Quick summary
- Drug Induced Liver Injury (DILI) is a rare side effect of some medicines.
- Drug induced liver injury symptoms range from nothing (asymptomatic) to very severe and are like the symptoms of other liver conditions.
- Drug induced liver injury is usually diagnosed by ruling out other types of liver disease.
- Most people recover from drug induced liver injury, but it can take some time and may involve changing or stopping medication.
- Always read the information about side effects that comes with your medicine and tell your doctor about anything that causes you problems.
- Always talk to your doctor before stopping or changing prescription medicines
What causes drug induced liver injury?
Drug induced liver injury is liver damage that happens as a side-effect of taking a medicine.
Your liver has a lot of different jobs. One of these is breaking down (metabolising) medicines. This usually stops the medicine from continuing to work and helps to remove it from your body.
But sometimes parts of the medicine will still be active after being broken down or can even be changed to a more harmful form. This makes them harder to get rid of. If they build up in your liver, they can cause damage.
It is usually impossible to predict who will develop drug induced liver injury, and which medicines will cause it. There are some things that can increase the risk but none of these mean you will definitely get drug induced liver injury.
Drug induced liver injury is rare, so even though these things slightly increase the chance of getting it, the overall risk is still very low.
Things to do with the medicine (drug factors)
How much you take (dose)
Any medicine is more likely to cause drug induced liver injury if it is taken at a high dose.
Dose means how much of the active medical ingredient you have each time, so higher doses might mean taking more of the medicine or taking stronger medicine.
For this reason, doctors might try medicines at different doses to make sure you take the lowest dose possible for it to work.
Drug to drug interactions
Some medicines will change how other medicines work. Or how they are broken down by your liver.
In some cases, this can cause drug induced liver injury, even when both medicines are okay on their own.
Things to do with you
Age
The chance of developing drug induced liver injury increases with age. We don’t know exactly why this happens. It could be because of changes in your body as you get older. Or because older people tend to take more medicines and so there is more chance that one of those medicines will cause a problem.
Sex
Drug induced liver injury is more common in females. We don’t know exactly why but it is thought that differences in hormones and the immune system could be involved.
Other liver conditions
People who already have another liver condition may have an increased risk of drug induced liver injury.
One of the liver’s jobs is to help get rid of medicines, but if the liver is already damaged it is harder for it to do this properly and so the medicines can build up in the liver and cause drug induced liver injury.
Weight
Being over weight can put a strain on your liver and lead to a liver condition called NAFLD.
There is some evidence that people living with obesity could also have a higher risk of drug induced liver injury.
Diabetes
People with diabetes have a higher risk of some liver conditions. There is some evidence that diabetes could increase the risk of drug induced liver injury. But more research is still needed to understand this link.
Genes
Our livers use proteins called enzymes to break down medicines. Some people will inherit genes from their parents that change how these enzymes are made. When this happens, the enzyme may not work in the same way and the person could be more at risk of drug induced liver injury.
Pregnancy
Drug induced liver injury is thought to be more common in pregnancy. In most cases it happens early in the first few weeks because of medicine taken before the pregnancy was known about.
Smoking and alcohol
Smoking and alcohol both put a strain on your liver. This makes it harder for the liver to do its normal jobs. If your liver can’t break down and remove medicines, then they can build up in the liver and cause drug induced liver injury.
Alternative medicines and supplements
Drug induced liver injury can be caused by alternative, natural, traditional Chinese, and herbal medicines.
If your doctor asks you about what medicines you are taking always tell them about supplements, alternative medicines, and complementary medicines as well as prescription medicines and those you buy ‘over-the-counter’ from a pharmacy.
You should be particularly careful if you already have a liver condition or if you are taking other medicines. Ask your doctor for advice if you are considering trying alternative medicines or supplements and talk to a pharmacist about possible interactions with your other medicines.
What are the symptoms of drug induced liver injury?
The symptoms of drug induced liver injury are very like the symptoms of some other liver conditions. For some people the symptoms will be very mild, others may feel very unwell. Some people will have no symptoms and liver damage may only be found when you have blood tests or a scan for something else.
If there are symptoms, these usually start within a few days or weeks of starting a new medicine.
If you were only taking the medicine for a short time, you might not have symptoms of drug induced liver injury until after you have finished the medicine. For example, if you were taking a course of antibiotics
Some of the most common symptoms of drug induced liver injury are:
- Tiredness or fatigue
- Loss of appetite
- Developing a yellow colour to your skin or eyes (jaundice)
- Itching
- Pain on the right-hand side of your body under your ribs (right upper quadrant or RUQ pain)
- Feeling sick (nausea)
- A skin rash
What should I do if I think I have drug induced liver injury?
Check the medicine information sheet
This is a leaflet that comes with your medicine. It should list all the known side effects and how common they are. If you no longer have the sheet, you can often find this information online or you can ask a pharmacist.
