Liver Damage

We all take our bodies for granted but drugs of any kind can be fatal.

I am writing this today after one of my sister’s in England told me something very disturbing that happened to an acquaintance. I think most of us don’t know enough about our bodies let alone the terrible things drugs can do to us. When it comes to the liver, I have never spent time learning much about drugs although of course I do know that the liver is very sensitive to everything you put into your body.

What she told me was quite shocking and was about a woman who had gone through a serious drug reaction many years ago, just like my sister. That drug was Baycol and it is one of the worse drugs in the history of the FDA. I did write about it in the past. She said she was shocked to find out that the woman passed away suddenly and two other ladies who knew her well, went to visit with her husband because they thought it was her heart or a stroke that caused her death.

What her husband said was, that she had awakened one morning and began throwing up violently. He stripped the bed and went to load the sheets and by the time he walked back into the bedroom, she was already dead. No warning signs other than the throwing up, just before it happened.

The autopsy he said reveled her liver had exploded and neither my sister nor I had ever heard of it. So I looked it up and correct term is ruptured liver. When I read what came up on Google, it was all about drugs.

When I looked up ruptured liver I found a case study for 5 people. This is a bit of what it said.

Spontaneous liver rupture is a rare and life-threatening condition. It is usually associated with pregnancy, although it can occur with other liver pathology and, very rarely, in isolation. It is difficult to diagnose, and the numerous treatment options suggested for this condition add to the complexity of the problem. We report a series of five female patients treated between 1988 and 1998. Three cases were associated with pregnancy and two had no underlying pathology. All five patients survived, although one fetus died.

The first three cases were during pregnancy but these are the other two.

A 57-year-old woman presented with severe right upper quadrant and epigastric pain of 2 days duration. She was pyrexial with right upper quadrant tenderness. A clinical diagnosis of acute cholecystitis was made as she previously had gallstones diagnosed on US. Investigations revealed a haemoglobin of 9.3 g/dl, white cell count of 22×109/L, platelets 430×109/L, bilirubin 6 mmol/L, alkaline phosphatase 83 U/L, AST 337 U/L, ALT 10 U/L. The patient became haemodynamically unstable, requiring large volume fluid resuscitation. US showed a large abnormal area in the right liver, which had appearances consistent with haematoma on CT scan. An angiogram and subsequent CT scan showed no other underlying pathology. One week later, she underwent elective laparoscopy and drainage of the haematoma. Her postoperative period was uneventful, and subsequent scans confirmed resolving haematoma. This haematoma disappeared completely without any residual scarring in 18 months. She remains well 9 years after operation.

44-year-old woman presented with right upper quadrant pain of 6 h duration.
She had been investigated for anaemia in the past, but no definite cause was found. On admission she had tachycardia and signs of acute abdomen. There was no history of trauma. Haemoglobin was 8.2 g/dl, haematocrit 22% and platelet count was 322×109/L- An emergency laparotomy revealed blood in the peritoneal cavity and a large liver haematoma with a shattered right liver; this was treated by right hemihepatectomy. The postoperative course was complicated by development of a right pleural effusion and right subdiaphragmatic collection, which required aspiration. Histology of the resected liver was reported as normal. The patient was discharged on the 10th postoperative day and remains well 13 years later.

Why the liver ruptured on the woman my sister knew, who knows, but it is worth learning everything about your body and how what drugs you are taking can affect your liver. Better be safe than sorry is my motto. So I decided to learn more and found a site with everything you would ever want to know about liver disease. I knew that women take a lot of drugs when they have mesh complications and I decided it was an important blog to write. In the past I have covered dangerous pain medication, and knew that although some women may not want to know what is going on, this is extremely important and could save your life. So let’s get educated together.

What surprised me was the various liver diseases. I did know that the liver can regenerate if you abuse anything, but like any other organ you have to learn more about what you put into your body especially if you are taking prescription drugs.

Drug-induced liver diseases are diseases of the liver that are caused by physician-prescribed medications, over-the-counter medications, vitamins, hormones, herbs, illicit (“recreational”) drugs and environmental toxins

What is the liver? The liver is an organ that is located in the upper right hand side of the abdomen, mostly behind the rib cage. The liver of an adult normally weighs close to three pounds and has many functions.

