Drug-induced liver injury
Content date: 14 November 2026
A medicine or supplement can injure liver cells or interfere with bile flow. Raised enzymes alone do not establish the cause; prompt assessment and a clear plan are needed.
Your next step
Prepare a dated medicine and supplement list, including cold remedies and herbal mixtures.
Get urgent help: Possible overdose of paracetamol or another medicine, jaundice with new confusion or unusual drowsiness, bleeding, persistent vomiting or rapid deterioration: go to emergency care; do not wait for a message reply.
What is drug-induced liver injury?
- Injury may follow an overdose, such as excess paracetamol (acetaminophen), or an unexpected reaction to a prescribed dose. It may appear after weeks or months, sometimes after treatment has ended. A supplement labelled “natural” is not necessarily safe.
- Tests may become abnormal without symptoms, or you may develop nausea, fatigue, itching, jaundice or dark urine. Viral hepatitis, blocked bile ducts and other conditions can look similar; symptoms or timing alone cannot confirm the cause.
What should I bring?
- List all medicines, supplements and herbs, including antibiotics, painkillers, weight-loss and bodybuilding products. Bring packaging or ingredient photos, with doses, start and stop dates and any dose changes.
- Bring previous and recent results. Your doctor may check liver function, clotting, alternative causes and imaging; not everyone needs a liver biopsy.
What happens when a product is suspected?
- Contact your doctor the same day for jaundice or new symptoms after a medicine or supplement. When the team suspects a cause, they promptly stop the responsible product and arrange alternatives and monitoring. Do not stop all long-term medicines indiscriminately.
- Do not take another dose of a suspected non-essential supplement or herbal mixture before assessment. Do not restart a medicine known to have injured your liver without specialist advice; repeat exposure can be more severe.
Paracetamol: check for duplicate ingredients
- Cold remedies and painkillers may contain paracetamol under different names. Check ingredients and your permitted dose, particularly with liver disease; do not combine products containing it without advice.
- For a possible overdose, go to the emergency department immediately even if you feel well. Symptoms may be delayed, and early treatment matters. Bring the package and the time and amount taken if known.
After you improve
- Tests may take weeks or months to improve. Continue follow-up until your team confirms recovery or a need for longer monitoring. Avoid products advertised as “liver cleanses”.
- Keep the responsible product in your medical record and medicine list. Tell any prescriber or pharmacist before starting something new. Ask your team to document and report the adverse reaction appropriately.
- You or your healthcare professional can report suspected adverse effects through the Saudi Food and Drug Authority’s Tayaqouth system. A report does not replace assessment or treatment; do not delay emergency care to complete it.
When to get help
Possible overdose of paracetamol or another medicine, jaundice with new confusion or unusual drowsiness, bleeding, persistent vomiting or rapid deterioration: go to emergency care; do not wait for a message reply.
New jaundice, dark urine, severe itching or new abnormal liver tests during or after treatment: contact your team the same day for assessment and medicine advice.
Related guides
Herbs, mixtures and supplements: benefits and risks