What Drugs Are Linked to Liver Problems?

Your liver is a vital organ that produces bile to aid digestion, removes chemicals from the blood and produces proteins necessary for well-being. Certain prescribed medications as well as over-the-counter medications, herbs and vitamins can cause liver damage.

Acetaminophen

An acetaminophen (Tylenol) overdose can cause liver damage. The amount of liver damage depends on the dosage ingested. In the U.S. and the United Kingdom, the leading cause of rapid onset liver failure is acetaminophen overdose. People who are at an increased risk for liver damage resulting from high levels of acetaminophen ingestion are those who drink alcohol regularly, malnourished individuals and people who take acetaminophen along with phenytoin (Dilantin), carbamazepine (Tegretol), phenobarbital or isoniazid (Nydrazid, Laniazid).

Cholesterol Medications

Statin medications are used to lower "bad" cholesterol to prevent strokes and heart attacks. Liver injury is rare, but statins can cause mild elevations of liver enzymes such as ALT and AST. Examples of statins include atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol) and rosuvastatin (Crestor). Due to the small risk of severe liver damage, the FDA recommends patients have liver enzyme blood tests performed before beginning statin medications, again 12 weeks after beginning treatment and then periodically.

Niacin is another medication used to treat high cholesterol and can cause increased liver enzymes, yellowing of the skin and, rarely, liver failure. The generic name for Niacin is nicotinic acid. People who drink regularly and those with pre-existing liver disease are at a greater risk for liver damage. The extended-release form of Niacin is more likely to cause liver damage than the immediate-release form.

Cordarone

Cordarone is a medication prescribed for irregular heart rhythms. The generic name of Cordarone is amiodarone. Cordarone can cause elevated liver enzymes, rapid liver failure and irreversible cirrhosis. Less than 1 percent of patients are at risk for serious liver damage. Liver damage can occur even after the medication is discontinued because Coradarone is stored in the liver. Serious liver damage can result in the need for a liver transplant.

Methotrexate

Methotrexate is prescribed for people with rheumatoid arthritis, psoriasis, psoriatic arthritis and Crohn's disease. The brand names of methotrexate are Rheumatrex and Trexall. This medication can cause liver cirrhosis, depending on the dose prescribed. People who drink alcohol regularly, who are obese and those with a pre-existing liver conditions are at an increased risk for cirrhosis while taking methotrexate.

Antibiotics

Certain antibiotics such as isoniazid, nitrofurantoin and augmentin can cause liver problems. Other antibiotics that can cause liver damage are minocycline and Cotrimoxazole.

Isoniazid is a medication used to treat tuberculosis. This medication can cause mild liver enzyme elevation and can cause isoniazid-induced hepatitis in 1 to 2 percent of patients. The risk of liver damage increases when isoniazid is taken with Tylenol and rifampin.

Nitrofurantoin is an antibiotic used to treat urinary tract infections. This medication can cause elevated liver enzymes and sudden onset and chronic liver disease. In rare cases, nitrofurantoin can cause nitrofurantoin hepatitis.

Augmentin is an antibiotic used to treat bacterial infections. This medication can rarely cause Augmentin-induced cholestasis that can result in cirrhosis, liver failure and liver transplant.

NSAIDs

NSAIDs, non-steroidal anti-inflammatory drugs, are used for joint and bone related inflammations. Examples of NSAIDs are ibuprofen (Motrin), diclofenac (Voltaren), indomethacin (Indocin), naproxen (Naprosyn), nabumetone (Relafen) and piroxicam (Feldene). These medications are generally safe when properly used, but can worsen liver function in people with advanced liver disease and cirrhosis. Liver disease from NSAID use is rare, but diclofenac carries a slightly higher risk for producing hepatitis.

Other Medications

Tacrine (Cognex) is prescribed for treating Alzheimer's disease. This medication can cause elevated liver enzymes and, rarely, hepatitis and serious liver damage. Disulfiram (Antabuse) is used to treat alcoholism and can cause a sudden onset of hepatitis which can lead to acute liver failure and liver transplant.

References

• Drug-Induced Liver Disease

Resources

• American Liver Foundation