Review Finds Herbal and Dietary Supplements Responsible for Increasingly Large Number of Drug-Induced Liver Injuries

Antibiotics remain a consistent problem, but herbal and dietary supplements now cause a higher percentage.

Aug. 27, 2026

Key Highlights

- Antibiotics, once the leading cause of drug-induced liver injury, now account for a smaller proportion of cases in Western countries.
- Herbal and dietary supplements, including green tea extract and turmeric, have seen a rise in liver injury reports, especially between 2008 and 2018.
- Approximately 15 million Americans use potentially hepatotoxic herbal supplements, increasing the risk of acute liver failure.
- Newer cancer treatments like immune checkpoint inhibitors and kinase inhibitors are increasingly linked to liver injury.
- The changing causes of liver injury highlight the need for increased awareness and monitoring of both traditional and alternative therapies.

A new review in Hepatology Communications found that the causes of drug-induced liver injury have changed over the last 20 years.

The most common drugs implicated in liver injury in western countries are antibiotics, which remains consistent with past findings. The proportion attributable to antibiotics, as well as anti-tuberculosis drugs and aromatic anticonvulsants, has decreased, however, as herbal and dietary supplements and cancer treatments have become more common causes.

Some of these herbal and dietary supplements include ashwagandha, turmeric, and green tea extract. Green tea extract in particular is often marketed as preventing liver disease. Acute liver failure caused by herbal and dietary supplements rose to 22% in 2008-2018, compared to 9.7% from 1998-2007. As many as 15 million Americans take one of six herbal supplements that may be toxic to the liver.

Immune checkpoint inhibitors, which are commonly used in cancer treatment, are also newer causes of liver injury. Kinase inhibitors, used in the treatment of certain cancers, as well as autoimmune and inflammatory conditions, and anti-tumor necrosis factor inhibitors, used for the treatment of Crohn's disease and ulcerative colitis, are also more prominent newly reported causes.