Hepatotoxicity of drugs used for treatment of obesity and its comorbidities

Obesity is an increasingly prevalent problem with many associated health risks. Obese patients may present with liver diseases directly attributable to their obesity, such as nonalcoholic steatohepatitis (NASH). However, many such individuals are prescribed various potentially hepatotoxic medications for obesity itself, as well as for the complications of obesity. Clinically, it may be difficult to distinguish the two. Furthermore, many of these medications are in common use, and some are not commonly recognized as potentially injurious to the liver. While some medications have predictable hepatotoxicity, many more have associated idiosyncratic reactions. We review the literature and case-reports of hepatotoxicity associated with four categories of medications: those used primarily in the treatment of obesity, those used in the treatment of diabetes mellitus, those used in the treatment of hyperlipidemia, and those used in the treatment of hypertension. For each class, we present the described epidemiology, clinical presentation, pathology, and prognosis.