Medical Oncologist
CION Cancer Clinics
Drug-induced liver injury: symptoms, causes and recovery | CION Cancer Clinics
Drug-induced liver injury happens when a medicine, supplement or herbal product damages the liver. In most people it settles once the cause is found and stopped. It is usually not cancer, though the two can be confused in both directions. This page explains the symptoms, which products are usual causes, when to go to hospital the same day, and how doctors decide whether a scan is needed. At CION Cancer Clinics, our team goes through your scan, blood test and biopsy reports with you and plans the next step.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What is drug-induced liver injury, and does it get better?
- Which medicines and products most often affect the liver?
- How do doctors work out whether a medicine is the cause?
- Is it the medicine, or something that needs a scan?
- What families often think about medicines and the liver
- What this page cannot tell you
- Common questions about medicines and liver injury
The short answer
What is drug-induced liver injury, and does it get better?
Drug-induced liver injury means a medicine, a supplement or a herbal product has irritated or damaged the liver. In most people it settles once the cause is found and stopped, and the blood tests drift back towards normal over the following weeks.
It is common, it is usually not cancer, and it is often found by accident on a routine blood test. Many people feel nothing at all. Others notice tiredness, a dull ache under the right ribs, nausea, dark urine, itching or yellow eyes. Those symptoms overlap with almost every other liver problem, which is why this condition is so often confused with something more serious.
Why it sits on a liver cancer site
The confusion runs both ways. A person on long-term medicine can be sent for scans and told to fear the worst, when the liver is simply reacting to a tablet. And a person whose liver tests are blamed on a tablet can have a real tumour that is missed for months. Neither should happen, and the way to avoid both is the same: a careful list of everything taken, a clear plan for the blood tests, and a scan when the numbers do not behave as expected.
This page is about liver injury from medicines, not about cancer that has started in or spread to the liver.The usual suspects
Which medicines and products most often affect the liver?
Almost any medicine can do it in a rare person. A few groups turn up again and again.
Everyday painkillers taken wrongly
Paracetamol is safe at the dose on the label for most people. The harm comes from taking more than prescribed, or from several cold and pain remedies that each contain it, taken together without realising.
Antibiotics and anti-TB medicines
Some antibiotics, and the standard TB combination in particular, are well known for raising liver enzymes. TB treatment has its own page, because it is so common in India.
Herbal, Ayurvedic and bodybuilding products
"Natural" does not mean gentle on the liver. Liver tonics, weight-loss and muscle-building supplements are a frequent cause, and people often forget to mention them because they do not think of them as medicine.
Cancer treatment itself
Chemotherapy, targeted drugs and immunotherapy can all affect the liver. Your oncology team checks the blood tests before each treatment for exactly this reason.
Also seen with
- Some epilepsy and seizure medicines
- Some antifungal tablets
- Some medicines for thyroid and joint conditions
Not sure whether this applies to you?
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When to go to hospital today
Go to hospital the same day if yellow eyes or skin appear together with fever, vomiting that will not stop, new confusion or drowsiness, bleeding or easy bruising, or severe pain in the abdomen. Go at once if someone may have taken too much paracetamol, even if they feel well. If you are on any medicine and notice dark urine, pale stools or yellow eyes without those signs, do not stop anything on your own, but call the doctor who prescribed it this week.
What the doctor does next
How do doctors work out whether a medicine is the cause?
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A complete list of everything you take
Prescription tablets, anything bought over the counter, herbal powders, tonics, gym supplements and anything a relative brought from another town. Bring the strips and bottles themselves if you can.
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Matching the timing
The doctor asks when each one was started. Liver injury from a medicine usually appears within the first few weeks or months of starting it, though some appear later.
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Ruling out the other causes
Blood tests for hepatitis viruses, an ultrasound of the liver and bile ducts, and questions about alcohol. A medicine is blamed only after the common alternatives have been looked for.
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Stopping or changing the likely culprit
This is a decision for the prescribing doctor. Some medicines, such as TB or seizure treatment, cannot simply be dropped and must be replaced safely.
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Repeating the tests
If the numbers fall after the change, that supports the diagnosis. If they do not, the doctor looks again, and a scan or a specialist opinion becomes more important.
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Telling them apart
Is it the medicine, or something that needs a scan?
Points towards a medicine
Points towards looking further
Tests rose soon after a new medicine was started
Tests were abnormal before any new medicine
Tests improve once the medicine is changed
Tests stay high or keep rising after the change
Ultrasound shows a normal liver and bile ducts
A scan shows a lump, a blocked bile duct or a scarred liver
Weight and appetite are steady
Weight loss, a hard lump or swelling of the abdomen
Commonly believed
What families often think about medicines and the liver
"Herbal medicines cannot harm the liver because they are natural."
