Immediate Action Required: Stop Amoxicillin and Seek Medical Evaluation
You should discontinue amoxicillin immediately and seek urgent medical evaluation, as liver pain combined with fatigue suggests possible drug-induced liver injury (DILI), which can progress to serious hepatotoxicity requiring monitoring and potentially treatment. 1, 2
Why This Matters
Amoxicillin can cause hepatotoxicity, though it's relatively uncommon when used alone (more frequent with amoxicillin-clavulanate). The pattern you describe—liver pain, extreme fatigue, and systemic symptoms—is consistent with drug-induced liver injury. 1, 3
The hepatocellular pattern of injury (which causes pain and fatigue) tends to be more severe than cholestatic patterns, and early recognition is critical to prevent progression. 1, 2
Delayed onset is possible: Antibiotic-induced liver injury can occur days to weeks after starting treatment, and symptoms may initially improve while underlying damage continues. 2
What You Need to Do Now
Immediate Steps
Stop the amoxicillin immediately—do not take another dose. The primary treatment for antibiotic-induced liver injury is prompt cessation of the offending drug. 3, 2
Seek medical attention within 24-48 hours for liver function testing, including ALT, AST, alkaline phosphatase, and bilirubin levels. 1, 2
Critical Warning Signs Requiring Emergency Care
Go to an emergency department immediately if you develop:
- Jaundice (yellowing of skin or eyes)—this indicates approximately 10% risk of death from liver failure or need for transplantation 2
- Severe abdominal pain
- Dark urine or pale stools
- Confusion or altered mental status
- Persistent vomiting
What Your Doctor Needs to Know
Essential Information to Provide
Exact timeline: When you started amoxicillin, when symptoms began, and the pattern of symptom resolution and recurrence 3, 2
Complete medication list: All other medications, supplements, and over-the-counter drugs (including acetaminophen), as concurrent medications can complicate diagnosis 3
Alcohol use: Any alcohol consumption, as this increases hepatotoxicity risk 4
Pre-existing liver conditions: Any history of liver disease 4
Expected Evaluation
Your physician should:
- Obtain baseline liver function tests (ALT, AST, alkaline phosphatase, bilirubin) 1, 2
- Rule out other causes of liver injury (viral hepatitis, other medications, toxins) 3, 2
- Establish causality assessment using temporal relationship between drug exposure and symptom onset 3
Prognosis and Follow-Up
Most patients with antibiotic-induced liver injury have favorable outcomes when the drug is stopped promptly 2
However, patients who develop jaundice face serious risk, with approximately 10% mortality or need for liver transplantation 2
In rare cases, progression to chronic liver injury or cirrhosis can occur, though this is more common with amoxicillin-clavulanate than amoxicillin alone 5
Serial monitoring of liver enzymes is necessary even after symptoms resolve to ensure normalization 1, 2
Important Caveats
"Teary eyes" may represent a hypersensitivity reaction rather than direct liver toxicity, suggesting an immunologic component to your reaction 3
The waxing and waning pattern you describe (symptoms improving then recurring) is concerning and may indicate ongoing liver injury despite initial improvement 2
Future antibiotic selection: You should inform all healthcare providers about this reaction, as you may need to avoid penicillin-class antibiotics in the future 1, 3
Do not restart amoxicillin even if symptoms have improved—rechallenge can lead to more severe reactions 6, 5