Signs and Types of Drug-Induced Liver Injury
Drug-induced liver injury is common, and nearly all classes of medications can cause liver diseases. Most cases of drug-induced liver disease are mild and usually improve after the individual has gone through a medical detox. It’s important to catch the signs of drug-related liver problems and remove the substance from the person’s routine as quickly as possible to reduce the risk of chronic liver disease or liver failure. As a drug rehab in Pennsylvania that has seen many cases of drug-related liver disease, we’re sharing the signs and the types of diseases to look out for.
What Is the Liver & What Does It Do?
The liver is an organ located in the upper right-hand side of the abdomen, tucked in mostly behind the rib cage. The liver of an adult normally weighs around three pounds. The purpose of the liver is to regulate most chemicals in the blood and excrete a product called bile.
All the blood leaving the stomach and intestines pass through the liver. The liver processes this blood and breaks it down and balances and creates nutrients. The liver also metabolizes or breaks down drugs into forms that are easier to use for the rest of the body or that are nontoxic.
While over 500 vital functions have been linked to the liver, here are a few major ones you should know about:
- Production of bile to help carry away waste and break down fats during digestion
- Production of proteins for blood plasma
- Production of cholesterol and special proteins that help carry fats through the body
- Production of excess glucose into glycogen for storage and to balance and manage glucose levels
- Regulating blood clotting
- Clearing the blood of drugs and other poisonous substances
- Resisting infections by removing bacteria from the bloodstream
When the liver breaks down harmful substances – such as drug enzymes – its by-products are excreted into the bile or blood. Bile by-products enter the intestine and leave the body in the form of waste or feces. The kidneys filter out blood by-products and leave the body in urine form.
Types of Drug-Induced Liver Disease
When drugs injure the liver and disrupt its normal functions, certain symptoms may develop. Abnormalities of liver damage from medication and drugs are similar to liver diseases caused by other agents, such as viruses. For instance, drug-induced hepatitis is similar to viral hepatitis in that they both cause elevations in blood levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as well as loss of appetite, fatigue, and nausea.
Drug-induced cholestasis is similar to the cholestasis caused by autoimmune liver disease, causing elevations in blood levels of bilirubin and alkaline phosphatase. This, in turn, leads to jaundice and itching.
If you’re taking any kind of medication, there are three main types of drug-induced liver injury you should know about:
- Hepatocellular: Hepatocellular carcinoma (HCC) refers to the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or C infection. This type of liver disease is also more likely to occur in people who abuse alcohol and have fatty liver.
- Cholestatic: Cholestatic refers to impairment in bile formation or flow, which can lead to fatigue, pruritus (itchy skin), and jaundice. Common causes of cholestasis liver disease include acute hepatitis, alcohol-related liver disease, primary biliary cholangitis, certain drugs (such as amoxicillin/clavulanate, chlorpromazine, azathioprine, and oral contraceptives), cholestasis of pregnancy, and liver cancer.1
- Mixed: Drug-induced liver disease is considered mixed when features of both hepatocellular and cholestatic injury are present.2
As you may have noticed, more specific types of drug-related liver diseases were previously mentioned, such as:
- Acute Hepatitis: Acute hepatitis refers to inflammation of the liver and is generally caused by infection from one of the five types of hepatitis viruses: hepatitis A, B, C, D, and E. This condition can cause anything from a minor flu-like illness to fatal liver failure.
- Alcohol-Related Liver Disease: Alcohol liver disease refers to liver damage caused by excessive alcohol consumption. It’s highly common in individuals who binge drink frequently or drink chronically. Often, many individuals who come to our Pennsylvania rehab for alcohol addiction treatment show signs of liver disease.
- Liver Cirrhosis: Cirrhosis refers to scarring of the liver. This condition can be caused by many other diseases and conditions, such as hepatitis or chronic alcoholism. Each time the liver is injured, it tries to repair itself. If it frequently has to repair itself, over time, it builds up scar tissue. This makes proper functioning more difficult.
