liver damage from medications is an underestimated yet significant health risk. While the liver is a resilient organ, it can suffer serious harm from inappropriate drug use or hidden side effects. Through increased awareness, regular monitoring, and responsible medication use, patients and healthcare providers can work together to protect this vital organ.

Sources:

Drug-induced liver injury as assessed by the updated Roussel Uclaf Causality Assessment Method following mild COVID-19 in a patient under anastrozole therapy—A case report
https://onlinelibrary.wiley.com/doi/full/10.1002/cnr2.2028

 Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)
Gastroenterology (journal)
https://www.leberhilfe.org/unterschaetzte-nebenwirkungen-dgvs-warnt-vor-leberschaeden-durch-medikamente/


© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9

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