Drug & Herb-Induced Liver Injury
Herbs and supplements are not automatically safe for the liver, and pretending otherwise would not serve you. If you take any product, including one of ours, your liver doctor needs to know.
Medically reviewed by the RIIMS medical team · Last updated: June 2026
Go to hospital now
- Yellow eyes or skin with confusion or unusual drowsiness
- Vomiting blood, or black tarry stools
- Severe abdominal pain or swelling together with yellowing of the eyes
See a doctor soon (not an emergency)
- Yellow eyes, dark urine or pale stools after starting any new medicine, herb or supplement
- Unusual tiredness or loss of appetite that does not improve within a few days of stopping a suspected product
What is drug and herb induced liver injury?
Drug and herb induced liver injury, sometimes shortened to DILI, happens when a medicine, herb or supplement damages the liver, usually without warning. In India, the single biggest cause is anti-tuberculosis medication, responsible for 46% of cases in the INDILI network study of 1,288 patients. Traditional and alternative medicines are second, at 14%, ahead of most other drug classes. Giloy (Tinospora cordifolia) is the most frequently reported herbal cause of liver injury in the country. A multicentre study of 43 patients found no contamination in the giloy products tested; the injury came from the herb itself, not an adulterant. In one smaller series, 4 of the 6 patients who developed giloy-related liver injury turned out to have a silent autoimmune liver disease that the herb brought to the surface. Other products linked to liver injury include ashwagandha, which can cause a form of cholestatic hepatitis, concentrated turmeric extracts taken as capsules or supplements, and bakuchi. This is specifically about concentrated extracts, not turmeric used as a cooking spice in ordinary food quantities, which is a different exposure altogether. Most people recover fully once the product responsible is stopped. The real danger is not the herb itself so much as continuing to take it without realising it is the cause, because the injury is silent in its early stages.
Symptoms to watch for
- Often none in the early stages
- Yellowing of the eyes or skin
- Dark urine or pale stools
- Loss of appetite or nausea
- Unusual tiredness
- Itching without a rash
When to consult a doctor
If you are on anti-TB treatment and notice yellow eyes, dark urine, nausea or unusual tiredness, contact your doctor the same day. Do not stop anti-TB treatment on your own, even if you suspect it is the cause; stopping it early carries its own serious risks, and your doctor needs to manage the change safely. For any other medicine, herb or supplement, tell your doctor about everything you are taking, at every visit, including products from us.