Hepatitis C increases your risk of inflammation, damage to your liver, and liver cancer. During and after treatment for the hepatitis C virus (HCV), your doctor may recommend dietary and lifestyle changes to help minimize long-term liver damage. This may include staying away from certain medications.

Your liver works by filtering blood from your gastrointestinal (GI) tract. It also gets rid of toxins from chemicals you might come into contact with and metabolizes medications.

Having a liver disease like hep C increases your risk of damage from taking certain drugs, herbal supplements, and vitamins. This effect is known as chemical-induced liver damage, or hepatoxicity.

Symptoms of hepatoxicity may include:

  • abdominal pain, especially in the upper right area of your abdomen
  • jaundice, which is when your skin and the whites of your eyes become yellow
  • dark-colored urine
  • fatigue
  • nausea or vomiting
  • fever
  • skin itching and rash
  • loss of appetite and subsequent weight loss

If you have acute or chronic hepatitis C, talk to your doctor about whether or not you should take the following medications and supplements.

Acetaminophen is an over-the-counter (OTC) pain reliever most commonly known as the brand Tylenol. It’s also found in certain cold and flu medications.

Despite its wide availability, acetaminophen can put you at risk for liver damage. The risk is greater when you take acetaminophen in large doses or in small doses for a long period of time.

These risks apply regardless if you have preexisting liver disease. Thus, acetaminophen may not be your best source of pain relief when you have hepatitis C.

However, there’s a lack of clinical guidelines on the use of acetaminophen for people with hepatitis C. Low, temporary doses may be safe for some people. But if you have cirrhosis of the liver or drink alcohol regularly, your doctor may recommend that you avoid it.

Some experts recommend testing for hepatoxicity every 3 to 6 months in people who have chronic hepatitis C and take acetaminophen on a regular basis.

It’s important to talk to your doctor before use to determine whether this medication could worsen any existing liver damage. If your doctor gives you approval, you should take no more than 2,000 mg per day, and for no more than 3 to 5 days at a time.

Amoxicillin is a common type of antibiotic used to treat bacterial infections. However, it may also increase your risk for hepatoxicity. While these effects are considered rare in healthy individuals, having a history of liver disease may increase your risk for drug-induced liver damage.

If you have HCV and experience an infection that requires an antibiotic, you may want to tell your doctor. They may prescribe another medication to treat your bacterial infection.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are another common class of OTC pain relievers. These are available in generic and brand name versions of aspirin and ibuprofen, as well as cold and flu medications.

Some experts suggest avoiding NSAIDs in certain situations. People with chronic HCV who don’t have cirrhosis may be able to tolerate NSAIDs at low doses without the risk of hepatoxicity. However, it’s best to avoid NSAIDs altogether if you have cirrhosis in addition to chronic hepatitis C.

Complementary and alternative remedies are on the rise, including those targeted toward liver health. But if you have hepatitis C, taking certain supplements and herbs may cause more harm than good. Furthermore, certain remedies may interact with your medications.

One supplement to avoid is iron. Iron overload is already prevalent in many people with hepatitis C and liver disease. Iron is available in most OTC multivitamins as a means to prevent iron-deficiency anemia. Unless you have anemia and are instructed otherwise, you should choose a multivitamin without iron in it.

Too much vitamin A can also cause hepatoxicity in people with hepatitis C. Experts recommend limiting your daily intake of vitamin A to less than 5,000 international units (IU) per day.

Certain herbs may also be dangerous when you have an HCV infection. This is the case with St. John’s wort, an herb that is often taken for depression, although its benefits are unclear. St. John’s wort can interfere with your hepatitis C treatments and make them less effective, so it’s best to avoid it.

Other potentially harmful herbs for the liver that can increase your risk of hepatoxicity include:

  • black cohosh
  • chaparral
  • comfrey
  • distaff thistle
  • germander
  • greater celandine
  • kava
  • red yeast rice extract
  • skullcap
  • yohimbe

Talk to your doctor about all medications, supplements, and herbs you take or are considering taking. This includes medications you can purchase over the counter.

Even if they have “natural” labels, this doesn’t mean they’re safe for your liver at this time. Your doctor may also recommend regular blood testing to ensure you’re getting the right level of nutrients from food and any multivitamins you take.

While certain medications and supplements can help improve your health and quality of life, not all substances are safe for people with hepatitis C. You may be especially vulnerable if you have chronic HCV or liver damage and scarring. Talk to your doctor before trying any new medications or supplements.