never make it to market. Yet people
who show signs of liver weakness on
pre-screening tests aren’t selected
for new drug trials. “So, when a drug
is on the market, the companies do
not know how it will affect those with
liver disease,” Dr Andrade says.
Dosage plays a major role.
Even common over-the-counter
medications, when taken in excess
of the recommended dose over
a long period of time, can cause
liver injury, failure and death.
One of them is paracetamol, also
known as acetaminophen, Tylenol
and Panadol—a pain-relieving
and fever-reducing drug. The
recommended adult dose is one
or two 500mg tablets up to four
times in 24 hours, with four to six
hours in between doses and without
exceeding four grams a day. When
exceeded, paracetamol sends nearly
100,000 people a year to hospital
in the UK alone and about 150 die.
“Paracetamol is the most common
cause of acute liver failure in the UK,”
says Dr Jalan.
There are no accurate statistics
Europe-wide for paracetamol-related
deaths, but Professor Karlsen says
that there are more cases in the
northern European countries than in
the southern ones.
Even a recommended amount
of paracetamol can be dangerous
combined with other substances.
When taken to clear a hangover
after heavy drinking, a regularVirgen de la Victoria. Francisco had a
high level of bilirubin, the brownish-
yellow compound the liver secretes
into bile, and cholesterol, which the
liver also makes. The doctors said
he had a reaction to his medicine—
probably because the dose was twice
the typically recommended amount.
He stayed in hospital for two weeks,
until his urine colour returned to
normal. His skin took over a month
to lose its yellow hue and his eyes
took about four months.
Generally, such extreme reactions
to approved drugs are rare, says
Dr Raul J Andrade, PhD, at the
University of Malaga, who runs the
European liver toxicity registry.
(Liver injury from Lamisil occurs
once in 50,000 to 120,000 cases.)
Medications that produce liver-
related side effects during trials
44 • JULY 2019
PHOTO BY JUHO KUVAToday Lasse eats
well and
exercises
regularly. "I got
my health and
my joy back"