- Primary Biliary Cholangitis: Previously called primary biliary cirrhosis, primary biliary cholangitis is a chronic liver disease in which the bile ducts in your liver are slowly destroyed. Chronic inflammation of the liver can damage bile ducts, cause irreversible scarring of the liver tissue (cirrhosis), and eventually, liver failure.
Drug-Induced Liver Injury Symptoms
It is possible for drugs to cause liver damage in several ways. Some drugs are directly harmful to the liver, while others are transformed into harmful chemicals by the liver that can lead to direct or indirect injury. Though this may sound strange, it happens.
There are three types of drug-induced liver toxicity: dose-dependent toxicity, idiosyncratic toxicity, and drug allergy.
Drugs that cause dose-dependent toxicity can cause liver damage in most people, depending on the amount that’s taken. The most common medication that causes dose-dependent liver toxicity is acetaminophen (Tylenol).
Drugs that cause idiosyncratic toxicity cause disease in only a few patients. These individuals have inherited specific genes that control the chemical transformation of that particular substance. Their genetic traits make it so that the drug or its metabolites accumulate in the liver and cause injury. These inherited idiosyncratic toxicities are rare.
Drug allergy can also cause liver disease, though it’s uncommon. In drug allergy, the inflammation that occurs when the body’s immune system attacks the drugs with antibodies and immune cells can strain the liver and cause injury.
Moreover, patients with mild liver disease may show few or no symptoms, while patients with more serious cases of liver injury may show more intense symptoms that may be specific or nonspecific.
Nonspecific drug-induced liver disease symptoms that can be seen in other disorders include:
- Flu-like symptoms
- Mild abdominal pain
- Loss of appetite
Specific signs and symptoms of drug-induced liver injury include:
- Jaundice (yellowing of the skin and whites of the eyes)
- Easy bruising
- Fluid accumulation in the legs
- Mental confusion
- Kidney failure
- Vulnerability to bacterial infections
- Gastrointestinal bleeding
Drugs That Cause Liver Damage
In addition to the symptoms and signs of liver disease, below are the most common medications that cause liver damage to be mindful of:
- Acetaminophen (Tylenol)
- Amiodarone (Cordarone)
- Antibiotics (Isoniazid, Nitrofurantoin, Augmentin)
- Disulfiram (Antabuse)
- Methotrexate (Rheumatrex, Trexall)
- Nicotinic acid (Niacin)
- Nonsteroidal anti-inflammatory drugs or NSAIDs (Sulindac, Diclofenac)
- Statins (Simvastatin, Atorvastatin)
- Tacrine (Cognex)
The above are all prescription medications. As you can see, there is still a risk of a prescribed drug causing a complication or even liver disease. Any time you get prescribed a new medication, be sure to speak to your doctor about these or other risks.
Certain illicit drugs can also cause liver damage, such as heroin, cocaine, and methamphetamine. In addition, alcohol is also notorious for causing liver problems, including cirrhosis and acute liver failure.
Help for Substance Abuse at Clearbrook
The long-term use or misuse of certain illicit and prescription drugs, as well as alcohol, can lead to more than just liver problems. Many commonly prescribed substances – such as opioids and benzodiazepines – are highly addictive and can lead to substance use disorders, withdrawals, liver problems, and more.
If you or someone you care about is battling drug or alcohol addiction, don’t wait until they develop liver disease, or worse, to get help. Our Clearbrook rehab offers addiction treatment in Pennsylvania for all types of drug use disorders. Our residential treatment prioritizes medical detox as the first step, helping patients overcome withdrawals and cravings by cleansing their bodies of these toxic substances.
Once medically stable, patients can begin working individually and in group settings with our therapists to establish sober habits and relapse prevention strategies. No matter how severe your addiction is, we’re here for you.
Call Clearbrook Treatment Centers today at 570-536-9621 or send us your contact information to speak to an admission specialist about our residential rehab.
- Merck Manual – Cholestasis
- NIH – LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].
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