How medications can harm the liver

Liver disease can change the way your body handles medications in several ways:

• Slower processing. The liver uses enzymes to break down medicines. When the liver isn't working well, this process slows down. Medicines can stay in your body longer than they should.
• More medications reach the bloodstream. When you take a pill, the medicine is partly filtered by the liver before it reaches the rest of the body. This is called first-pass metabolism. In liver disease, more of the medicine may bypass this step, allowing more of the medicine to go directly into your system. This can make the medicine stronger or last longer.
• Changes in how medicine travels through the body. Medications often attach to proteins in the blood, such as albumin. A damaged liver may make less albumin, leaving more free, also known as unattached, medicine in the blood. This can increase side effects.
• Problems getting rid of medications. The liver and kidneys work together to remove medicines from the body. If the liver isn't working well, medicine may build up and cause harm.

Because of these changes, people with liver disease are at a higher risk of medication-related side effects and drug interactions. And people who don't have liver disease are at risk of a condition called drug-induced liver injury (DILI).