What medication causes high liver count? A guide to drug-induced liver injury

October 12, 2025 •

3 min read

Drug-induced liver injury (DILI) is a leading cause of acute liver failure in the United States. Understanding what medication causes high liver count is crucial for patients and healthcare providers to identify risks associated with various drugs and supplements and prevent serious complications.

Quick Summary

A wide array of prescription, over-the-counter, and herbal supplements can elevate liver enzyme counts, a condition known as drug-induced hepatotoxicity. The severity ranges from mild, transient increases to severe liver failure, depending on the drug, dose, and individual factors.

Key Points

Acetaminophen Overdose is a Top Cause: Unintentional or intentional overdose of acetaminophen is the leading cause of acute liver failure in the United States.
Many Common Medications are Culprits: Besides acetaminophen, numerous drugs, including statins, antibiotics like Augmentin, certain NSAIDs, and anti-seizure medications, can cause elevated liver enzymes.
'Natural' is Not Always Safe: Herbal and dietary supplements, such as green tea extract, ashwagandha, and kava, have been linked to serious and sometimes fatal liver damage.
Regular Monitoring is Essential: For those on long-term medications, periodic liver function tests are crucial for early detection of potential liver injury.
Symptom Recognition is Vital: Be aware of symptoms like jaundice, nausea, fatigue, or abdominal pain and report them to a doctor immediately to prevent more severe injury.
Communication is Key to Prevention: Always inform your healthcare provider of all medications and supplements you are taking to assess the overall risk of drug-induced liver injury.

The liver plays a vital role in detoxifying the body and processing medications. Drug-induced liver injury (DILI), also known as hepatotoxicity, occurs when medications disrupt this function, leading to liver cell damage and the release of enzymes into the bloodstream. DILI can be categorized as intrinsic (dose-dependent and predictable) or idiosyncratic (rare and unpredictable).

Common Medications That Cause High Liver Count

Acetaminophen (Tylenol)

Acetaminophen is a common pain and fever reducer. While safe at recommended doses, exceeding these limits is the most frequent cause of acute liver failure in the U.S.. Overdosing overwhelms the liver's ability to detoxify acetaminophen, leading to the buildup of a toxic substance that damages the liver. Factors like chronic alcohol use and malnutrition increase the risk.

Statins (Cholesterol-Lowering Drugs)

Statins, used for high cholesterol, may cause a slight, temporary rise in liver enzymes in a small number of users. This usually doesn't cause symptoms and often resolves with continued use or a dose change. Serious liver issues from statins are very uncommon. Liver function tests are often recommended when starting or adjusting statin treatment.

Antibiotics

Antibiotics frequently cause unpredictable DILI, partly due to their widespread use. Amoxicillin-clavulanate is a commonly cited antibiotic, often causing liver injury that appears later. Other antibiotics linked to hepatotoxicity include isoniazid (for tuberculosis) and some fluoroquinolones and macrolides. While most cases improve after stopping the antibiotic, some can lead to lasting liver issues.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs like ibuprofen and naproxen are widely used for pain. Though uncommon, liver injury has been reported with NSAID use, particularly with diclofenac. This injury is usually unpredictable and may involve symptoms like fever and jaundice. Individuals with existing liver conditions should use NSAIDs cautiously.

Anticonvulsants (Anti-Seizure Medications)

Some anti-seizure drugs, such as valproic acid, phenytoin, and carbamazepine, are known to potentially cause liver toxicity. This can occur as part of an immune-related reaction or cause fatty liver. Monitoring is important for patients taking these medications.

Herbal and Dietary Supplements

Despite being seen as natural and safe, many herbal and dietary supplements contain liver-toxic compounds. A significant portion of DILI cases in the U.S. are linked to herbal supplements. Notable examples include green tea extract, ashwagandha, black cohosh, kava, and in rare cases, high doses of turmeric/curcumin.

