Calls to poison centers involving liver injuries caused by medications, supplements, alcohol, and other substances jumped nearly 400% between 2000 and 2024, according to a new study from UVA Health published in Clinical Gastroenterology and Hepatology.
Researchers led by UVA's Christopher P. Holstege, MD, looked at liver damage caused by xenobiotics — foreign substances not naturally found in the human body. This category includes drugs, food additives, alcohol, and environmental pollutants. More than 80% of the liver injuries required inpatient care, with the majority of cases stemming from medications.
Acetaminophen was the most frequently implicated substance. The researchers found that exposures from acetaminophen-containing drugs decreased significantly — by 60% to 85% — after the FDA imposed a cap on the amount of acetaminophen allowed in combination prescription products. By contrast, potentially harmful exposures to acetaminophen by itself increased steadily over the 24-year period, indicating that regulatory action successfully reduced liver damage from combination products, while acetaminophen alone remains a leading contributor to liver injuries.
"Xenobiotic-induced liver injuries reported to U.S. poison centers have steadily increased," said Holstege, director of UVA Health's Blue Ridge Poison Center. "The public should be aware of potential liver injury with various substances that are readily available to consumers."
Females had higher rates of acetaminophen-associated liver injury than males, and suspected suicide was the most common reason for exposure in both sexes. Alcohol was a distant second in the top causes of liver injuries, seen more frequently in men than women, with injuries increasing in both sexes during the COVID-19 pandemic.
The study also identified increases in liver injuries caused by stimulants and street drugs, herbal and dietary supplements, and environmental toxins, though these were far less common than acetaminophen and alcohol. The researchers identified a total of 220,160 cases of xenobiotic liver injury over the 24 years reviewed, with population-adjusted exposure rates rising from 10.9 per million people to 52.9 per million.
