Liver

Shown to raise ALT above 3 times normal in 5.3% against 1.1% on placebo. The label warns of serious liver injury after approval, including transplant and death.

Shown to raise ALT or AST to 3 times normal or more in about 1% of women on Oriahnn and under 1% on Myfembree, against 0% to 0.4% on placebo.

Shown to raise the liver enzyme ALT to three times the normal limit or more in 2.0% against 0.3% on placebo in short trials.

Shown to raise mean GGT and alkaline phosphatase in placebo-controlled trials, mostly within the normal range. ALT and AST did not differ.

Shown to raise liver test abnormalities, reported in 6% on tizanidine against 2% on placebo. The label warns of liver cell injury.

Shown to raise liver enzymes on duloxetine, with ALT above 3 times the upper limit in 1.25% against 0.45% on placebo. Liver failure has been reported.

Shown to raise the liver enzyme ALT above twice the reference limit in 1.9% on glimepiride against 0.8% on placebo. Liver failure appears in postmarketing reports.

The label reports rises in AST, ALT and alkaline phosphatase in 1% or more of people, and cases of reversible liver injury.

The label reports ALT or AST above twice the upper limit in 1% to 2% of patients on ondansetron with chemotherapy, transient, with chemotherapy's role unclear.

Shown to raise gallbladder and bile duct disease about 37% across GLP-1 drug trials. In REWIND, serious acute cholecystitis occurred in 0.5% on dulaglutide against 0.3%.

Shown to raise liver enzymes in about 0.2% on high doses. Severe muscle injury rose with dose, and myopathy was more frequent on simvastatin 80 mg.

The label reports multiorgan hypersensitivity reactions, some fatal, and deaths from organ or liver failure in 2 of 3,796 adults and 4 of 2,435 children in trials.

Case reports: serious liver injury occurred on the daily fibroid dose, with five liver transplants reported in Europe. One review estimated severe injury at 13.5 per 100,000 users.

Linked to sharply higher cirrhosis risk with heavy drinking, 12 to 25 times in women at 5 or more drinks a day. Women had higher risk at the same intake.

Case reports: people developed jaundice and liver injury after 2 to 12 weeks, most recovering within months. Three with existing liver disease died.

Germany's BfR advises children, pregnant and breastfeeding women, and people with liver disease not to take ashwagandha, citing case reports of liver damage.

Shown to raise levels of drugs cleared by CYP2D6, CYP2C9 and CYP3A4 in healthy men, and cyclosporine levels by about 29% in kidney transplant recipients.

Shown to raise clobazam levels by about 60% in children with epilepsy, and to change levels of several other antiepileptic drugs.

FDA states it has not found adequate evidence on how much CBD can be consumed, and for how long, before causing harm, naming liver harm and drug interactions.

Linked to liver injury in 22 US registry cases, mostly in products with green tea. 91% were hospitalized, one needed a transplant and one died.

The FDA states grapefruit juice can interact with some statins. One glass daily raised simvastatin levels 3.6-fold in a small trial, and pravastatin was unaffected.

EFSA's panel concluded that trials show 800 mg or more of EGCG a day as a supplement raises liver enzymes compared with control.

Linked to 3% of US registry liver injury cases, 35% of them severe, with 3 needing transplants. USP linked injury to 140 to about 1,000 mg EGCG a day.

Case reports: liver failure and transplants in 11 kava users by 2002, including a 14-year-old girl. Most likely cases exceeded dose or duration limits.

FDA issued a 2002 advisory on the potential risk of severe liver injury with kava, and five other countries restricted kava sales.

Across GLP-1 drug trials, shown to raise gallbladder and bile duct disease about 37%, and more in weight loss trials, at higher doses and with longer use.

Shown to raise gallbladder and bile duct disease about 37% across GLP-1 drug trials, more at higher doses and longer use. The analysis pooled all GLP-1 drugs.

Shown to lower levels of the HIV drug indinavir about 57% in healthy volunteers. Reports show lower levels or effect of warfarin, cyclosporine, digoxin and birth control pills.

Case reports: 10 US cases of turmeric liver injury, one fatal, plus 7 Italian cases with high-dose, high-bioavailability products, most improving after stopping.

Shown to raise the INR by a mean 0.62 against placebo in people on vitamin K antagonists, more at higher daily doses. No major bleeding was reported.

The label warns of a syndrome that starts with jaundice or hepatitis and can progress to liver failure and death. It gives no rate.

FDA states acetaminophen has been associated with acute liver failure, at times resulting in liver transplant and death, mostly at doses above 4,000 mg a day.

