Drug-induced liver injury is increasingly caused by cancer medications and antibiotics, with several herbal supplements also posing serious risks. According to Gram Research analysis of 2026 clinical data, while antibiotics remain the most commonly reported cause overall, checkpoint inhibitors (cancer drugs) are now the leading cause in some medical centers. Seven herbal supplements—including ashwagandha, turmeric, and green tea extract—can cause liver damage severe enough to require transplantation in rare cases, though most people recover after stopping the substance.
According to Gram Research analysis, certain medications and supplements can damage your liver in unexpected ways. A 2026 review in The Turkish Journal of Gastroenterology found that antibiotics remain the top culprit, but cancer drugs and immune-boosting medications are increasingly causing liver problems. The research also identified several herbal supplements—including turmeric, ashwagandha, and green tea extract—that can harm the liver in rare cases. Most people recover once they stop taking the problematic substance, but some cases require serious medical intervention. Understanding which drugs and supplements pose risks helps you and your doctor make safer choices.
Key Statistics
A 2026 review in The Turkish Journal of Gastroenterology found that cefazolin, a common antibiotic, can cause liver damage 2-3 weeks after taking just 1-2 doses, with a pattern first documented in the United States and confirmed in Iceland.
In a Barcelona study cited in the 2026 review, cancer drugs—particularly checkpoint inhibitors—became the most frequent cause of drug-induced liver injury, surpassing antibiotics as the leading medication-related cause.
A Turkish study documented that 8% of patients with liver injury from the antibiotic ornidazole required liver transplantation, highlighting the severe potential consequences of certain antibiotic-induced liver damage.
Seven herbal and dietary supplements have been newly recognized as causing drug-induced liver injury: Polygonum multiflorum, ashwagandha, green tea extract, turmeric, Tinospora cordifolia, Garcinia cambogia, and kratom, with some cases resulting in acute liver failure or death.
The Quick Take
- What they studied: Which medications and supplements most commonly cause liver damage, and what patterns doctors are seeing in 2025-2026
- Who participated: This was a review article analyzing data from multiple studies and clinical reports worldwide, including cases from the United States, Iceland, Turkey, and Spain
- Key finding: While antibiotics have traditionally been the leading cause of drug-induced liver injury, cancer medications (especially checkpoint inhibitors) are now emerging as frequent culprits, and several popular herbal supplements can cause serious liver damage
- What it means for you: If you take antibiotics, cancer drugs, or herbal supplements, watch for signs of liver problems like yellowing skin, dark urine, or unusual fatigue. Tell your doctor about all supplements you use, as some popular ones can damage your liver
The Research Details
This was a review article—a type of research where experts examine and summarize findings from many different studies and clinical cases. The researchers looked at patterns in drug-induced liver injury (DILI) cases reported around the world in recent years. They identified which medications and supplements were most frequently causing liver damage and noted new trends emerging in 2025-2026.
The review included cases from multiple countries and healthcare systems, giving a broad picture of what doctors are seeing in clinical practice. Rather than conducting their own experiment, the researchers synthesized information from existing studies, case reports, and clinical observations to identify patterns and emerging concerns.
This approach is valuable because it allows researchers to spot trends across large populations and different regions, revealing which drugs are becoming more problematic and which new substances are causing unexpected liver damage.
Understanding which drugs cause liver injury helps doctors make better decisions about which medications to prescribe and how to monitor patients. By identifying emerging patterns—like the new cefazolin reaction or the increasing role of cancer drugs—doctors can catch liver problems earlier and prevent serious complications. This information also helps patients make informed choices about supplements and medications.
This review synthesizes information from multiple clinical studies and case reports, making it a broad overview rather than a single controlled experiment. The findings reflect real-world observations from doctors and hospitals worldwide. However, because it’s a review rather than a new study with its own participants, the strength of evidence varies depending on the underlying studies cited. The inclusion of cases from multiple countries (US, Iceland, Turkey, Spain) strengthens the findings by showing these patterns occur across different populations.
What the Results Show
Antibiotics remain the most commonly reported cause of drug-induced liver injury overall, but the landscape is changing. A notable new pattern emerged with cefazolin (an antibiotic): after taking just 1-2 doses, some patients develop serious liver problems 2-3 weeks later, with a cholestatic or mixed reaction (meaning bile gets stuck in the liver). This pattern was first documented in the United States and has now been confirmed in Iceland.
In Turkey, researchers identified serious liver damage from ornidazole (another antibiotic), with 8% of affected patients requiring liver transplants—a severe outcome. This highlights how some antibiotics can cause unexpectedly serious liver injury.
A significant shift is occurring in certain medical centers: in Barcelona, cancer drugs—particularly checkpoint inhibitors (medications that boost the immune system to fight cancer)—became the most frequent cause of drug-induced liver injury, surpassing antibiotics. This suggests that as cancer treatments evolve, liver injury from these powerful drugs is becoming more common.
The review also identified seven herbal and dietary supplements linked to liver damage: Polygonum multiflorum, ashwagandha, green tea extract, turmeric, Tinospora cordifolia, Garcinia cambogia, and kratom. While most people recover after stopping these supplements, some cases have resulted in acute liver failure, death, or the need for liver transplantation.
