Researchers from prominent U.S. universities and a national health system agency have identified 17 medications that show the strongest potential to harm liver health. The findings were reported in a major medical journal focused on internal medicine.
To reach these conclusions, the team examined health records from nearly 8 million individuals provided by the Veterans Health Administration. The data spanned two decades, from 2000 through 2021, and included the most commonly prescribed drugs in the United States. Researchers followed the liver health of participants who did not have existing liver or biliary tract disease to see how different drugs might influence outcomes.
Across the study population, researchers recorded 1,739 hospitalizations due to severe acute liver failure. The frequency of these events varied considerably according to the specific medications taken, highlighting the varying risk profiles among drugs used in routine care.
The analysis identified 17 drugs with the highest hepatotoxic risk. Notably, 11 of these had not previously been classified as highly toxic to the liver. Metronidazole, an antibiotic used for giardiasis, trichomonas vaginitis, and gastric ulcers, appeared under scrutiny for potential liver-related harm.
Other drugs on the high-risk list include stavudine, an antiviral; erlotinib, prescribed for certain cancers; lenalidomide and thalidomide, used in cancer therapy; chlorpromazine and prochlorperazine, both antipsychotics; and isoniazid, a medication for tuberculosis. These findings emphasize that hepatotoxic risk can appear with drugs across different therapeutic classes, including antivirals, anticancer agents, antibiotics, and antipsychotics.
In contrast, the researchers also named eight drug classes that showed relatively low toxicity to the liver. Among these were certain statins used to lower cholesterol, along with several antibiotics and antifungal agents, suggesting that liver safety can vary widely within common medication categories.
Additional context from the study helps explain why some patients experience liver-related side effects while others do not. Factors such as age, overall health, concomitant medications, and existing metabolic conditions can influence how the liver processes a given drug. Clinicians are encouraged to evaluate these risk factors when selecting therapies, monitor liver function where appropriate, and balance benefits against potential harm for each patient. The work contributes to a growing, safety-focused understanding of how everyday medicines can affect liver health over time, underscoring the need for ongoing pharmacovigilance and individualized care. (Citations: JAMA Internal Medicine—study findings and author commentary.)