Jaundice, the medical term for the yellowing of the skin and eyes, is a visible sign that the body’s normal processing of waste is being interrupted. While often associated with diseases like hepatitis or gallstones, many prescription and over-the-counter medications can also trigger this symptom. This reaction is known as Drug-Induced Liver Injury (DILI). DILI occurs because the liver is the body’s primary filter for drugs, making it highly susceptible to chemical stress.
How Bilirubin Causes Yellow Eyes
Jaundice results from an excessive buildup of bilirubin in the bloodstream. Bilirubin is a yellowish waste product created when old or damaged red blood cells break down. The liver captures this unconjugated bilirubin, modifies it into a conjugated form, and excretes it as a component of bile.
Bile is a digestive fluid that travels through ducts from the liver to the intestine for elimination. If the liver’s ability to process bilirubin is overwhelmed or if the flow of bile is blocked, bilirubin accumulates in the blood. When high levels of bilirubin circulate, it deposits in tissues throughout the body, becoming most noticeable in the sclera, the white part of the eye, giving it a yellow hue.
Types of Drug-Induced Liver Damage
Drugs can disrupt the liver’s function through different pathways, leading to three main patterns of injury.
Hepatocellular Injury
The most common pattern is Hepatocellular Injury, which involves direct damage and death of the liver cells (hepatocytes). This form of injury often mimics acute viral hepatitis. It is characterized by a rapid elevation of liver enzymes in the blood. Damage caused by high doses of acetaminophen is a classic example of this pattern.
Cholestatic Injury
Cholestatic Injury does not necessarily destroy liver cells. Instead, it interferes with the liver’s ability to excrete bile. The drug or its metabolites block the bile flow from the liver cells into the small bile ducts, causing bilirubin to back up into the bloodstream. This injury is often associated with certain antibiotics and psychiatric medications.
Mixed Pattern
Many drugs cause a Mixed Pattern of injury. This displays features of both hepatocyte damage and impaired bile flow.
Common Pharmaceutical Culprits
The list of medications capable of causing DILI is extensive, but some classes are more frequently implicated.
- Antibiotics: These are a significant cause of cholestatic jaundice. The combination drug amoxicillin-clavulanic acid is one of the most common causes of DILI worldwide, often leading to bile flow obstruction. Other antibiotics in the penicillin and sulfonamide groups, such as dicloxacillin, can also trigger this reaction.
- Pain Relievers: This is a high-risk category, particularly acetaminophen (paracetamol). While safe at recommended doses, overdose is the leading cause of acute liver failure in many countries. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can also cause liver toxicity, though less frequently.
- Anti-Seizure Medications: Drugs such as phenytoin and carbamazepine have been linked to DILI.
- Cholesterol-Lowering Drugs: Statins are known to pose a risk.
- Psychiatric Medications: Certain antipsychotics, such as chlorpromazine, have been linked to cholestatic jaundice.
- Herbal and Dietary Supplements: Some supplements, even those viewed as natural, contain compounds that are directly toxic to the liver, leading to the risk of DILI and subsequent jaundice.
Immediate Action and Medical Evaluation
Observing a yellow tint in the white of the eyes should prompt immediate communication with a healthcare provider. Jaundice signifies a problem with bilirubin processing that requires medical assessment. The first step is usually a blood test to measure bilirubin levels and a liver function panel to check for elevated liver enzymes.
If a medication is suspected as the source of injury, the drug will likely be stopped. Patients should not abruptly discontinue any prescribed medication without first speaking to the prescribing physician. In cases of severe DILI, particularly acetaminophen poisoning, specific antidotes and supportive care may be administered to minimize further damage and allow the liver to recover.