hepatotoxicity
12 interactions related to hepatotoxicity
alcohol + red yeast rice
Red yeast rice contains monacolin K, chemically the same as a statin, which carries a small, uncommon risk of liver injury. Alcohol is also hard on the liver, so combining the two — especially heavy or regular drinking — can add to the strain on the same organ.
diazepam + kava
Kava's kavalactones act on the GABA-A receptor, the same system diazepam enhances, so combining them produces additive central nervous system depression and excessive sedation. A published case report describes a man who became semicomatose within days of adding kava to a benzodiazepine. Kava also carries a separate, documented liver-safety signal.
fluoxetine + kava
Kava carries a well-documented risk of serious, unpredictable liver injury and acts as a central nervous system depressant, so combining it with fluoxetine raises concern about additive sedation and liver harm. Kava also inhibits the liver enzymes that clear fluoxetine, though this has only been shown in laboratory studies and any rise in fluoxetine levels in people remains theoretical.
sertraline + kava
Kava (Piper methysticum) is a central nervous system depressant with a documented risk of serious liver injury, and combining it with sertraline raises the chance of additive sedation and additive liver stress. Kava also inhibits drug-metabolizing enzymes, and a case report describes prolonged serotonin syndrome in a patient taking kava alongside a serotonergic antidepressant.
alcohol + kava
Kava and alcohol both depress the central nervous system, producing additive sedation and impaired coordination. More importantly, both are hepatotoxic: kava is a well-documented cause of severe and occasionally fatal liver injury, and alcohol adds a second liver stressor.
noni juice + warfarin
Noni juice (Morinda citrifolia) products vary widely in vitamin K content, and 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, which can secondarily destabilize warfarin. The interaction is real but rests on case reports rather than large studies.
alcohol + duloxetine
Duloxetine (Cymbalta) can occasionally cause liver injury, and its FDA label advises against prescribing it to people with substantial or chronic alcohol use or existing liver disease, because both substances stress the liver. Documented cases have generally been reversible after stopping the drug, with no clear pattern of alcohol-linked liver failure in the published case series.
alcohol + statins
Statins and alcohol are both processed by the liver, and heavy or chronic combined use can add to the strain on liver cells, modestly raising the risk of liver enzyme elevation and, less commonly, muscle problems. In people with established alcohol-related liver disease, statin levels in the blood can run higher than normal. For most people who drink lightly to moderately, a statin is still safe with routine monitoring.
rooibos tea + liver enzymes
Rooibos (Aspalathus linearis) is generally well tolerated. A small number of case reports describe transient elevations in liver enzymes (AST, ALT) with heavy or prolonged consumption, though the clearest acute-injury report involved rooibos taken together with another herb rather than rooibos alone. Laboratory (in vitro) work suggests rooibos can modulate hepatic CYP450 enzymes, which raises a theoretical, unproven possibility of affecting the metabolism of some co-administered drugs.
alcohol + celecoxib
Combining alcohol with celecoxib increases the risk of gastrointestinal irritation, ulcers, and bleeding, and adds stress to the liver and kidneys. Celecoxib's COX-2 selectivity makes it gentler on the stomach than older NSAIDs, but the FDA label still names alcohol as a factor that raises GI-bleeding risk.
alcohol + vitamin a
Alcohol depletes the liver's vitamin A by inducing cytochrome P450 enzymes (notably CYP2E1) that break retinol down into toxic byproducts. Adding high-dose vitamin A or beta-carotene supplements on top of regular drinking can worsen liver injury rather than correct the deficiency, so repletion in drinkers is not as simple as taking a pill.
cbd + valproate
Taking CBD (including prescription Epidiolex and over-the-counter products) together with valproate raises the chance of liver enzyme elevations well above either drug alone, and the combination has been linked to high blood ammonia that can cause confusion or worsening seizures even when liver tests look only mildly abnormal. This pairing should be managed by the prescribing neurologist with baseline and follow-up liver testing.