When we think of liver disease, alcohol and infections usually come to mind. But a growing, often overlooked threat is silently damaging livers across India — Drug-Induced Liver Injury (DILI) and Herbal-Induced Liver Injury (HILI) . As Dr.Pathik Parikh, a leading liver specialist in Ahmedabad, explains: “Your liver doesn’t read the label — whether it’s a prescribed pill or a herbal remedy, harm is harm.”
From prescription medicines to ‘natural’ herbal powders, everyday substances can unexpectedly trigger significant liver injury. And in India, with high rates of polypharmacy and widespread use of herbal/self-medication, DILI and HILI are becoming an urgent clinical concern.
What Are DILI & HILI?
Drug-Induced Liver Injury (DILI)
Occurs when prescription drugs, over-the-counter medicines, or supplements damage liver cells. It may be dose-dependent (predictable, like paracetamol overdose) or idiosyncratic (unexpected reaction even at normal doses).
Herbal-Induced Liver Injury (HILI)
Triggered by herbs, Ayurvedic formulations, weight-loss powders, bodybuilding supplements, or traditional tonics. Despite being marketed as “natural” or “safe”, many herbs can be hepatotoxic or adulterated with steroids or heavy metals.
The Elephant in the Room: Why India Faces a Bigger Problem
In India, DILI and HILI often go unnoticed because patients believe:
- “Herbal products can’t be harmful.”
- “My doctor must already know if a drug is risky.”
- “If it’s sold over the counter, it must be safe.”
India-Focused Data Highlights
- >10% of acute liver failure cases in tertiary centers are linked to DILI/HILI.
- Major culprits: Anti-tubercular drugs, antiepileptics, painkillers, herbal tonics, bodybuilding supplements.
- Under-reporting: Less than 10% of DILI cases are reported to pharmacovigilance systems.
- Widespread self-medication and unregulated herbal markets add to the risk.
Common Symptoms to Watch For
DILI and HILI may present with subtle or severe symptoms:
- Fatigue
- Nausea, vomiting
- Loss of appetite
- Right-upper abdominal pain
- Jaundice (yellow eyes/skin)
- Dark urine, pale stools
- Itching
- Swelling (legs/abdomen) in severe cases
Why DILI & HILI Are Difficult to Diagnose
Dr. Pathik Parikh follows an evidence-based approach:
- Detailed medication & herbal history
- Liver function tests
- Imaging studies
- Rule-out evaluation for viral hepatitis, autoimmune disease, alcohol related injury
- Causality assessment scales (RUCAM)
Common Offenders — Prescription vs. Perception
DILI Culprits
- Anti-tubercular therapy (INH, Rifampicin)
- Antibiotics
- NSAIDs & painkillers
- Anticonvulsants
- Chemotherapy agents
HILI Culprits
- Ayurvedic tonics
- Weight-loss herbs
- Herbal immune boosters
- Bodybuilding powders
- Traditional mixtures or “desi kadhas”
How DILI & HILI Are Managed
✔️ Immediate withdrawal of the offending drug/herb
✔️ Supportive medical care
✔️ Specific antidotes (e.g., NAC for paracetamol toxicity)
✔️ Close monitoring of liver tests
✔️ Liver transplant (rare, severe cases)
Most patients recover with timely diagnosis and expert treatment.
How to Prevent DILI & HILI
- Avoid unnecessary medications or supplements
- Do not mix herbal and allopathic medicines without supervision
- Never exceed recommended doses
- Avoid self-medication for long durations
- Inform your doctor about all herbs/supplements you consume
- Monitor LFTs when on high-risk drugs
The Take-Home Message
“When the cure becomes the cause, the liver pays the price.”
DILI and HILI are rising but preventable causes of liver injury. The key is awareness, early diagnosis, and expert guidance. If you have unexplained liver test abnormalities or develop symptoms after starting a medicine or herbal product, consult a specialist immediately.
With timely care from experts like Dr.Pathik Parikh, most patients make a full recovery.
Conclusion
Drug-Induced Liver Injury (DILI) and Herbal-Induced Liver Injury (HILI) are growing yet under recognized causes of liver damage in India. Both prescribed medicines and ‘natural’ herbal remedies can trigger liver injury, especially when used without supervision. Early detection and expert evaluation are essential to prevent serious complications. Awareness, safe medication practices, and proper monitoring can significantly reduce the burden of DILI and HILI.