Don’t just pop pills – their side effects may outweigh their benefits!

It is important not to simply pop pills. The body must be able to process by altering its form and utilize the amount that is beneficial and be able to eliminate the rest successfully.

Most of this processing occurs in the liver. If there is already a preexisting liver disorder and damage, the capacity to eliminate is lost by the liver and the drug can build up and cause toxic side-effects.

Paracetamol (acetaminophen) is the most widely used over-the-counter painkiller in the world. It is one the most common causes of medication overdose in the West, the data from India as such is insufficient - a 10 year retrospective hospital based study reported less than 1% of acute paracetamol overdoses, while another report covering Asians including Indians over 5 years found the rate of liver toxicity with paracetamol to be 7%.

Paracetamol overdose can cause serious liver damage that can lead to acute liver failure. Paracetamol-linked liver failure is so severe that the patient would need a liver transplant to survive. Paracetamol is an effective treatment for mild to moderate pain and fever in adults and children, when used as directed. The minimal amount of paracetamol known to cause liver toxicity in adults is usually associated with paracetamol doses of > 10 g/day.

Many other drugs can affect the way the liver functions, damage it, or do both. Statins are medications used in the treatment of high cholesterol. These medications can increase the levels of liver enzymes and cause minor liver damage without leading to any symptoms appearing. So, doctors recommend regular blood tests to monitor liver enzyme levels in persons taking statins. 

Hormonal contraceptives can cause jaundice. Antibiotics, anti-tuberculous drugs are also commonly cause liver toxicity. The regulatory authorities recommend taking dietary supplements with caution as several instances of liver damage has been reported. Non-steroidal anti-inflammatory medications such as diclofenac, ibobrufen also have been found to cause liver damage.

While, the genetic make-up can make a person more susceptible to a drug's effects, there is no easy way to identify the people who might be vulnerable. An aging population is more likely to be taking several different types of medications. Some of the elderly are fragile with a higher risk for liver damage.

Usually, stopping the drug results in a recovery. If possible, an antidote that reverses the toxic effect can be used. Acetylcysteine can be used in paracetamol overdose, though a liver transplant is needed when there is serious liver damage.

It is important to keep the liver healthy. It is almost never safe to mix alcohol and medications. Finally, only take medications in the recommended doses and never advocate over-the-counter use of medicines. Govt of India should pass a legislation to make prescriptions mandatory to purchase medicines in pharmacy.