  • The liver produces and secretes bile into the intestine where the bile assists with the digestion of dietary fat.
  • The liver helps purify the blood by changing potentially harmful chemicals into harmless ones. The sources of these chemicals can be outside the body (for example, medications or alcohol), or inside the body (for example, ammonia, which is produced from the break-up of proteins; or bilirubin, which is produced from the break-up of hemoglobin.
  • The liver removes chemicals from the blood (usually changing them into harmless chemicals) and then either secretes them with the bile for elimination in the stool, or secretes them back into the blood where they then are removed by the kidneys and eliminated in the urine.
  • The liver produces many important substances, especially proteins that are necessary for good health. For example, it produces proteins like albumin (a protein that carries other molecules through the blood stream), as well as the proteins that cause blood to clot properly.

When drugs injure the liver and disrupt its normal function, symptoms, signs, and abnormal blood tests of liver disease develop. Abnormalities of drug-induced liver diseases are similar to those of liver diseases caused by other agents such as viruses and immunologic diseases. For example, drug-induced hepatitis (inflammation of the liver cells) is similar to viral hepatisis; they both can cause elevations in blood levels of aspartate amino transferase (AST) and alanine aminotransferase (ALT) (enzymes that leak from the injured liver and into the blood) as well as anorexia(loss of appetite) fatigue and nausea. Drug-induced cholestasis (interference with the flow of bile that is caused by injury to the bile ducts) can mimic the cholestasis of autoimmune liver diseas (e.g., prmary biliary cirrhosis) and can lead to elevations in blood levels of bilirubin (causing jaundice), alkaline phosphatase (an enzyme that is leaked from injured bile ducts), and itching.

We cannot live without a liver but we may not know we have a liver disease.

What are the symptoms of liver disease? Patients with mild liver disease may have few or no symptoms or signs. Patients with more serious disease develop symptoms and signs that may be nonspecific or specific.

Nonspecific symptoms (symptoms that also can be seen in other disorders) include:

  • fatigue,
  • weakness,
  • vague abdominal pain
  • loss of appetite.

Symptoms and signs that are specific for liver disease include:

  • yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood,
  • itching associated with liver disease, and
  • easy bruising due to decreased production of blood clotting factors by the diseased liver.

Severe, advanced liver disease with cirrhosis can produce symptoms and signs related to cirrhosis; these symptoms include:

  • fluid accumulation in the legs (edema) and abdomen (ascites, due to increased pressure in the vessels going into the liver),
  • mental confusion or coma (from hepatic encephalopathy due to increase in ammonia),
  • kidney failure
  • vulnerability to bacterial infections and
  • gastrointestinal bleeding, secondary to varices (enlarged blood vessels in the esophagus or stomach).
  • How do drugs cause liver disease? Drugs can cause liver disease in several ways. Some drugs are directly injurious to the liver; others are transformed by the liver into chemicals that can cause injury to the liver directly or indirectly. (This may seem strange in light of the liver’s important role in transforming toxic chemicals into nontoxic chemicals, but it happens.) There are three types of liver toxicity; dose-dependent toxicity, idiosyncratic toxicity, and drug allergy.

If you think avoiding prescription drugs and then adding over the counter drugs is okay, then read on.

  • Drugs that cause dose-dependent toxicity can cause liver disease in most people if enough of the drug is taken. The most important example of dose-dependent toxicity is acetaminophen (Tyenol) overdose (discussed later in this article.).
  • Drugs that cause idiosyncratic toxicity cause disease in only those few patients who have inherited specific genes that control the chemical transformation of that specific drug, causing accumulation of the drug or products of their transformation (metabolites) that are injurious to the liver. These inherited idiosyncratic toxicities usually are rare, and depending on the drug, typically occur in less than 1 to10 per 100,000 patients who are taking that drug; however, with some drugs the prevalence of toxicity is much higher. Even though the risk of developing drug-induced idiosyncratic liver disease is low, idiosyncratic liver disease is the most common form of drug-induced liver disease because tens of millions of patients are using drugs, and many of them are using several drugs.
  • Idiosyncratic drug toxicity is difficult to detect in early clinical trials that usually involve, at most, only a few thousand patients. Idiosyncratic toxicity will surface only after millions of patients begin to receive the drug after the drug is approved by the FDA.
  • Drug allergy also may cause liver disease, though it is uncommon. In drug allergy, the liver is injured by the inflammation that occurs when the body’s immune system attacks the drugs with antibodies and immune cells.
  • In more serious cases, patients can develop dark urine, fever, light-colored stool, and jaundice (a yellow appearance to the skin and white portion of the eyes). Patients with hepatitis usually have high blood levels of AST, ALT, and bilirubin. Both acute and chronic hepatitis typically resolve after stopping the drug, but sometimes acute hepatitis can be severe enough to cause acute liver failure (see discussion later in this article), and chronic hepatitis can on rare occasions, lead to permanent liver damage and cirrhosis.

