What causes

drug-induced liver injury?

Drug-induced liver injury (DILI) is liver damage that happens as a side-effect of taking a medicine.

The information on this page is for:

Adults and children with DILI or suspected DILI.
Family, friends, carers, and healthcare professionals.

Our livers have a lot of different jobs. One of these is breaking down (metabolising) medicines. This usually stops the medicine from continuing to work and helps to remove it from the body.

But sometimes parts of the medicine will still be active after being broken down. Or they can even be changed to a more harmful form. This makes them harder to get rid of. If they build up in the liver, they can cause damage.

It is usually impossible to predict who will develop drug-induced liver injury. Or which medicines will cause it. Some things can increase the risk. But none of these mean someone will definitely get drug-induced liver injury.

Drug-induced liver injury is rare. These things may raise the chance of getting it, but overall the risk stays very low.

On this page:

Things to do with the medicines (drug factors)

How much medicine is taken (dose)

Any medicine is more likely to cause drug-induced liver injury if it is taken at a high dose.

Dose means how much of the active medical ingredient is taken each time. Higher doses might mean taking more of the medicine or taking stronger medicine.

For this reason, doctors might try different doses to find the lowest dose possible for it to work.

Drug to drug interactions

Some medicines will change how other medicines work. Or how the liver breaks them down. This can include some supplements. Including herbal and natural supplements.

In some cases, this can cause drug-induced liver injury, even when both medicines are okay on their own.

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Things to do with you

Age

Drug-induced liver injury can happen in children, but this is very rare.

The chance of developing drug-induced liver injury increases with age. We don’t know exactly why this happens. It could be because of changes in the body as you get older. Or because older people tend to take more medicines. So there is more chance that one of those medicines will cause a problem.

Sex

Drug-induced liver injury is more common in females. We don’t know exactly why. Researchers think that differences in hormones and the immune system could be involved.

Other liver conditions

People with another liver condition may be at greater risk of drug-induced liver injury.

One of the liver’s jobs is to help get rid of medicines. But if the liver is already damaged it is harder for it to do this properly. So the medicines can build up in the liver and cause drug-induced liver injury.

Weight

Being overweight can cause fat to build up in the liver. Over time this can cause scarring and lead to a liver condition called MASLD.

There is some evidence that people living with obesity could also have a higher risk of drug-induced liver injury.

Diabetes

People with diabetes have a higher risk of some liver conditions. There is some evidence that diabetes could increase the risk of drug-induced liver injury. But more research is still needed to understand this link.

Pregnancy

Drug-induced liver injury is thought to be more common in pregnancy. It usually occurs in the first few weeks. This often happens due to medicine taken before the pregnancy was known about.

Smoking and alcohol

Smoking and alcohol both put a strain on the liver. This makes it harder for the liver to do its normal jobs. If the liver can’t break down medicines, they can build up. This build-up may lead to drug-induced liver injury.

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Alternative medicines and supplements

Drug-induced liver injury can be caused by alternative, natural, traditional Chinese, and herbal medicines.

Always tell your doctor about all the medicines you take. This includes supplements, alternative medicines, complementary medicines, and over-the-counter items from a pharmacy.

You should be particularly careful if you already have a liver condition. Or if you are taking other medicines. Talk to your doctor if you want to try alternative medicines or supplements. And talk to a pharmacist about possible interactions with your other medicines.

There are no alternative medicines or supplements that have been shown to help treat drug-induced liver injury. They seem to be more likely to cause it or make it worse.

Complementary and alternative medicines

Vitamins and supplements

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Useful links
Drug induced liver injury
Causes
Symptoms
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Tests
Treatment
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This content was last reviewed: February 2026

Our expert reviewers:

We would like to thank everyone who helped with creating and reviewing this page. Including Catherine Wood, virtual hepatology nurse specialist. Dr Hyder Hussaini, consultant hepatologist. And all our patient reviewers.

Find out how we make our patient information.

Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.