Comparison of Common Culprits


Drug Class	Example	Type of Injury	Typical Latency	Key Considerations
Analgesic	Acetaminophen	Intrinsic (high dose)	1-4 days (overdose)	Do not exceed recommended dose. Risk increases with alcohol use.
Statins	Atorvastatin	Idiosyncratic (rare)	Months to years	Often mild, transient enzyme increases. Monitor periodically.
Antibiotics	Amoxicillin-clavulanate	Idiosyncratic	1-6 weeks (often delayed)	Monitor for symptoms like jaundice and fatigue, especially in older patients.
NSAIDs	Diclofenac	Idiosyncratic (rare)	1-3 months	Risk is low, but higher in those with underlying liver issues. Discontinue if symptoms appear.
Anticonvulsants	Valproic Acid	Intrinsic & Idiosyncratic	Variable (early or delayed)	Requires close monitoring. Can cause steatosis or a hypersensitivity reaction.
Herbal Supplements	Green Tea Extract	Idiosyncratic	Variable	Regulation is limited; inform your doctor about use. Natural does not mean safe.

Recognizing the Symptoms of Liver Injury

Symptoms of DILI can be subtle. Be aware of these signs and seek medical advice if they occur.

Fatigue: Feeling persistently tired.
Digestive Issues: Nausea, vomiting, poor appetite, or stomach pain.
Jaundice: Yellowing of the skin and eyes due to bilirubin buildup.
Changes in Waste: Dark urine and pale stools can indicate problems with bilirubin removal.
Skin Issues: Itching or a rash can be related to liver reactions.

Managing and Preventing Medication-Related Liver Damage

Preventing DILI involves careful management and open communication with your healthcare provider.

Talk to Your Doctor: Always provide a full list of all medications, including over-the-counter products, supplements, and herbs.
Check Labels: Be cautious of products containing multiple ingredients, especially those with acetaminophen.
Follow Dosing Instructions: Never take more than the recommended dose of any medication.
Get Tested: Regular liver function tests are often recommended for those taking potentially liver-toxic medications long-term.
Stop if Suspected: If significant liver injury is suspected, the primary treatment is to stop taking the medication.

Conclusion

While many medications can raise liver enzymes, serious DILI can often be avoided with awareness and careful management. Understanding the risks associated with common drugs like acetaminophen and statins, alongside less regulated supplements, is crucial for liver health. Open communication with your doctor, correct dosing, and watching for symptoms are key preventative steps. For more detailed information on drug-induced liver injury, consult the LiverTox database from the NIDDK.

Frequently Asked Questions

Medications typically cause an elevation in alanine aminotransferase (ALT) and aspartate aminotransferase (AST), enzymes that normally reside within liver cells. If liver cells are inflamed or damaged, these enzymes leak into the bloodstream, raising their levels in blood tests.

Yes, many herbal supplements, often perceived as safe because they are 'natural,' can cause liver damage. Common culprits include green tea extract, kava, black cohosh, and ashwagandha, which can lead to elevated liver enzymes and, in severe cases, liver failure.

In many cases, yes. Mild, transient increases in liver enzymes from statins often resolve on their own, and statins are considered safe for most patients with chronic liver disease. Your doctor will monitor your enzyme levels and may adjust the dosage or switch medication if needed.

Symptoms of drug-induced liver injury can include jaundice (yellow skin/eyes), dark urine, fatigue, nausea, and abdominal pain. It's crucial to report any such symptoms to your doctor, who can perform blood tests to check liver function and investigate the cause.

Intrinsic DILI is a predictable, dose-dependent liver injury, such as a high-dose acetaminophen overdose. Idiosyncratic DILI is an unpredictable, rare reaction that occurs in a susceptible minority of patients and is often not dose-dependent, like with many antibiotics.

Yes, combining alcohol with certain medications, such as acetaminophen, significantly increases the risk of liver damage. Chronic alcohol consumption also increases the risk of hepatotoxicity from many other drugs.

If you suspect a medication is affecting your liver, contact your healthcare provider immediately. They may order blood tests to assess your liver function and will determine if the medication should be stopped or if a dose adjustment is necessary.