Warning about a low probability event: adverse liver reaction to GLP-1 drug

[keangkong]

I wanted to warn folks about a low probability event: an adverse liver reaction to a GLP-1 drug.

For background, my doctor said that I most likely experienced a drug-induced-liver injury (DILI). I have no noticeable symptoms but do have ALT levels 10 times the upper limits or normal and also elevated AST and bilirubin levels. He doesn't know which drug is the cause but believes the most likely cause is Lipitor, which I've stopped taking along with retatrutide. Per doctor's order, I continue to take tirzepatide. (I'm a little skeptical that it's the Lipitor since I've been on Lipitor for 20 years. DILIs from Lipitor usually start much sooner although there have been other cases where the injury occurred much later).

As a result, I've been researching drugs I take. I found the articles below information about what medical journals believe to be liver problems caused by tirzepatide. I should emphasize that liver problems with tirzepatide are extremely rare (far less common than with Lipitor, for instance).

To research DILI by drug in general, the best source is probably LiverTox.

Abdullah, et al. (2024). Tirzepatide-Related Acute Liver Injury. Eur. J. Case Rep. Internal Med., 11(9), 004813 [24-year old female teacher; 6 months to onset].

Ahmed, et al. (2025). A Rare Case of Tirzepatide-Induced Hepatitis - Causality Assessment With the RUCAM Criteria. Annals Internal Med., 4(1) [female in her thirties; three months to onset].

Berihun, et al. (2023). A Rare Case of Tirzepatide-Induced Liver Injury. Am J. Gastroenterology, 118(10S), S2282 [37-year old woman; 2.5 months to onset]. This appears to be same person/incident described in Sohal, et al. (2024). A rare case of tirzepatide-induced hepatotoxicity. ACG Case Reps. J. 11(10), e01484.

LiverTox on Tirzepatide (C).

Phox, et al. (2025). Tirzepatide-Induced Liver Injury - A Rare Medication Side Effect. ACG Case Rep. J. 12(4), e01661 [76-year old female; eight weeks to onset].

Sohal, et al. (2024). A rare case of tirzepatide-induced hepatotoxicity. ACG Case Reps. J. 11(10), e01484 [37-year old female; 2 1/2 months to onset]. This appears to the same incident reported in Berihun, et al. (2023). A Rare Case of Tirzepatide-Induced Liver Injury. Am J. Gastroenterology, 118(10S), S2282.

 

[byefatlicia]

Thank you for sharing🙂

 

[clayd]

Thanks for the warning. Are these things that heal/repair themselves once the offender is eliminated?

best of luck figuring it out

 

[keangkong]

Are these things that heal/repair themselves once the offender is eliminated?

Usually.

best of luck figuring it out

Thanks.

 

[Mr. Blonde]

Is this something Tudca or NAC could help with? Anabolic users take these for liver support. But I hadn't heard of glp1s doing liver damage before.

 

[keangkong]

Is this something Tudca or NAC could help with? Anabolic users take these for liver support. But I hadn't heard of glp1s doing liver damage before.

GLP-1s rarely cause liver damage. Even in my case, the doctor believes Lipitor is the most likely cause.

I had never heard of tudca or NAC before. (I did look them up after seeing your post.) I'm not going to say whether I'd take them right now because I don't know yet. . I'm inclined to be cautious in what I take. If my blood results don't improve, I'll likely have a liver biopsy, a surgical procedure that is outpatient but will require that I be off work for two weeks.

 

[peptidepower77]

GLP-1s rarely cause liver damage. Even in my case, the doctor believes Lipitor is the most likely cause.

I had never heard of tudca or NAC before. (I did look them up after seeing your post.) I'm not going to say whether I'd take them right now because I don't know yet. . I'm inclined to be cautious in what I take. If my blood results don't improve, I'll likely have a liver biopsy, a surgical procedure that is outpatient but will require that I be off work for two weeks.

I wouldn't be so quick to dismiss it. There have been reports on Reddit of people having to quit Tirz or Reta for elevated liver enzymes too. Let us know what happens though, wishing you the best.

 

[Stone]

I've been on tirz and switched to reta a couple months ago. I'm only doing 1mg x Mon/Wed/Fri

Did my labs a couple weeks ago and the only thing out of place was higher level enzymes. Doc wanted me to do another set of labs a couple weeks later (which will be tomorrow morning). I don't have them in front of me one had went up double and the other was four times what it had been the last 10 or so years.

They weren't to a point he was really concerned, if they kept going up. I know one had been in the 20's and was 80 and he said unless it went to the 100's then 1000's it would be a problem we would need to dig into.

If I had to guess tirz/reta would probably be the cause but only speculation.

 

[peptidepower77]

My ALT was about 30 on Tirz. When Is switched to Reta it climbed to 50, the 60, then 70, then 90, then dropped to 70, then to 50, now back to 42. I think it's the glucagon component forcing the liver to burn fat. It stresses the liver out which is why it caused elevated liver enzymes. It's likely a net positive, but the liver compensates while it's adjusting and clearing liver fat I think.