Know what can happen with every pill or capsule you take BEFORE you take it.
If you don’t see your drug and you live in another country, it is often registered under a different name.

  • Examples of drugs that can cause acute hepatitis include
    acetaminophen (Tylenol)
    phenytoin (Dilantin)
    isoniazid (Nydrazid, Laniazid)
    diclofenac (Voltaren)
    amoxicillin/clavulanic acid (Augmentin)
  • Examples of drugs that can cause chronic hepatitis include
    minocycline (Minocin)
    nitrofurantoin (Furadandine Macrodantin)
    phenytoin (Dilantin),
  • Fenofibibrate (Tricor)
    and methamphetamine (“ecstasy”)..
  • Cholestasis
  • Cholestasis is a condition in which the secretion and/or flow of bile is reduced. Bilirubin and bile acids normally secreted by the liver into bile and eliminated from the body via the intestine, collect in the body leading to jaundice and itching, respectively. Drugs causing cholestasis typically interfere with the liver cell’s secretion of bile without causing hepatitis or liver cell necrosis (death). Patients with drug-induced cholestasis typically have elevated blood levels of bilirubin but have normal or mildly elevated AST and ALT levels. Blood levels of alkaline phosphate (an enzyme made by bile ducts) increase because the cells of the bile ducts also are dysfunctional and leak the enzyme. Aside from itching and jaundice, patients usually are not as sick as patients with acute hepatitis.
  • Examples of drugs that have been reported to cause cholestasis include
  • erythromycin (E-Mycin, Ilosone),
  • chlorpromazine (Thorazine)
  • sulfamethoxazole and trimethorprim (Bactrim; Septra)
  • amitriptyline (Evavil, Endep)
  • carbamazepine (Tegretol)
  • ampicillin (Omnpen; Polycillin; Principen)
  • ampicillin/clavulanic acid (Augmentin),
  • rifampin (Rifadin)
  • estdiol (Estrace; Climara)
  • Estraderm; Menostar),
  • Captopril (Capoten)
  • Birth control pills (oral contra ceptives
  • Anabolic steroids
  • Naproxen (Naprosyn)
  • Amiodarone (Cordarone)
  • Haloperidol (Haldol)),
  • Imipramine (Tofranil)
  • Tetracycline (Achromycin)
  • phenytoin (Dilantin).

    You should also know that the woman who died was NOT obese nor had diabetes, but she took a lot of prescription drugs for her illness caused by another prescription drug.

  • Steatosis (fatty liver) The most common causes of accumulation of fat in the liver are alcoholism and non-alcoholic fatty liver disease (NAFLD) associated with obesity and diabetes. Drugs may cause fatty liver with or without associated hepatitis. Patients with drug-induced fatty liver may have only a few symptoms, or none. They typically have mild to moderate elevations in blood levels of ALT and AST, and also may develop enlarged livers. In severe cases, drug-induced fatty liver can lead to cirrhosis and liver failure.
  • Drugs reported to cause fatty liver include total parenteral
  • nutritian
  • methotrexate (Rheumatrex)
  • griseofulvin (Grifulvin V)
  • tamoxifen (Nolvadex)
  • steroids,
  • valproate (Depakote)
  • amiodarone (Cordarone)

Cirrhosis. Chronic liver diseases such as hepatitis, fatty liver, or cholestasis can lead to the necrosis (death) of liver cells. Scar tissue forms as part of the healing process that is associated with the dying liver cells, and severe scarring of the liver can lead to cirrhosis.
The most common example of drug-induced cirrhosis is alcoholic cirrhosis . Examples of drugs that can cause chronic liver diseases and cirrhosis include

methotrexate (Rheumatrex),
amiodarone (Cordarone)
methyldopa (Aldomet)
Please read the article on Cirrhosis for more information.

I do know that if you are on a drug long term, doctors will generally run a blood test every six months. However, many times they do not check every drug you are on nor the side effects of mixing them together. You, however can save your relatives anguish and sadness if they were to find you dead one morning by learning all you can about the drugs you take. It is not so easy diagnosing liver disease or problems until things get bad.

How is drug-induced liver disease diagnosed? The diagnosis of drug-induced liver diseases often is difficult. Patients may not have symptoms of liver disease or may have only mild, nonspecific symptoms. Patients may be taking multiple drugs, which makes it difficult to identify the offending drug. Patients also may have other potential causes of liver diseases such as non-alcoholic fatty liver disease (NAFLD) and alcoholism.

What are some important examples of drug-induced liver disease? This is a big one!

