hepatotoxicity
11 interactions related to hepatotoxicity
fluoxetine + kava
Kava carries a documented risk of hepatotoxicity and produces CNS depression, and combining it with fluoxetine raises the risk of additive sedation and liver injury. Kava also inhibits CYP2D6 and CYP3A4, the enzymes that metabolize fluoxetine, which can elevate fluoxetine levels and side effects.
sertraline + kava
Kava (Piper methysticum) has central nervous system depressant effects and a documented risk of hepatotoxicity, and combining it with sertraline raises the risk of additive sedation and liver injury. Sertraline itself is associated with hepatic adverse effects in a small subset of users, and stacking hepatotoxic agents is discouraged.
diazepam + kava
Kava's kavalactones bind GABA-A receptors and produce additive central nervous system depression when combined with diazepam, a long-acting benzodiazepine. Concurrent use is not recommended due to risk of excessive sedation, impaired coordination, and potential additive hepatotoxicity.
alcohol + kava
Kava and alcohol both depress the central nervous system through GABAergic and other mechanisms, producing additive sedation and motor impairment. More importantly, both substances are hepatotoxic, and concurrent use significantly increases the risk of severe liver injury, including cases of fulminant liver failure requiring transplantation.
noni juice + warfarin
Noni juice (Morinda citrifolia) products vary substantially in vitamin K content - one published case of warfarin resistance was attributed to a high-vitamin K noni preparation. Noni has also been linked to drug-induced liver injury and may induce CYP2C9, both of which can destabilize warfarin in unpredictable directions.
alcohol + duloxetine
Duloxetine (Cymbalta) and heavy alcohol use both can damage the liver. The FDA-approved label explicitly states that Cymbalta should not be prescribed to patients with substantial alcohol use because the combination has been linked to severe, sometimes fatal, hepatotoxicity in clinical trial data.
alcohol + statins
Statins and alcohol are both metabolized by the liver and can independently raise transaminases; combined heavy use increases the risk of hepatotoxicity and, in some cases, myopathy or rhabdomyolysis. Atorvastatin plasma levels rise sharply in patients with alcoholic liver disease.
rooibos tea + liver enzymes
Rooibos (Aspalathus linearis) is generally well tolerated, but rare case reports describe transient elevations in liver enzymes (AST, ALT) and one report describes acute liver injury after heavy consumption. Rooibos can also modulate hepatic CYP450 enzymes in vitro, creating a theoretical risk of altering metabolism of co-administered drugs.
alcohol + celecoxib
Celecoxib combined with alcohol increases the risk of gastrointestinal bleeding and ulcers, though somewhat less than non-selective NSAIDs because celecoxib spares COX-1 and has minimal platelet effects. The combination also increases liver enzyme elevations and kidney injury risk through additive effects on hepatic metabolism and renal perfusion.
alcohol + vitamin a
Alcohol depletes hepatic vitamin A by inducing cytochrome P450 enzymes (especially CYP2E1, CYP26A1, CYP26B1) that catabolize retinol. Paradoxically, vitamin A supplementation in heavy drinkers is hepatotoxic — alcohol potentiates retinol's toxicity to liver cells, and high-dose beta-carotene combined with alcohol increases liver injury.
cbd + valproate
Concomitant CBD (Epidiolex) and valproate use produces a significantly higher rate of ALT/AST elevations than either drug alone - up to ~17% of patients in the combination group versus ~1-2% on valproate alone in pooled Epidiolex trial data. Postmarketing reports also describe hyperammonemia in patients on the combination.