BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuDrug-induced liver injuryToxic hepatitis; Drug-induced hepatitis; DILIDrug-induced liver injury (DILI) is an injury of the liver that may occur when you take certain medicines.Other types of liver injury include:Viral hepatitis Alcoholic hepatitis Autoimmune hepatitis Iron overload Fatty liver Causes The liver helps the body break down certain medicines. These include some drugs that you buy over-the-counter or your health care provider prescribes for you. However, the process is slower in some people. This can make you more likely to get liver damage.Some drugs can cause hepatitis with small doses, even if the liver breakdown system is normal. Large doses of many medicines can damage a normal liver.Many different drugs can cause drug-induced hepatitis.Painkillers and fever reducers that contain acetaminophen are a common cause of liver injury, particularly when taken in doses greater than those recommended. People who drink alcohol to excess are more likely to have this problem.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, and naproxen, may also cause drug-induced hepatitis.Other drugs that can lead to liver injury include: Amiodarone Anabolic steroids Birth control pills Chlorpromazine Erythromycin Halothane (a type of anesthesia) Methyldopa Isoniazid Methotrexate Statins Sulfa drugs Tetracyclines Amoxicillin-clavulanate Some anti-seizure medicines Disulfiram Niacin Azathoaprine Ketoconazole Symptoms Symptoms may include:Abdominal pain Abdominal painAbdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.ImageRead Article Now Book Mark Article Dark urine Dark urineBlood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...ImageRead Article Now Book Mark Article Diarrhea DiarrheaDiarrhea is when you pass loose or watery stool.ImageRead Article Now Book Mark Article Fatigue FatigueFatigue is a feeling of weariness, tiredness, or lack of energy.Read Article Now Book Mark Article Fever Headache Jaundice Loss of appetite Loss of appetiteA decreased appetite is when your desire to eat is reduced. The medical term for a loss of appetite is anorexia.Read Article Now Book Mark Article Nausea and vomiting Rash White or clay-colored stools Exams and Tests You will have blood tests to check liver function. Liver enzymes will be higher if you have the condition.Liver enzymesLiver function tests are common tests that are used to see how well the liver is working. Tests include:AlbuminAlpha-1 antitrypsinAlkaline phosphata...ImageRead Article Now Book Mark Article Your provider will do a physical exam to check for an enlarged liver and abdominal tenderness in the right upper part of the belly area. A rash or fever may be part of some drug reactions that affect the liver.Enlarged liverEnlarged liver refers to swelling of the liver beyond its normal size. Hepatomegaly is another word to describe this problem. If both the liver and ...ImageRead Article Now Book Mark Article Abdominal tendernessAbdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.ImageRead Article Now Book Mark Article Treatment The only specific treatment for most cases of liver damage caused by taking a drug is to stop taking the drug that caused the problem.However, if you took high doses of acetaminophen, you should get treated for liver injury in the emergency department or other acute treatment setting as soon as possible as there is a specific antidote for acetaminophen poisoning.High doses of acetaminophenAcetaminophen (most common brand name Tylenol) is a pain medicine. Acetaminophen overdose occurs when someone takes more than the recommended amount...Read Article Now Book Mark Article If symptoms are severe, you should rest and avoid heavy exercise, alcohol, acetaminophen, and any other substances that might harm the liver. You may need to get fluids through a vein if nausea and vomiting are severe. Outlook (Prognosis) Drug-induced liver injury most often goes away within days or weeks after you stop taking the drug that caused it. Possible Complications Rarely, drug-induced liver injury can lead to liver failure. When to Contact a Medical Professional Contact your provider if:You develop symptoms of liver injury after you start taking a new medicine. You have been diagnosed with drug-induced liver injury and your symptoms do not get better after you stop taking the medicine. You develop any new symptoms. Prevention Never use more than the recommended dose of over-the-counter medicines containing acetaminophen (Tylenol).Do not take these medicines if you drink heavily or regularly. Talk to your provider about safe doses.Always tell your provider about all the medicines you take, including over-the-counter drugs and herbal or supplemental preparations. This is very important if you have liver disease. Talk to your provider about other medicines you may need to avoid. Your provider can tell you which medicines are safe for you.Open ReferencesReferencesChalasani NP, Hayashi PH, Bonkovsky HL, et al. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109(7):950-966. PMID: 24935270/ pubmed.ncbi.nlm.nih.gov/24935270/.Chitturi S, Teoh NC, Farrell GC. Liver disease caused by drugs. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 88.Devarbhavi H, Bonkovsky HL, Russo M, Chalasani N. Drug-induced liver injury. In: Sanyal AJ, Boyer TD, Lindor KD, Terrault NA, eds. Zakim and Boyer's Hepatology. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 56.Gill RM, Kakar S. Liver and gallbladder. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 18.AllVideoImagesTogDigestive system - illustration The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.Digestive systemillustrationHepatomegaly - illustration Hepatomegaly is enlargement of the liver beyond its normal size. Certain conditions such as infection, parasites, tumors, anemias, toxic states, storage diseases, heart failure, congenital heart disease, and metabolic disturbances may all cause an enlarged liver.HepatomegalyillustrationDigestive system - illustration The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.Digestive systemillustrationHepatomegaly - illustration Hepatomegaly is enlargement of the liver beyond its normal size. Certain conditions such as infection, parasites, tumors, anemias, toxic states, storage diseases, heart failure, congenital heart disease, and metabolic disturbances may all cause an enlarged liver.HepatomegalyillustrationA Closer Look Cirrhosis - InDepth(In-Depth)Hepatitis - InDepth(In-Depth)Alcohol use disorders - InDepth(In-Depth)Gastroesophageal reflux disease and heartburn - InDepth(In-Depth)Peptic ulcers - InDepth(In-Depth)Depression - InDepth(In-Depth)Radiation damage(Alt. Medicine)Asthma in adults - InDepth(In-Depth)Asthma in children and adolescents - InDepth(In-Depth)Cysteine(Alt. Medicine)Related Information Hepatitis(Condition)Stools - pale or clay-colored(Symptoms)Over-the-counter pain relievers(Special Topic)Pulmonary tuberculosis(Condition)Bile(Special Topic)Hepatitis - InDepth(In-Depth) Review Date: 10/31/2022 Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited. © 1997- All rights reserved. 