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What Recreational Drugs Cause Liver Damage? Drugs and Liver Disease

Liver disease

The Function of the Liver

The liver plays an extremely important role in the body. It ensures the removal of toxins and has numerous other functions, including:

  • Fat metabolism: Liver cells—or hepatocytes—are able to process dietary and stored fats into energy. In addition, the liver acts as a key player in our exocrine systems by producing bile acids, which are secreted into our digestive tracts. There, they function to break down and facilitate the intestinal absorption of fats that we consume in our diet. Supplementing this activity, the liver also synthesizes cholesterol to aid in fat transport.
  • Carbohydrate metabolism: The liver helps to regulate blood sugar by utilizing stored glycogen when glucose levels are low and removing it from the blood when levels are high.
  • Protein metabolism: The liver breaks down proteins and converts amino acids into useable energy, or further processes them into needed macronutrients. Ammonia is a toxic byproduct of this process. As ammonia builds up, the liver further modifies it into a chemical known as urea, which travels to the kidneys, where it is safely released in urine.

Other functions of the liver include:1,2

  • Producing circulating proteins that help blood clot normally.
  • Breaking down old blood cells.
  • Processing the hemoglobin protein found in red blood cells in order to salvage/recycle the iron that it contains.
  • Storing minerals (such as iron) and vitamins to release when necessary.
  • Removing bacteria and other foreign bodies from the bloodstream.
  • Eliminating excess bilirubin, a component released from red blood cells that are damaged or otherwise at the end of their lifecycle which can be harmful to the body and brain.

How the Liver Metabolizes Drugs

When blood enters the liver via the portal vein, it carries nutrients, as well as drugs and other toxic substances the individual may have consumed.1 The liver’s job is to detoxify these drugs and remove the byproducts resulting from the process of metabolism.1

The majority of drugs are fat-soluble, meaning that they are difficult to pass in urine. The enzymes in the liver work to break down these substances and convert them into water-soluble forms, which can then pass in bile and/or urine.

A hepatocyte, or liver cell, contains several sub-cellular organelles that serve as the primary sites of drug metabolism. Additionally, there are dozens of hepatic enzymes that contribute to a complicated chain of events that eventually result in the breakdown of drugs (and other liver toxins).

Not everyone metabolizes drugs at the same rate. Different genetic and physiological characteristics can influence the speed at which an individual metabolizes a drug. A few influential factors are as follows:

  • Sex.
  • Age.
  • Inherited enzyme structure.
  • The flow of substances from the liver to the bile.
  • Microorganisms present in the gut.
  • Overall nutrition.

Certain medical conditions can slow drug metabolism. These include:

Even different drugs themselves can alter the rate of metabolism. Some drugs fall into the class of enzyme inducers, which boost metabolism, while others are classified as enzyme inhibitors, which reduce the speed at which a drug is broken down.

In many cases, the liver is able to metabolize drugs (and other toxins) without significant damage to the organ itself. However, when persistent detoxifying demands are made of the hepatic system—for example, when drugs are taken in excess, when the frequency of drug use is daily or hourly, or when multiple substances are consumed simultaneously—can cause significant, cumulative liver damage from drugs.

Drug-Induced Liver Injury (DILI)

damaged liver due to substances
Drug-Induced Liver Injury (DILI) occurs when the consumption of a substance, such as a drug, nutritional supplement, medicinal herb, or plant, causes direct damage to the liver. In some cases, there might not be any symptoms, which can allow damage to go unnoticed.3

While some drugs—such as acetaminophen (also known as Tylenol)—elicit predictable and dose-dependent effects on the liver, others may have unforeseeable results, oftentimes unrelated to dose.3 DILI typically occurs within 3 months of beginning a drug, but this timeframe can vary from a couple hours to a year after drug initiation.4

Drug-Induced Hepatitis

One example of DILI is drug-induced hepatitis, which is characterized by inflammation of the liver.5 This condition can be caused by a number of different drugs. Below are just a few of the many medications that can cause drug-induced hepatitis:5

These drugs, among others, can cause drug-induced hepatitis even at moderate doses. It’s important that you take your medication exactly as prescribed and avoid drinking alcohol while taking it.5

If you have drug-induced hepatitis or any other drug-induced liver damage, your physician will likely tell you to stop taking your medication immediately.5 The symptoms usually dissipate once an individual stops taking the drug, although medical treatment may be necessary in cases of excessive acetaminophen consumption.5

Alcohol and the Liver

When alcohol reaches the liver, it is broken down and excreted through urine. This process produces many harmful by-products—such as free radicals and acetaldehyde—that may play a part in liver toxicity.8 If it is consumed in moderation, the liver typically has no problem with alcohol metabolism, but chronic and long-term alcohol abuse can lead to significant liver damage.8

2 major conditions caused by excessive alcohol consumption are cirrhosis and alcoholic hepatitis.


Cirrhosis is characterized by scarring of the liver, which blocks the flow of bile and blood and inhibits proper functioning. The harm caused by cirrhosis of the liver is irreversible, but early detection can prevent further damage.9

Some signs and symptoms of cirrhosis include:9

  • Redness of palms.
  • Mental confusion.
  • Hand tremor (asterixis).
  • Jaundice (yellowing of skin and eyes).
  • Weight loss.
  • Nausea.
  • Fatigue.
  • Abdomen swelling (peritoneal ascites).
  • Swelling of limbs (peripheral edema).
  • Generalized edema (anasarca).
  • Itching.