Speak to your doctor
If you are experiencing very unpleasant side effects from any medicine, even if you do not think you have drug induced liver injury, talk to your doctor. When possible, this should be the same doctor who last prescribed the medicine for you.
This may be your GP or a specialist at the hospital. They will be able to help you decide if you should stop taking the medicine or if you could change the amount you take or change to a different medicine. Make sure they know about any medical conditions or other medicines you take.
Never stop taking a prescription medicine without talking to your doctor first.
If you feel very unwell and cannot talk to your doctor call NHS 111 for advice.
Report the problem
If you think you have had any side effect from a medicine that isn’t listed in the medicine’s information leaflet you can report it to the MHRA yellow card website.
Some side effects are very rare and so they are not found when medicines are first tested. Reporting a problem to the yellow card scheme will not get you medical help. But it does help doctors and scientists to find out about rare side effects.
Tests for drug induced liver injury
There is no specific test for drug induced liver injury. Doctors will usually diagnose it by first ruling out other problems, including other liver conditions.
Medicines list
If your doctor thinks you might have drug induced liver injury, they will ask for a list of all medicines you have taken in the last 3 to 6 months. This will include medicines prescribed by a doctor, bought from a pharmacy, herbal, natural or alternative medicines and recreational drugs.
It is important that you tell the doctor about all the medicines you have taken. Even if they seem unlikely to have caused the problem. Sometimes one medicine can unexpectedly change the way another medicine works.
Your doctor might recommend stopping or changing medicine. If your liver condition starts to get better after stopping a medicine, then it is quite likely that the medicine was causing drug induced liver injury.
Always talk to your doctor before stopping a prescription medicine. It is important to make sure that there is a plan to deal with whatever the medicine was prescribed for.
Blood tests
If you have symptoms of drug induced liver injury, you will probably have some blood tests. These will include tests to see how your liver is doing. You can read more about liver blood tests on this page.
Ultrasound scan
If doctors think you might have drug induced liver injury, you should have an ultrasound scan. This is a simple procedure where a probe is put on your tummy. The probe uses sound waves to make a picture of your liver. This helps doctors to see any possible damage. Find out more about ultrasound scans here.
Depending on your symptoms you may have some more tests to rule out other possible liver conditions.
Other tests you might have
Biopsy
Your doctor may suggest a liver biopsy if it is not clear what is wrong. Or if you are thought to have drug induced liver injury, but you are not getting better as expected.
A doctor will numb an area of skin on your tummy and then use a needle to take a small sample of your liver. This sample can then be examined under a microscope to better understand the problem.
Viral hepatitis blood tests
You may have a blood test to check for some types of liver disease that are caused by viruses. This is often done if you have symptoms of extreme tiredness. You can read more about viral hepatitis blood tests here.
Bile duct tests
If you have itching, jaundice, or pain in your tummy you should have blood tests and an ultrasound scan to look for problems with your bile ducts. For example, gallstones.
Autoimmune disease tests
You might also have a blood test or liver biopsy to look for autoimmune hepatitis. Autoimmune hepatitis is caused by your immune system developing a fault and attacking your liver. In some very rare cases drug induced liver injury can cause autoimmune hepatitis. You can read more about autoimmune hepatitis here.
Other imaging tests
Other imaging tests
Other imaging tests include:
- MRI scans
- CT scans
- MRCP
Your doctor might want to do imaging tests to get a better picture of your liver. You can find out more about imaging tests for liver disease here.
Always keep a record of all your medicines and how often you take them.
You could keep this in a notebook or as a note on your phone or computer.
Write down:
- The name of the medicine as it is written on the packet
- The date you started taking it
- The dosage – this will be a number followed by some letters e.g.
500ug, 200µg, 75mg
- How much you take and whether that has changed e.g.
1 pill, 3 times a day. Or, 2 pills, once a day
- Did you always take every dose, or did you sometimes miss some?
- If you are no longer taking the medicine, how long did you take it for? e.g.
Just once. Or, for two weeks
TIP: The names and dosages of medicines are often complicated. A quick way to keep a record of these is to take a photo of the packet or label.
Names for different types of drug induced liver injury
Doctors often refer to drug induced liver injury as “DILI”.
They might also give your DILI different names depending on which part of your liver is damaged and which medicine caused the problem.
Here are some words they might use and what they mean.
Intrinsic
DILI that develops after taking a medicine that has DILI as a known side effect.
Idiosyncratic
DILI that develops after taking a medicine that was not thought to cause DILI.
Hepatocellular
DILI that has caused damage to liver cells (hepatocytes). The main symptom of hepatocellular DILI is feeling very tired.
Cholestatic
DILI that has caused damage to your bile ducts. The main symptoms are itching, jaundice (a yellow colour to the skin or eyes) and pain on your right-hand side under your ribs.
Mixed pattern
DILI that has symptoms of both hepatocellular and cholestatic DILI.
