How Medications Can Lead To Drug-Induced Liver Disease

Toxic industry

The pharmacy and drug store industry made over $250 billion in 2014 (Statista). The global pharmaceutical market is on the rise looking for more sales and expansion. Thus, in total 1,453 drugs were approved by the FDA and released onto the market (Drug Discovery Today). To note, the misuse of over-the-counter medication (OTC) causes 178,000 hospitalizations annually in the United States (FDA). Not surprisingly, that drug-induced liver injury (or hepatotoxicity) is the second most frequent reason for the withdrawal of the medications, after the cardiac toxicity (FDA).

On average, U.S. households spend about $338 per year on medication (IRI, 2015). In 2019, the dietary supplement market is expected to exceed $15 billion in sales in 2019 (Euromonitor).

While so many people consider over-the-counter medication as an essential part of their overall family healthcare, the researchers from the Perelman School of Medicine at the University of Pennsylvania found that the over-the-counter drugs and dietary/herbal supplements are most common causes of liver failure.

The researchers have discovered that 75% of acute liver failure cases caused by the prescription drugs actually resulted from over-the-counter products such as acetaminophen or herbal supplements. Surprisingly, the prescription drugs were found to be a rare cause of acute liver failure.

Liver damage and medications

In their recent study published in “Gastroenterology” magazine, Icelandic researchers also warned against possible liver damage caused by medications. The study has found that liver damage due to the medicines occurs even more frequently than was thought before. For their experiment, the research team of the University of Iceland analyzed the cases of drug-induced liver injury collected over 2 years. The result has shown that in 19 out of 100.000 individuals per year the liver damage was induced by medications. A similar study in France showed 14 drug-induced cases per 100.000 individuals.

Paracetamol, NSAIDs, and antibiotics are particularly harmful for the liver

The liver has an important role in processing and removing drugs from the blood and eliminating them from the body. Normally, a healthy liver does not have any problems with the processing of a reasonable amount of substances and recovering from it. However, when either too many medications are being taken, the body reacts hypersensitively to certain substances or when the liver is already damaged, the liver becomes susceptible to damage from drugs.

To the liver-damaging medicines particularly belong paracetamol, NSAIDs (Nonsteroidal anti-inflammatory drugs), and antibiotics, according to the study. The combination of amoxicillin and clavulanic acid was responsible for 22% of all liver damage cases.

Drug-induced liver disease

Drug-induced liver disease (DILI) is a very common form of liver damage and accounts for approximately 13% of all cases of acute liver failure in the United States*. DILI is a very serious and challenging type of liver disease due to its unpredictable course, difficult diagnosis, and possible mortality risk. In the United States, DILI is the cause of 15% of the liver transplants performed due to acute liver failure**.

Drug-induced liver disease refers to liver damage caused by the medications, including both prescription and over-the-counter drugs. The liver damage symptoms can be acute (sudden) or appear in a couple of weeks after drug intake. The liver damage can appear in a light and even fatal form. Unspecific symptoms of the drug-induced liver disease make it difficult to indicate disease at the early stages that are why medical help is strictly required for setting a diagnosis. It takes only several days for liver damage to develop into liver failure or even death.

Do not exceed the recommended dosage

The drugs can be considered safe when used according to the directions on the label and doctor´s prescription. Exceeding the recommended dose or treatment duration may result in serious health issues, such as liver dysfunction or liver damage, acute liver failure, and even death.

The older patients, women, and people taking several medications are most affected by drug-induced liver disease. It is still unknown why some people tolerate certain medicines much better than others. It is assumed that such differences can be associated with a combination of specific genetic constellations (genotypes) and environmental factors.

To avoid liver damage, the recommended daily dosage of the medications should be strictly followed.

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Safety recommendations

Read carefully the directions on the label of your medication and do not exceed the allowed dosing. Make sure to the following important information before taking the medicine:

• Daily dosing for adults and children and recommended treatment duration
• Possible health risks, side effects, and allergic reactions
• Usage of the medication in combination with the other drugs and alcohol
• Storage requirements
• Strictly follow your doctor's prescriptions and never take more medicines than directed
• Keep track of the medicines (doses and time) you have to take daily
• Do not take any medications longer than it is recommended in the directions or prescribed by the doctor
• Store medicines out of reach of children and pets

Sources

*Ostapowicz G, Fontana RJ, Schiødt FV, et al. U.S. Acute Liver Failure Study Group. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137(12):947–954.

**Russo MW, Galanko JA, Shrestha R, Fried MW, Watkins P. Liver transplantation for acute liver failure from drug-induced liver injury in the United States. Liver Transpl. 2004;10(8):1018–1023.