Liver Damage From Medication: The Risks And Dangers Of Drug Abuse

The liver is a very essential organ in drug uptake, distribution, and metabolism. However, It is susceptible to harm by various factors including drug abuse and alcoholism. When it is injured by medications, it is termed drug-induced hepatic damage. In the United States, about 2000 people annually suffer from liver toxicity, also referred to as hepatotoxicity, and 60% of such cases are recorded as liver damage from medication. Though it is not so common, liver toxicity poses a clear and present danger to everyone, especially drug addicts and abusers.

Table Of Contents:

• Drug Metabolism: How Does It Work?
• Liver Damage From Medication
• Drug-induced Liver Toxicity
• Medicines to Avoid in Hepatotoxicity
• Drugs to Avoid with Fatty Liver Disease
• Liver Toxicity Treatment

Drug Metabolism: How Does It Work?

When a drug is ingested, it goes through a process where the ingredients are released to treat a particular ailment or symptom. The medicines are either metabolized through oxidation, hydrolysis, hydration, condensation, isomerization, or condensation. The goal is to alter the drug’s chemical structure to make it easily excretable. This process is known as drug metabolism. Drug metabolism takes place mainly in the liver. This is why abusing medications can cause hepatotoxicity. To avoid hepatotoxicity, drugs have to be taken according to a physician’s prescription. Kidneys also excrete drugs, find out what medications can damage your kidneys.

What Medications Can Cause Liver Damage

People ask what medications can cause liver damage. Unlike the lungs or heart, the liver has no replacement. That is why it is essential to protect it from medications that can cause hepatotoxicity. To answer this popular question we’ve compiled a list of drug classes that have the potential to inflict hepatic injury:

Analgesics

These are medicines that are used to relieve pain and reduce fever. Analgesics work by inhibiting or blocking pain signals to the brain. There are two types of analgesics namely: opioids and non-narcotic analgesics.

Some Analgesics That Can Cause Hepatotoxicity Include:

• Acetaminophen
• Naproxen
• Naltrexone
• Methadone
• Hydrocodone
• Oxycodone
• Codeine
• Demerol (meperidine)
• Ketamine 

Opioids

Heroin is a medicine that is derived from morphine, a naturally occurring substance found in opium. Heroin comes in three forms – brown powder, black tar, and white powder. Studies indicate that heroin is strongly linked to hepatic dysfunction. It is therefore advisable to completely stay off the drug to avoid health complications. Since Heroin is a highly addictive substance, some may wonder what causes addiction in the brain?

Inhalants

Inhalants are volatile substances that produce chemical vapors that can be inhaled to produce a psychoactive or mind-altering effect. These are regular items like glues, spray paints, cleaning fluids, etc, that are mostly inhaled to elicit a sense of intoxication. Inhalants are also known to cause shortness of breath. The chronic use of inhalants can cause damage to several organs in the body including hepatic injury.

Steroids and Appearance Enhancement Drugs

Steroids and appearance enhancement drugs are medicines used by people to enhance performance and physique. Though these medications do not produce euphoria, they help the users feel good about themselves. These drugs then cause dependence which later develops into addiction. It is reported that the use of steroids can cause a rare form of hepatic injury known as peliosis hepatis. People may also wonder: do steroids make your heart beat faster?

List of Supplements That Cause Liver Damage

Supplements are drugs that are administered in place of orthodox medicines. These alternatives have a strong connection to hepatic injury. This is because some of these supplements contain synthetic minerals, vitamins, and amino acids. Also, performance-enhancing supplements may contain banned synthetic chemicals that can cause hepatic injury.

Here Is a List of Supplements That Cause Liver Damage:

• Green tea
• OxyElitePro
• Anabolic-androgenic steroids

This list of supplements that can cause liver damage is not an exhaustive one. There may be other supplements that may cause hepatotoxicity. Consult your physician or a health worker before taking any supplements to prevent hepatic injury. Patients should be monitored to ensure they are taking the drugs when and how they have to. Medical professionals should also look out for signs of liver toxicity and advise appropriately.

The Dangers And Signs Of Liver Toxicity

Liver toxicity is a hepatic inflammation caused by various factors including drug ingestion and abuse. Depending on the toxin, it may take hours or months for the symptoms to surface. When the toxin is stopped, the symptoms wane off. However, the toxins can permanently cause hepatic damage.

Here Are Some Signs of Liver Toxicity to Look Out For:

• Itching
• Loss of appetite
• Yellowing of the skin and eyes
• Dark-colored urine
• Fever
• Weight loss
• Rash
• Pain in the abdomen (especially the top right portion)

Once these signs of liver toxicity surface, see a medical doctor immediately. There may be other symptoms not mentioned in this list. Thus, patients should report any changes they observe while taking a drug. Overdosing on some medications can also cause toxic hepatitis. To prevent this, patients should stick to the prescribed drugs. When detected early, toxic hepatitis can be treated.

Medications To Avoid In Hepatotoxicity

Though most medicines have the potential to cause hepatic damage when abused or overdosed, certain medications like acetaminophen are more dangerous even when used according to prescription. If a patient has cirrhosis they should stay off these medications to avoid worsening their plight. Medical doctors may either prescribe an alternative or offer lower doses of these medications if they are available.

Hepatotoxic Drugs Include:

• Acetaminophen
• Ibuprofen
• Azithromycin
• Methotrexate
• Lansoprazole
• Metformin
• Pioglitazone
• Herbal supplements
• Sertraline
• Tacrolimus

Patients with hepatitis should also avoid hepatotoxic drugs such as green tea, abacavir, and COX-2 inhibitors. Hepatic injury can heavily influence how a drug works in the body. Knowing what drugs affect the liver helps patients to avoid hepatotoxicity. Patients should consult their health providers before administering any of these medicines. Pharmacists should also monitor patients with hepatitis to ensure medications are taken as prescribed.