Alcoholic Hepatitis

Alcoholic hepatitis, which is often seen in heavy drinkers, often co-occurs with cirrhosis10 and is most often seen in people between the ages of 40- and 60-years-old.11 Alcoholic hepatitis is fatal in approximately 30-50% of those affected by the disease.11

Liver with Hepatitis

Some signs and symptoms of alcoholic hepatitis are:10

  • Enlarged liver.
  • Fever.
  • Rapid heart rate.
  • Pain in right upper quadrant (abdominal region below right ribcage).
  • Jaundice.

Individuals with alcoholic hepatitis may have a variant of the disease called alcoholic steatohepatitis, which presents as pathological fat accumulation in the liver. It is caused by an increased production of fatty acids due to poor nutrition.12

Severe forms of alcoholic hepatitis may lead to the following complications:10

  • Portal hypertension (high blood pressure in the liver’s major vein).
  • Deficient clotting mechanisms leading to bleeding issues.
  • Kidney failure.
  • Hepatic encephalopathy (brain dysfunction due to liver damage and accumulation of toxins in the blood).

Individuals afflicted with alcoholic hepatitis are more vulnerable to infections, such as:10

  • Tuberculosis.
  • Bacterial peritonitis.
  • Bacterial pneumonia.
  • Urinary tract infections.

Although not actually caused by alcohol use, hepatitis C, which is an infection leading to liver inflammation,20 is very common among those who abuse alcohol.19 Chronic hepatitis C that goes untreated can lead to liver damage and liver cancer.20

Those with hepatitis C who consume alcohol are at increased risk of developing liver disease and cirrhosis.19 For this reason, patients who are diagnosed with hepatitis C should abstain from drinking any alcohol.

Drugs That Can Damage the Liver

There are certain drugs and drug classes that have a higher likelihood of damaging the liver. These substances include:3,5,7

Prescription Drugs

  • Antibiotics:
    • Erythromycin.
    • Amoxicillin-clavulanate.
    • Tetracyclines (doxycycline, minocycline, tetracycline).
  • Antipsychotic drugs:
    • Risperidone.
    • Chlorpromazine.
  • Statins (treats high cholesterol).
  • Antifungal drugs:
    • Terbinafine.
    • Ketaconazole.
  • Antihypertensives:
    • Lisinopril.
    • Captopril.
    • Methyldopa.
  • Halothane (anesthetic).
  • Birth control pills.
  • Antidepressants:
    • Setraline.
    • Fluoxetine.
    • Bupropion.
  • Anticonvulsants:

Other Drugs That Cause Liver Damage

  • Supplements and herbs (can lack thorough testing and are not tightly regulated):
    • Comfrey tea.
    • Chaparral.
    • Skullcap.
    • Kava.
    • Excess vitamin A and iron.
    • Pyrrolizidine alkaloids.
    • Camellia sinensis (in black and green tea).
    • Pennyroyal oil (used in production of teas).
  • Over the counter pain-relievers:
    • Acetaminophen.
    • Nonsteroidal anti-inflammatory drugs:
      • Naproxen.
      • Ibuprofen.
  • Anabolic steroids
  • Recreational and illicit drugs: 
  • Heroin.13
  • Inhalants.14
  • Cocaine.15
  • MDMA or Ecstasy.16
  • Methamphetamine.17

Symptoms of Liver Damage

If you or someone you love may be at risk of substance-induced hepatic injury, it is vital that you are aware of the signs and symptoms of liver damage so that you can seek medical attention immediately.

Symptoms of liver damage include:5,18

  • Dark urine.
  • Fever.
  • Pain in the abdomen.
  • Nausea.
  • Vomiting.
  • Headache.
  • Diarrhea.
  • White stools.
  • Rash.
  • Build-up of fluid in the abdominal cavity.
  • Jaundice (yellowing of eyes and skin).
  • Enlarged liver.
  • Fatigue.
  • Weight loss.
  • Loss of appetite.

Preventing Liver Damage Due to Drugs

There are many different things you can do in order to prevent liver damage. Be mindful of the following tips:5,7

  • Don’t take more than the recommended dose of acetaminophen or other non-prescription medications.
  • Don’t take the maximum recommended dose for an extended period of time.
  • Follow your doctor’s prescribing instructions carefully.
  • Avoid drinking alcohol while taking medication.
  • Inform your physician of the drugs and supplements that you are currently taking.
  • If you suffer from liver disease, avoid taking drugs containing acetaminophen or phenytoin (Dilantin) and consult with your doctor about any other contraindicated pharmaceuticals.
  • If you abuse drugs or alcohol, seek addiction treatment to help you get clean.

Finding Substance Abuse Treatment

If you or someone you love is struggling with substance misuse or addiction, it’s important to know that there is help out there. American Addiction Centers (AAC) owns and operates a 24/7 addiction helpline that can answer your questions about substance abuse, connect you with suitable rehab centers, and verify your insurance benefits. Recovery is possible. Please call us today free at to get started.

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