Herbal and Ayurvedic products are among the more common causes of liver injury seen in clinics. That does not mean you will be scolded for taking them. It means your doctor needs to know, so the real cause is not missed.
"Raised liver enzymes mean the liver is failing."
Enzymes show that liver cells are irritated. How well the liver is actually working is judged from other results, such as bilirubin, albumin and the clotting test. Raised enzymes alone often settle without lasting harm.
"A liver tonic will protect me while I take strong medicines."
There is no good evidence that a tonic protects the liver from a medicine. Adding one gives the liver another product to handle and makes it harder to tell which one caused a problem.
"If my tests are high, I should stop all my tablets."
Stopping heart, seizure, TB or diabetes medicine suddenly can be dangerous. Call the prescribing doctor first, so the right medicine is changed and the others are kept going.
Being straight with you
What this page cannot tell you
It cannot tell you whether your raised liver tests are caused by a medicine, by a virus, by fat in the liver or by something that needs a scan. Only a doctor who has your full medicine list, your blood results over time and, where needed, an ultrasound can work that out. Our page on reading a liver function test explains what each value on the report means.
Who this does not apply to
If you already have cirrhosis or liver cancer, the rules about which medicines are safe are different and stricter. See medicines to avoid with cirrhosis. If you are on immunotherapy, a rise in liver tests can be an immune reaction rather than a simple drug effect, and it is handled differently; read about immune hepatitis from immunotherapy.
Who to ask
Start with the doctor who prescribed the medicine. If you are a cancer patient, call your oncology team before your next dose. At CION, the medical oncology team reviews liver tests before every cycle and coordinates a hepatologist's opinion through partner hospitals when one is needed.
Questions we are asked
Common questions about medicines and liver injury
How long does it take the liver to recover?
Most people see their blood tests improve within a few weeks of stopping the cause, and many are back to normal within a few months. Some injuries, especially those with jaundice, take longer. Your doctor will repeat the tests at intervals to make sure the trend is going the right way.
Can drug-induced liver injury turn into cancer?
A single episode that settles is not known to lead to liver cancer. The concern is long-term, repeated damage that leads to scarring, which is uncommon with medicines. If your tests never return to normal, your doctor will look for another cause, including with a scan.
Will I be able to take the same medicine again?
Usually the medicine that caused a clear injury is avoided afterwards, because a second reaction can be faster and worse. Sometimes, as with TB treatment, doctors carefully reintroduce medicines one at a time under close blood monitoring. That is always a doctor's decision.
Can I keep taking paracetamol for pain?
For most people, yes, within the limit your doctor sets. Check the labels of cold and flu remedies, which often contain it too. People with liver disease may be given a lower limit. Our page on why paracetamol is often still allowed explains why.
Do I need a scan if my liver tests are raised?
Often an ultrasound is done to check the liver and bile ducts, even when a medicine is the likely cause. A scan becomes more important if the tests keep rising after the medicine is changed, or if there is weight loss, a lump or swelling. A raised test alone does not mean cancer.
Should I tell the doctor about the herbal powder I take?
Yes. Bring the packet or a photo of the label. Doctors ask because these products are a common and easily missed cause of liver injury, not to judge you. Leaving it out can lead to the wrong medicine being stopped. The page on herb-induced liver injury covers this.
Can chemotherapy be given if my liver tests are high?
Sometimes the dose is changed, the cycle is delayed or a different drug is chosen until the tests settle. It depends on the drug, how high the values are and why they are raised. Your oncologist decides this before each cycle, which is why the blood test is never skipped.
Who should I call if I notice yellow eyes on treatment?
Call the doctor who prescribed the medicine on the same day. If you are a cancer patient, call your oncology team. If the yellow eyes come with fever, confusion, bleeding or vomiting, go to hospital today rather than waiting for a call back.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- MedlinePlus — Liver Diseases
- MedlinePlus — Liver Function Tests
- MedlinePlus — Herbal Medicine
- NHS — Jaundice
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Anti-TB medicines and liver damageThe most common medicine cause of liver injury in IndiaRaised liver enzymes on a routine blood testWhat to do when a routine report comes back highHerb-induced liver injury explainedWhen the cause is a herbal or Ayurvedic productJaundice that is not cancerThe other common reasons for yellow eyes
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Send us your recent liver reports and your medicine list, and an oncologist can go through them with you. One helpline serves every CION centre.