Acetaminophen (Tylenol) An overdose of acetaminophen can damage the liver. The probability of damage as well as the severity of the damage depends on the dose of acetaminophen ingested; the higher the dose, the more likely it is that there will be damage and the more likely it is that the damage will be severe. (The reaction to acetaminophen is dose-dependent and predictable; it is not idiosyncratic – peculiar to the individual.) The liver injury from an overdose of acetaminophen is a serious matter since the damage can be severe and result in liver failure and death. In fact, acetaminophen overdose is the leading cause of acute (rapid onset) liver failure in the U.S. and the United Kingdom.

You may now be thinking “I don’t take Tylenol”. So I looked up about all the over the counter drugs that contain it and there are 600. YES, 600. If you are taking any over the counter medicine EVERY DAY, then please read up on it.

Acetaminophen is the most common drug ingredient in America. There are more than 600 medicines that contain acetaminophen, including over-the-counter (OTC) and prescription (Rx) medicines. Below is a list of some common brand-name medicines, some forms of which contain acetaminophen.

This list does not include every medicine that contains acetaminophen. There are many other OTC and Rx medicines that contain acetaminophen as an active ingredient. Some brands listed below also have products that do not contain acetaminophen. If you have a medicine that is not listed here, simply check the label to see if it contains acetaminophen or ask your healthcare provider.

Some Common Over-the-Counter Brand Name Drugs That Contain Acetaminophen

Alka-Seltzer Plus®
Formula 44®
Goody’s® Powders
Saint Joseph® Aspirin-Free
TYLENOL® Brand Products
*And store brands

Some Common Prescription Drugs That Contain Acetaminophen (or APAP)

Hydrocodone Bitartrate®
TYLENOL® with Codeine
*And generic drugs

*Many OTC and Rx medicines have store-brand or generic versions. For example, there are many store-brand products that are similar to brands like TYLENOL®, NyQuil®, and Robitussin®. Prescription medicines that come in generic form may list the ingredients in place of a drug name. For example, the generic version of “Vicodin” has “hydrocodone and acetaminophen” written on its label. Your prescription label may list the ingredients, the brand name, or both. Always read and follow the label and ask your healthcare provider if you have questions about the ingredients in your medicine. Read all about your liver here

I do know the government is on a crackdown about pain killers and one thing you need to know is, if you still have pain and cannot deal with it, don’t mix drugs with over the counter drugs. Read this.

Extra care is needed because oxycodone with acetaminophen is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed. Read more here

These are High Alert drugs.

  • Warfarin (Coumadin) A blood thinner

  • Lovenox (enoxaparin) This one prevents blood clotsFentanyl (Duragesic) You may be using this for pain management
  • Methotrexate (Rheumatres Trexal)  used for cancers
  • Hydrocodone with acetaminophen (Vicodin, Lorcet) used to control pain

  • Oxycodone with acetaminophen (Percocet, Roxicet) more pain medsIf you are a diabetic, pay close attention to ANY drugs you are on for pain. The following could be deadly if you mix with another drug or pain killers.
  • Humalog (insulin lispro)

  • Novolog (insulin aspart) fast acting insulin
  • Lantus (insulin glagine)

  • Apridra (insulin glulisine)
  • Levemir (insulin detemir)

The FDA has linked these drugs as ‘high alert’ for good reason and I know that they put medical mesh in both men and women without consideration as to their other health issues so it is wise to be your own advocate. Health issues also arise after mesh so first work at getting it all out and do all you can to take good care of yourself.

If you are having difficulties getting off of pain meds, this is a great read.

In the past I have written about pain meds and antidepressants.

Just how much pain are you living with? Learn more here

I don’t know if by writing this blog, it will save one woman’s life, but if it does, it is worth the time I took to edit so that you can learn easier and take precautions.


  1. Sugar Sue

    Thank u for article. How can we detox?

    1. Linda (Post author)

      I gave the link to the ‘liver’ information site and if you click on it you will find everything you ever want to know, including about detox.

  2. Virginia

    I was diagnosed with crypogenic liver disease last yr. 5 yrs ago i was told i had non alcoholic liver disease. Ive has cushions disease syndrome since 7yrs old, 5 surgeries for it. Then genetic testing. Diagnosed with men type 2, hypo parathyroid tumors, pancreatic tumors. Now im without a pituitary, thyroid & parathyroid. Chronic fatigue, gain weight, lose weight etc. No one has ever explained, what i can do, what i should do, ect. Im lost. I lost my growth gland & sex gland with yrs of radiation, cyberknife radion, surgeries. I want to live. Im 58yrs old, 4′ 11, 168lbs. Please help.

    1. Linda (Post author)

      Virginia I am not a doctor and don’t know how to help you.


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