One trial found a liter of regular cola daily for 6 months raised liver fat more than milk, diet cola or water. Cross-sectional studies link sugary drinks to fatty liver.

The label states that alkalinizing agents raise amphetamine blood levels, acidifying agents lower them, and tricyclic antidepressants can strengthen cardiovascular effects. It gives no rate.

FDA requires over-the-counter acetaminophen labels to warn of severe liver damage, and NSAID labels of stomach bleeding, with 3 or more drinks every day.

The labels warn against tamsulosin, alfuzosin or silodosin with strong CYP3A4 inhibitors such as ketoconazole or clarithromycin, which raise drug levels. Ketoconazole nearly tripled tamsulosin exposure.

The label states that SSRIs, quinidine, cimetidine and other drugs that block the liver enzyme CYP2D6 can raise tricyclic levels, and topiramate raised them sharply in some people.

The labels warn of liver injury, including cholestatic jaundice with amoxicillin-clavulanate and severe, sometimes fatal hepatotoxicity with azithromycin.

The label states that a clopidogrel metabolite strongly inhibits the enzyme CYP2C8 and can raise blood levels of the diabetes drug repaglinide.

The aspirin label lists indigestion, raised liver enzymes, hepatitis and Reye's syndrome among adverse reactions. It gives no rates.

Case reports: the label describes rare severe liver injury after approval, including liver failure and one transplant. None was found in trials of about 6,000 patients.

The labels contraindicate both drugs with MAO inhibitors. Fluoxetine and paroxetine raise atomoxetine levels 3 to 8 times, and viloxazine raises duloxetine, ramelteon, tizanidine and theophylline levels.

The label states that strong blockers of two liver enzymes raise aripiprazole exposure, including fluoxetine and paroxetine, and that enzyme blockers and inducers change quetiapine exposure.

The label reports alprazolam blood levels rising about 4 times with ketoconazole and 2.7 times with itraconazole, and lists such strong enzyme blockers as contraindicated.

Case reports: one person had acute kidney injury, muscle breakdown and liver toxicity after drinking black seed oil.

The label states bupropion slows a liver enzyme and can raise levels of many antidepressants, antipsychotics, beta blockers and heart rhythm drugs.

The label reports buspirone blood levels rising 3 to 50 times with certain antibiotics, antifungals, heart drugs, nefazodone and large amounts of grapefruit juice.

The labels state strong CYP3A4 inhibitors such as clarithromycin raise gepant levels up to almost tenfold, and inducers such as rifampin cut them about 80%.

Case reports: a woman taking 1,200 to 2,400 µg a day for months developed anemia, liver injury and kidney failure needing dialysis, and recovered.

The labels state tricyclic antidepressants can blunt clonidine's blood pressure effect, and drugs that block or speed the liver enzyme CYP3A4 change guanfacine levels.

Case reports: a fatal case of air in the liver's portal vein and systemic air embolism after colon hydrotherapy.

The labels warn that ketoconazole, itraconazole and ritonavir raise blood levels of these drugs, and that rifampin, carbamazepine, phenytoin and St. John's wort lower them.

Case reports: a US public health investigation of two severe illnesses, one fatal, in people drinking kombucha daily, and a report of severe liver injury.

Case reports: liver injury in 17 people after Hydroxycut, a multi-ingredient product containing hydroxycitric acid. Three needed transplants and one died.

Case reports: a woman taking only water and green tea catechin supplements for 2 weeks developed severe pancreatitis and suspected toxic hepatitis.

USP's monograph label warns not to take it on an empty stomach or with a liver problem, and to stop with symptoms such as dark urine or jaundice.

The cimetidine label states it slows the liver's clearance of warfarin, phenytoin, theophylline, lidocaine and other drugs, with clinically significant effects reported for warfarin.

Limited evidence: liver test abnormalities were more frequent on kava in one trial, and community kava use was linked to higher liver enzymes.

One trial found a moderate rise in the liver enzyme AST and in diastolic blood pressure at 0.6 g a day in people with metabolic syndrome.

One small trial at 300 mg a day was stopped when 3 of 4 patients had liver enzyme rises, which resolved after stopping.

Limited evidence: one trial reported more gallbladder disease and urinary incontinence during estrogen plus progestin, with most risks fading after stopping.

The label states that strong inducers of a liver enzyme lower mirtazapine blood levels, and that strong inhibitors and cimetidine may raise them.

