Can a steroid shot cause liver damage?

Steroid Shots and Liver Effects

Steroid injections generally do not cause significant liver damage when administered at standard therapeutic doses, though rare cases of hepatotoxicity have been reported with certain types of steroids and high-dose regimens.

Types of Steroids and Their Liver Effects

• Corticosteroids (like methylprednisolone, prednisolone) are generally considered safe for the liver when administered as injections at standard therapeutic doses 1
• Anabolic steroids (testosterone derivatives) carry a much higher risk of hepatotoxicity, especially those with 17-α-alkylation modifications that allow oral administration 2
• The route of administration matters - injectable corticosteroids typically have less liver impact than oral formulations due to bypassing first-pass metabolism 3

Potential Liver Effects of Therapeutic Corticosteroid Injections

• Standard therapeutic corticosteroid injections (such as those used for joint pain or inflammation) rarely cause liver injury 3
• The FDA drug label for methylprednisolone injection lists "elevation in serum liver enzyme levels (usually reversible upon discontinuation)" and "hepatomegaly" as possible adverse reactions 3
• When liver effects do occur with therapeutic corticosteroid injections, they typically resolve after discontinuation of the medication 3, 4

Risk Factors for Steroid-Induced Liver Injury

• High-dose methylprednisolone pulse therapy has been associated with rare cases of severe liver injury 5, 4
• Pre-existing liver conditions may increase risk of adverse effects 6
• Hepatitis B carriers are at particular risk as steroids can trigger viral reactivation leading to severe hepatitis 6
• Supraphysiologic doses or multiple steroids used simultaneously (as seen in anabolic steroid abuse) significantly increase hepatotoxicity risk 2

Anabolic Steroid Hepatotoxicity

• Anabolic steroids can cause various forms of liver injury including:
  • Elevated liver transaminases
  • Acute cholestatic syndrome
  • Chronic vascular injury
  • Hepatic tumors
  • Toxicant-associated fatty liver disease
  • Significant changes in lipoproteins 2, 7
• Anabolic steroid-induced liver injury often resolves with cessation of use but can occasionally be life-threatening 2, 7

Clinical Monitoring Considerations

• For patients receiving therapeutic corticosteroid injections, routine liver function monitoring is generally not required unless:
  • The patient has pre-existing liver disease
  • The patient is receiving high-dose pulse therapy
  • The patient is a hepatitis B carrier 6
• Patients with hepatitis B who require steroid therapy should have liver function tests and serological hepatitis markers closely monitored 6

Important Caveats

• Corticosteroids are actually used as treatment for certain types of hepatitis and alcoholic hepatitis, highlighting their generally favorable liver safety profile 8, 1
• The rare cases of corticosteroid-induced hepatotoxicity typically involve high doses, prolonged use, or specific patient risk factors 5, 4
• Over-the-counter supplements can sometimes be contaminated with anabolic steroids, causing unexpected hepatotoxicity 2