Autoimmune DILI
DILI that has caused your immune system to make antibodies that attack your liver.
Treatment for drug induced liver injury
Changing or stopping the medicine
Never cut down or stop any medicines without talking to your doctor first.
The best way to treat drug induced liver injury is to stop taking the medicine that is causing it. But this isn’t always simple. If the medicine is for another serious medical condition, or one with severe symptoms, then simply stopping might not be an option.
In some cases, other medicines might be available that you can try instead, or it might be possible to stop the medicine for a while and then try starting it again while keeping a close eye on your liver.
Your doctor should work with you to find the best combination of treatments to deal with your other medical conditions, without damaging your liver. This might take some time and you might have to try out different options to see which is best.
Other treatments
Most people will get better without any other treatment once they stop taking the medicine that is causing the problem.
If you are feeling unwell you may have treatment to help with the symptoms while you get better. For example, a medicine called ursodeoxycholic acid can help if you have jaundice or other symptoms related to your bile ducts.
You may be given steroid medicine if your drug induced liver injury has caused autoimmune hepatitis .
In some cases, drug induced liver injury can cause more serious damage to the liver. If this happens you should be referred to a hepatologist (a doctor who specialises in liver conditions). Severe damage to the liver is called cirrhosis. You can read more about cirrhosis here.
In very severe cases, where the liver has been very badly damaged a liver transplant can be necessary. This is very rare. If your doctor thinks you may need a transplant, they will refer you to a specialist centre. You can read more about liver transplants here.
Recovering from drug induced liver injury
Your liver has an amazing ability to repair itself and so most people with drug induced liver injury will make a complete recovery.
How long it takes for your liver to repair itself varies from person to person and the repair work can make you feel unwell. Some people will continue to feel worse for a little while after tests show that their liver is recovering. It is common for people to continue to feel sick or very tired for weeks or even months. This is a normal part of recovering. But it can make it hard to do normal activities and can be worrying.
You may have regular blood tests to check that your liver is getting better. But always speak to your doctor if you are concerned.
Looking after yourself
The main thing that will help you to get better is time. But you might want to do some other things to help keep your liver healthy. Eating a healthy balanced diet, taking exercise, and avoiding smoking and alcohol will all help your liver to work well. You can find out more about looking after your liver here.
You can try other things to help with symptoms such as a cooling gel or ice packs to relieve itching or a massage for relaxation.
Always talk to your doctor before trying alternative or complementary medicines, even if they are natural or have been recommended by a practitioner. You can read more about complementary and alternative treatments here.
Getting Support
Drug induced liver injury can have an impact on many areas of your life. It can be hard to ask for help, but family and friends may be able to offer practical or emotional support. You can find out more about looking after your mental health here.
You can also call our helpline and speak to one of our specialist liver nurses about what you are going through. Or join our online forum to talk to other people living with liver disease.
I spoke to a nurse who answered all of my questions, and more. It was like getting the biggest hug from my mum! She told me that “treatment was time” … and she was right.
Common worries
Will I get drug induced liver injury again?
Many people who have had drug induced liver injury worry that they will get it again the next time they need a new medicine.
Although some things make people more likely to get drug induced liver injury. In most cases it just happens by chance, and you are no more likely to get drug induced liver injury from a new medicine than someone who has never had the problem.
Not treating a medical problem because of concerns about drug induced liver injury could be more dangerous than the risk of drug induced liver injury itself. But it is normal to be worried, and sensible to reduce the risk as much as possible.
Always tell your doctor that you have had drug induced liver injury when they give you a prescription. And keep a record of all the medications you take, including any that you buy from a pharmacy or any supplements or complementary treatments you take.
Ask to talk to your pharmacist If you are taking more than one medicine or are taking medicine from the doctor and want to try a supplement or something from a pharmacy as well. Pharmacists are experts in how medicines can interact with each other and will be able to help you avoid any problem combinations.
What if I really need my medicine?
Sometimes stopping the medicine that has caused drug induced liver injury is straightforward. It could be something you were only taking for a short time, like a course of antibiotics for an infection. Or there might be different medicines that you can take instead.
But for some people it is more of a problem. Especially if the medicine is something that you rely on for a serious long term or life-threatening condition.
What to do in this situation will be different for each person and your doctors should discuss the different options with you so that you can decide together what to do.
It is normal to feel worried about this. If you think this worry is having an impact on your mental health, you can find more information and links on our Looking after your mental health page.
We have a range of other support options, you can find out more about them here.
Thanks
We would like to thank everyone who helped with creating and reviewing this page. In particular Kirsty Turnbull, British liver trust deputy nurse manager. Catherine Wood, virtual hepatology nurse specialist. Dr Hyder Hussaini, consultant hepatologist. And Julia Faulks who also shared her own experiences of having drug induced liver injury.
This page was published: January 2023
Review date: January 2026