4. Antiseizure medications
What they are: These medications are used to prevent and treat seizures and certain types of nerve pain.
Common names: phenytoin (Dilantin), carbamazepine (Tegretol)
How they affect the liver: Antiseizure medications such as phenytoin (Dilantin) and carbamazepine (Tegretol) can prompt an abnormal immune response in the liver, sometimes called hypersensitivity syndrome, which can damage nearby tissues. Medications like valproic acid (Depakene) and lamotrigine (Lamictal), can also affect the liver. Liver injury may appear within days to months after starting treatment and can be severe in rare cases.
Tips to lower your risk of injury: If you are prescribed these medications, your health care provider may perform blood tests to check your liver health. Depending on test results, they may adjust your dose or switch you to a different medication.
5. Methotrexate
What it is: Methotrexate is a prescription drug used to treat rheumatoid arthritis, certain cancers and autoimmune diseases.
Common names: Trexall, Rheumatrex
How it affects the liver: Methotrexate can harm the liver, especially if taken for a long time or at high doses. (People taking the drug short-term may not be affected.) It may cause liver inflammation and, over time, lead to scarring (fibrosis) or serious liver disease (cirrhosis). The risk increases if you drink alcohol or already have liver problems.
Tips to lower your risk of injury: If this is prescribed, your health care provider may test your liver with blood work and adjust your medication if needed. Discuss your treatment plan with your doctor, and avoid alcohol while taking this medication.
6. Nonsteroidal anti-inflammatory drugs (NSAIDs)
What they are: NSAIDs are OTC medications used to treat pain, inflammation and fever.
Common names: ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac (Voltaren)
How they affect the liver: NSAIDs are usually safe for short-term use at recommended doses. However, taking them for a long time, at higher doses or combining with alcohol can put stress on the liver and, in some cases, cause liver damage. People with liver conditions or those taking multiple medications that affect liver function are at higher risk.
Tips to lower your risk of injury: Before using NSAIDs, check with your health care provider. They may recommend starting with the lowest dose for the shortest time or may suggest an alternative.
7. Certain herbal and dietary supplements
What they are: Herbal and dietary supplements are often marketed for various health benefits, but some can cause damage to the liver. Kava and black cohosh are two examples.
Common names: kava (Piper methysticum), black cohosh (Cimicifuga racemosa)
How they affect the liver: Kava is used for anxiety and insomnia and has been associated with rare but potentially serious liver damage, though the exact cause is unclear. Black cohosh, often used for menopause symptoms, has been linked to liver problems such as a rise in liver enzymes and liver failure. Dozens of cases of liver injury linked to these supplements have been reported in the U.S.
Because the FDA does not regulate or approve herbal or dietary supplements in the same way it does other medications, ingredients in marketed products can vary, and some may contain harmful substances.
Tips to lower your risk of injury: Be a savvy consumer and know that “natural” doesn’t always mean safe. Always talk to your doctor before using supplements, and avoid using these supplements if you have existing liver problems.