Every week, Dr. Kavya Harika Dendukuri, Lead Hepatologist at Gleneagles Hospitals Lakdikapul Hyderabad, sees patients wheeled into her liver unit with acute hepatitis or drug-induced liver failure. And most of the time, the culprit isn’t what you’d expect. It’s not usually alcohol. It’s a painkiller someone bought at a pharmacy without a prescription. An antibiotic a neighbour recommended. A supplement they ordered online that promised to detox their liver. The cruel part is that these patients were often trying to protect their health. They were just doing it wrong.“The very organ patients were trying to protect is the one quietly dying,” says Dr. Dendukuri.India has a particular relationship with medication. We buy, we self-prescribe, we share what worked for us with whoever asks. A 2023 report estimated that nearly 60% of Indians self-medicate without consulting a doctor. That makes India the world’s largest consumer of over-the-counter medications, and it’s creating a silent health crisis that most people don’t even know they’re at risk for.The problem is that the liver doesn’t complain until it’s too late.Red, yellow, and green bell peppers are not the same: What their colours actually tell you about nutritionDiabetes: 5 fruits that can be secret weapon against high blood sugar
The organ that never asks for anything
The liver is extraordinarily forgiving. It can lose up to 75% of its functional capacity before a person feels anything at all. You can damage it steadily for months, for years, and keep going about your day without any warning. That resilience has made us careless. We assume that if we haven’t felt sick yet, we’re fine. That whatever we’re taking isn’t hurting us.But the liver isn’t invincible. It’s just patient. And by the time it stops being patient: by the time jaundice shows up, or the abdomen swells, or someone becomes confused, or bleeding starts from the gums , the damage is often advanced. Sometimes irreversible.Dr. Dendukuri sees this pattern constantly. “Drug-induced liver injury is now among the leading causes of acute liver failure in India, second only to viral hepatitis. Yet most patients I speak to had no idea that the medications they took could harm the liver at all.”That lack of awareness is the real problem. People assume that because something is available without a prescription, it must be safe. Because their grandmother used it, or their friend recommended it, or they saw it advertised online, it couldn’t possibly be dangerous. But a 2022 study published in Hepatology Communications found that drug-induced liver injury accounts for several acute liver failure cases in India — and that number is rising.
The drugs that are silently damaging livers
Paracetamol is the biggest culprit. It’s sold under dozens of brand names, available in every pharmacy, and most people think of it as basically harmless. And at the therapeutic dose, it is. The problem is that people don’t read labels. They double-dose without realising it. They take paracetamol for a headache, then a few hours later take a cold medicine that also contains paracetamol, then maybe something else. And suddenly they’ve taken three times the safe amount.“Paracetamol is the single most common cause of drug-induced liver failure I encounter,” says Dr. Dendukuri. “The therapeutic dose is safe. The problem is that most people do not read labels, double-dose without realising it, or combine it with alcohol. At toxic doses, paracetamol overwhelms the liver’s detoxification capacity and can cause catastrophic failure within 72 hours.”Seventy-two hours. Not weeks. Not months. That’s how fast the liver can collapse when paracetamol reaches toxic levels.Then there are the anti-tuberculosis drugs like isoniazid and rifampicin. These are life-saving medications. They work. But they require mandatory liver monitoring. And here’s where unsupervised drug use becomes genuinely dangerous — patients prescribed these drugs sometimes stop coming for follow-up visits. They might think they’re fine. Or they might get bored with the process. And meanwhile, their liver enzymes are quietly spiking, their organ is deteriorating, and nobody’s watching.NSAIDs, ibuprofen, diclofenac, are everywhere too. People take them for back pain, for fever, for period cramps. They’re so common that nobody thinks twice about them. But they’re particularly dangerous if you already have fatty liver disease or early cirrhosis. And in modern India, fatty liver disease is increasingly common. A 2021 study in the Journal of Clinical and Experimental Hepatology found that non-alcoholic fatty liver disease affects nearly 30% of the Indian population, which means there are millions of people taking NSAIDs without knowing they’re at elevated risk.
The supplement trap
This is where the danger gets insidious. People see the word “natural” and assume “safe.” The marketing is brilliant. Detox supplements, weight-loss blends, Ayurvedic formulations — they all promise health. They all promise to help the liver specifically. And because they’re herbal, because they’re traditional, because they’re not “chemicals,” people take them without hesitation or supervision.Dr. Dendukuri has seen young, otherwise healthy people develop fulminant liver failure from supplements purchased online. Supplements that were supposed to help them, that they trusted because they were natural.“Certain herbal weight-loss blends and traditional formulations taken in unsupervised doses can cause severe hepatotoxicity,” she says. “I have seen young, otherwise healthy patients develop fulminant liver failure from supplements purchased online.”The natural medicine industry is booming. And most of it is unregulated. There’s no oversight, no dosage standardisation, no monitoring of who’s taking what. Someone could be buying the same supplement under different brand names without realising it. Someone could be taking a dosage that’s ten times higher than safe. And nobody would know until the liver starts failing.
Who gets hurt most
Anyone can develop drug-induced liver injury. But the risk is significantly higher in specific groups. If you already have fatty liver disease, if you’re diabetic, if you’re older, if you’re on multiple medications, or if you drink alcohol regularly, even in moderate amounts, your liver’s reserve is already depleted. For you, a standard dose of a seemingly harmless drug can be the thing that tips the balance.This is where self-medication becomes especially dangerous. Because the people most likely to self-medicate, people who are already dealing with chronic conditions, are often the most vulnerable to liver damage. An older person with diabetes taking NSAIDs for joint pain, plus paracetamol for a headache, plus an herbal supplement they think will help, that combination might be fine for a healthy 25-year-old. For someone with compromised liver function, it might be catastrophic.
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What actually needs to change
Dr. Dendukuri isn’t asking people to live in fear of medication. She’s asking for something simpler: respect. Respect for an organ that filters over 1,400 litres of blood every single day, that detoxifies everything you consume, that works silently in the background and asks for nothing except that you stop treating it like it’s invincible.Never assume a drug is safe simply because it doesn’t require a prescription. All medications, including vitamins, supplements, and herbal preparations, are processed by the liver. They all carry some degree of risk. Always tell your doctor about every substance you’re taking. If you’re on long-term medication, insist on periodic liver function tests. If you notice yellowing of the eyes, dark urine, unusual fatigue, or abdominal pain, don’t wait. Go to a hospital.The next time you reach for a tablet without a prescription, pause. That small act of restraint might be the most important health decision you make.Medical experts consulted This article includes expert inputs shared with TOI Health by:Dr. Kavya Harika Dendukuri, Lead Hepatologist at Gleneagles Hospitals Lakdikapul HyderabadInputs were used to explain how self medication affects liver and causes irreversible damage. The doctor has shared common medicines that cause drug induved liver injury.