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Drug-induced liver injuryToxic hepatitis; Drug-induced hepatitis; DILIDrug-induced liver injury (DILI) is an injury of the liver that may occur when you take certain medicines.Other types of liver injury include:Viral hepatitis Alcoholic hepatitis Autoimmune hepatitis Iron overload Fatty liver Causes The liver helps the body break down certain medicines. These include some drugs that you buy over-the-counter or your health care provider prescribes for you. However, the process is slower in some people. This can make you more likely to get liver damage.Some drugs can cause hepatitis with small doses, even if the liver breakdown system is normal. Large doses of many medicines can damage a normal liver.Many different drugs can cause drug-induced hepatitis.Painkillers and fever reducers that contain acetaminophen are a common cause of liver injury, particularly when taken in doses greater than those recommended. People who drink alcohol to excess are more likely to have this problem.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, and naproxen, may also cause drug-induced hepatitis.Other drugs that can lead to liver injury include: Amiodarone Anabolic steroids Birth control pills Chlorpromazine Erythromycin Halothane (a type of anesthesia) Methyldopa Isoniazid Methotrexate Statins Sulfa drugs Tetracyclines Amoxicillin-clavulanate Some anti-seizure medicines Disulfiram Niacin Azathoaprine Ketoconazole Symptoms Symptoms may include:Abdominal pain Abdominal painAbdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.ImageRead Article Now Book Mark Article Dark urine Dark urineBlood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...ImageRead Article Now Book Mark Article Diarrhea DiarrheaDiarrhea is when you pass loose or watery stool.ImageRead Article Now Book Mark Article Fatigue FatigueFatigue is a feeling of weariness, tiredness, or lack of energy.Read Article Now Book Mark Article Fever Headache Jaundice Loss of appetite Loss of appetiteA decreased appetite is when your desire to eat is reduced. The medical term for a loss of appetite is anorexia.Read Article Now Book Mark Article Nausea and vomiting Rash White or clay-colored stools Exams and Tests You will have blood tests to check liver function. Liver enzymes will be higher if you have the condition.Liver enzymesLiver function tests are common tests that are used to see how well the liver is working. Tests include:AlbuminAlpha-1 antitrypsinAlkaline phosphata...ImageRead Article Now Book Mark Article Your provider will do a physical exam to check for an enlarged liver and abdominal tenderness in the right upper part of the belly area. A rash or fever may be part of some drug reactions that affect the liver.Enlarged liverEnlarged liver refers to swelling of the liver beyond its normal size. Hepatomegaly is another word to describe this problem. If both the liver and ...ImageRead Article Now Book Mark Article Abdominal tendernessAbdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.ImageRead Article Now Book Mark Article Treatment The only specific treatment for most cases of liver damage caused by taking a drug is to stop taking the drug that caused the problem.However, if you took high doses of acetaminophen, you should get treated for liver injury in the emergency department or other acute treatment setting as soon as possible as there is a specific antidote for acetaminophen poisoning.High doses of acetaminophenAcetaminophen (most common brand name Tylenol) is a pain medicine. Acetaminophen overdose occurs when someone takes more than the recommended amount...Read Article Now Book Mark Article If symptoms are severe, you should rest and avoid heavy exercise, alcohol, acetaminophen, and any other substances that might harm the liver. You may need to get fluids through a vein if nausea and vomiting are severe. Outlook (Prognosis) Drug-induced liver injury most often goes away within days or weeks after you stop taking the drug that caused it. Possible Complications Rarely, drug-induced liver injury can lead to liver failure. When to Contact a Medical Professional Contact your provider if:You develop symptoms of liver injury after you start taking a new medicine. You have been diagnosed with drug-induced liver injury and your symptoms do not get better after you stop taking the medicine. You develop any new symptoms. Prevention Never use more than the recommended dose of over-the-counter medicines containing acetaminophen (Tylenol).Do not take these medicines if you drink heavily or regularly. Talk to your provider about safe doses.Always tell your provider about all the medicines you take, including over-the-counter drugs and herbal or supplemental preparations. This is very important if you have liver disease. Talk to your provider about other medicines you may need to avoid. Your provider can tell you which medicines are safe for you.Open ReferencesReferencesChalasani NP, Hayashi PH, Bonkovsky HL, et al. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109(7):950-966. PMID: 24935270/ pubmed.ncbi.nlm.nih.gov/24935270/.Chitturi S, Teoh NC, Farrell GC. Liver disease caused by drugs. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 88.Devarbhavi H, Bonkovsky HL, Russo M, Chalasani N. Drug-induced liver injury. In: Sanyal AJ, Boyer TD, Lindor KD, Terrault NA, eds. Zakim and Boyer's Hepatology. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 56.Gill RM, Kakar S. Liver and gallbladder. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 18.