Factors Affecting Drug Hepatotoxicity

There are physiological factors that influence the way drugs affect the body. These factors control the way drugs are absorbed, distributed, metabolized, and excreted. The main factors that affect drug hepatotoxicity are:

• Age
• Genetics
• Disease

Other Important Influences That Affect Drug-Induced Liver Injury Include:

• Obesity
• Lifestyle
• Sex
• hormonal status

Patients who have HIV, rheumatoid arthritis, and hepatitis C are vulnerable because these diseases can impair the absorption and excretion of drugs. The elderly, who are susceptible to renal impairment, may also have trouble excreting drugs. Obesity also affects the distribution of drugs. The metabolism of drugs is also affected by age, sex, and disease.

Medications To Avoid With Fatty Hepatic Disease

Fatty hepatic disease is the accumulation of excess fat in the liver. It is caused by a variety of factors including obesity, diabetes mellitus, and excess calories. Excess hepatic fat can negatively impact the uptake, distribution, metabolism, and excretion of medications which can lead to hepatotoxicity.

Here Is Some Information On Medicines To Avoid:

• Acetaminophen
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Naproxen
• Ibuprofen
• Niacin (Detox medication)
• Antiretroviral drugs
• Steroids

Though hepatic fat is normal, excessive fat can lead to a condition called steatohepatitis. Patients are required to modify their diets to reduce excess calories. Regular exercise must also be encouraged to ensure weight loss. Patients should avoid medications that cause liver damage as they can worsen their condition. Patients must consult their health providers before administering any drug to prevent health complications of different body systems. As for instance, some drugs may affect fertility.

Liver Toxicity Treatment

First, the cause of hepatic damage has to be determined. It could either be due to medicines, alcohol, or both. Once the cause is determined, the health professional will prescribe adequate treatment for the patient. Treatment will depend on the length or stage of the hepatotoxicity. Treatment may include:

• Reverse medication– when it is diagnosed that the hepatotoxicity was due to an overdose or abuse of a drug, medication can be prescribed to reverse it. For example, when hepatic damage is diagnosed due to a combination of Acetaminophen and alcohol abuse, acetylcysteine can be used to reverse the damage. This is very effective within the first 16 hours of overdose or abuse.
• Supportive care– also known as palliative care, it is the type of treatment that promotes quality of life by alleviating the suffering of seriously ill patients. People who are suffering from serious hepatotoxicity are put on intravenous fluids and medication to relieve their plight. This type of treatment also includes the side effects, psychological, and social side of the disease.
• Transplant– this is an option that is taken when there is severe hepatic damage. It is an operative procedure where the damaged liver is replaced with a healthy one.

DILI is a common disease that accounts for over 2 million deaths worldwide. Liver damage from medication is one of the main causes of hepatotoxicity. This is why measures are being taken to forestall this phenomenon by educating people on the dangers of drug abuse. Symptoms of hepatotoxicity include itching, loss of appetite, yellowing of the skin and eyes, fever, weight loss, etc. People who are obese and the elderly are more prone to hepatotoxicity. Several treatment options are available for patients who suffer from addiction. Patients must also stay away from medications that cause liver damage. However, if there is complete hepatic damage, then a transplant is required. To avoid toxic hepatitis, eat healthily, exercise well, and take medicines according to a medical doctor’s prescription.

Related Topics

• Drugs Effects Of Abuse
• Drugs Effects On Heart
• Drugs Effects On Kidneys
• Drugs Effects On Brain
• Drugs Effects On Hypersexuality
• Drugs Effects On Lungs

Page Sources

1. W. Lee, MD. (2013). Drug-induced Acute Liver Failure. US National Institutes of Health. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838908/
2. K. Suk, D. Kim. (2012). Drug-induced Liver Injury: Present and Future. Clinical and Molecular Hepatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467427/
3. S. Safari, M. Motavaf, S. Siamdoust, S. Alavian. (2014). Hepatotoxicity of Halogenated Inhalational Anesthetics. Iranian Red Crescent medical journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270648/
4. V. Sundaram, E. Bjornsson. (2017). Drug-induced Cholestasis. Hepatology Communications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678916/#
5. Clinical Info. (n.d). Non-Nucleoside Reverse Transcriptase Inhibitor. Clinical Info. https://clinicalinfo.hiv.gov/en/glossary/non-nucleoside-reverse-transcriptase-inhibitor-nnrti
6. R. Mann, PhD, R. Smart, PhD, R. Govoni, PhD. (2003). The Epidemiology of Alcoholic Liver Disease. National Institute of Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/arh27-3/209-219.htm
7. V. Marks, M. Path, P. Chapple. (1967). Hepatic Dysfunction in Heroin and Cocaine Users. Wiley Online Library. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1967.tb05345.x
8. C. Anderson, MD, G. Loomis, MD. (2003). Recognition and Prevention of Inhalant Abuse. American Family Physician. https://www.aafp.org/afp/2003/0901/p869.html
9. National Institute on Drug Abuse. (n.d). What Are the Side Effects of Anabolic Steroid Misuse? National Institute of Drug Abuse. https://www.drugabuse.gov/publications/research-reports/steroids-other-appearance-performance-enhancing-drugs-apeds/what-are-side-effects-anabolic-steroid-misuse
10. S. Asrani, H. Devarbhavi, J. Eaton, P. Kamath. (2019). Burden of Liver Diseases in The World. J. Hepatol. https://pubmed.ncbi.nlm.nih.gov/30266282/