The label states modafinil can lower cyclosporine levels and raise levels of drugs cleared by CYP2C19, such as diazepam, propranolol, phenytoin and omeprazole.

The label warns of thyroid C-cell tumors seen with related drugs in rodents, with human relevance not determined. Pancreatitis and gallstones were slightly more common.

The label lists reports of severe liver injury, some ending in transplant or death. A UK study found injury rose before starting, which its authors tie to prior health changes.

Case reports: two men developed liver problems on reishi products, which resolved after stopping.

Case reports: severe liver injury with jaundice after SARM products, usually reversible after stopping. Products were rarely tested, so hidden steroids cannot be ruled out.

Case reports: 15 men had liver injury, myocarditis or tendon rupture after SARMs. Most were athletes taking doses far above those in clinical studies.

FDA states life-threatening reactions, including liver injury needing hospitalization, have occurred with SARM products, and lists potential heart attack, stroke, psychosis and infertility.

The duloxetine label reports a 6-fold rise in its blood levels with fluvoxamine, and a 3-fold rise in desipramine levels when taken with duloxetine.

The labels state that sertraline and paroxetine slow a liver enzyme and can raise levels of drugs it clears. The paroxetine label warns of reduced tamoxifen benefit.

Limited evidence: statins appeared in 9% of FDA autoimmune hepatitis reports, strongest for fluvastatin. Spontaneous reports cannot give a rate or prove cause.

Case reports: one man developed jaundice and raised liver enzymes shortly after starting tongkat ali, improving after he stopped.

One trial found people given trazodone for sleep after alcohol detox improved less in days abstinent and drank more per drinking day after stopping it.

The label states that strong blockers of one liver enzyme raise trazodone levels, inducers lower them, and trazodone can raise digoxin and phenytoin levels.

Case reports: three men developed serious liver or kidney injury after taking tribulus. Case reports cannot give a rate or prove cause.

The label lists dozens of drugs that change warfarin's effect through liver enzymes, including amiodarone, fluconazole, metronidazole, some statins, oral contraceptives, rifampin, carbamazepine and phenytoin.

The label lists hepatitis and raised liver enzymes, allergic reactions, rash, hair loss, nausea and diarrhea among other adverse reactions. It gives no rates.

The label states ketoconazole raised zolpidem exposure and effects, while rifampin lowered them and St. John's wort may lower blood levels. It gives no rate.

The label warns that drugs acting on GABA receptors have been associated with hepatic encephalopathy in people with liver failure, and lists postmarketing reports of liver injury.

Adverse events occurred in about 27% to 31% of users across hundreds of studies, most often digestive, reproductive and skin effects, with 4.7% severe.

Case reports: hepatitis, jaundice and liver failure needing transplant were reported, mostly within 3 months. Experts rated the cases possibly caused by black cohosh.

The Australian label warns black cohosh may harm the liver in some individuals. UK, EU and US Pharmacopeia bodies also require liver warnings.

Shown to raise adverse reactions, mainly liver damage, added to blood pressure drugs in diabetic kidney disease. In lupus nephritis, liver problems matched steroids alone.

Case reports: four women in Korea developed toxic hepatitis after weeks to months of oral aloe. In three, liver enzymes returned to normal after stopping.

One pilot trial found liver enzymes, mainly AST, rose over 6 weeks on extract in 40 adults with obesity awaiting bariatric surgery.

Case reports: liver injury was reported with Petadolex, including nine severe cases and two transplants. Many patients also took other liver-toxic medicines.

The EMA herbal committee lists Petasites among plants with pyrrolizidine alkaloids, linked to liver vein blockage and lung hypertension, and sets an adult limit of 1 µg a day.

Case reports: three women developed hepatitis with jaundice after 20 to 60 days of centella, improving after stopping. In one, it returned when she took it again.

One small study found liver and muscle enzymes rose after a single immersion below 4°C in 13 young men, all staying within non-pathological limits.

Case reports: a 76-year-old woman taking Lyprinol developed acute hepatitis reported as caused by the extract.

Case reports: liver injury in a man taking a horse chestnut supplement and in a man given an injected extract.

FDA states kratom is not appropriate for use as a dietary supplement, and lists reported liver toxicity, seizures and substance use disorder.

Small trials found dizziness, nausea and headache rising with dose, and no serious adverse events. Higher doses raised drug liking ratings.

Case reports: liver injury with jaundice after kratom, mostly improving after stopping, with four cases progressing to liver transplant.

Case reports: rhodiola was named a possible co-cause of liver injury in one patient, with ashwagandha the main suspect.