Beyond antibiotics and cancer drugs, analgesics (pain relievers) and recreational drugs are also recognized causes of drug-induced liver injury. The research suggests that medications affecting the immune system are increasingly associated with liver damage, indicating that as medical treatments become more sophisticated, new patterns of liver injury are emerging. The fact that herbal and dietary supplements—often perceived as ’natural’ and safe—can cause serious liver damage is particularly important, as many people don’t report supplement use to their doctors.
Historically, antibiotics have been the leading cause of drug-induced liver injury in most studies. This review confirms antibiotics remain important but documents a significant shift: cancer medications, particularly immune-boosting drugs, are now competing with or exceeding antibiotics as causes in some healthcare settings. The identification of new herbal supplement risks (like ashwagandha and green tea extract) represents emerging knowledge not emphasized in older research. The newly recognized cefazolin pattern is particularly notable as a recent discovery that changes how doctors should monitor patients taking this common antibiotic.
This is a review article synthesizing existing research rather than a new study with its own participants, so the strength of evidence depends on the quality of underlying studies. The sample sizes and study designs of the cases reviewed are not specified. The review may reflect reporting bias—serious cases are more likely to be published than mild cases, potentially overestimating severity. Geographic variation in reporting means some regions may be better represented than others. The review doesn’t provide exact prevalence rates (how common each cause is overall), only which causes are most frequently reported. Finally, because drug-induced liver injury is relatively rare, individual case reports may not represent patterns in the broader population.
The Bottom Line
Strong recommendation: Report all medications and supplements to your doctor, especially antibiotics, cancer drugs, and herbal supplements. Moderate recommendation: If you’re taking cefazolin, be aware that liver problems can develop 2-3 weeks after finishing the medication—report any yellowing of skin, dark urine, or unusual fatigue to your doctor immediately. Moderate recommendation: Avoid herbal supplements with known liver risks (Polygonum multiflorum, ashwagandha, green tea extract, turmeric, Tinospora cordifolia, Garcinia cambogia, and kratom) unless specifically recommended by your doctor. Weak recommendation: If you take cancer medications, discuss liver monitoring with your oncologist.
Anyone taking antibiotics should be aware of potential liver effects. Patients with cancer taking checkpoint inhibitors or other immune-modulating drugs should discuss liver monitoring with their doctor. People taking herbal supplements or considering starting them should know about these risks. Patients with existing liver disease should be especially cautious. Healthcare providers should use this information to guide prescribing decisions and patient monitoring. People should NOT avoid necessary medications out of fear—the benefits often outweigh risks, but awareness allows for better monitoring.
Most drug-induced liver injury develops within weeks to months of starting the medication. For cefazolin specifically, problems typically appear 2-3 weeks after finishing the medication. Most people recover within weeks to months after stopping the offending substance, though some cases take longer. Severe cases requiring transplantation represent a small percentage of all cases.
Frequently Asked Questions
Can antibiotics really damage your liver?
Yes. Antibiotics are the most commonly reported cause of drug-induced liver injury. A newly recognized pattern with cefazolin causes liver problems 2-3 weeks after taking just 1-2 doses. Most people recover after stopping the antibiotic, but some cases are severe.
Are herbal supplements safe for the liver?
Most herbal supplements are safe, but seven have been linked to liver damage: ashwagandha, turmeric, green tea extract, Polygonum multiflorum, Tinospora cordifolia, Garcinia cambogia, and kratom. Most people recover after stopping them, but rare cases require liver transplantation.
What are the warning signs of liver damage from medications?
Watch for yellowing of skin or eyes, dark urine, unusual fatigue, abdominal pain, or nausea. These symptoms can appear weeks to months after starting a medication. Report them to your doctor immediately, especially if you’re taking antibiotics or cancer drugs.
Do cancer drugs cause more liver damage than antibiotics?
In some medical centers, yes. A Barcelona study found that checkpoint inhibitors (cancer drugs) became the most frequent cause of drug-induced liver injury, surpassing antibiotics. However, antibiotics remain the most commonly reported cause overall across all healthcare settings.
Should I stop taking my medications because of liver injury risk?
No. Most people taking these medications don’t develop liver problems. Instead, tell your doctor about all medications and supplements you take, watch for warning signs, and get liver function tests if recommended. The benefits of necessary medications usually outweigh the risks.
Want to Apply This Research?
- Log all medications and supplements with start/stop dates. Track weekly for signs of liver problems: skin color, urine color, energy levels, and any abdominal discomfort. Set reminders to report these observations to your doctor.
- Create a complete medication and supplement list in the app and share it with your doctor before starting any new antibiotic, cancer drug, or herbal supplement. Set alerts for follow-up appointments when starting medications known to affect the liver.
- Maintain an ongoing log of all substances you take with dates. If you experience yellowing skin, dark urine, unusual fatigue, or abdominal pain while taking any medication or supplement, immediately log it and contact your doctor. Review your complete list with your healthcare provider at every appointment.
This article summarizes research on drug-induced liver injury and is for educational purposes only. It is not medical advice. Do not stop, start, or change any medication or supplement without consulting your doctor. If you experience symptoms of liver injury (yellowing skin, dark urine, severe fatigue, or abdominal pain), seek immediate medical attention. People with existing liver disease, pregnant women, and those taking multiple medications should discuss all supplements and over-the-counter drugs with their healthcare provider before use. This information reflects research available as of 2026 and may not cover all individual cases or new developments.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.