Semaglutide Linked to Rare Case of Drug-Induced Liver Injury With Transient Liver Failure

What the researchers found

A middle-aged female patient presented with rapidly worsening liver function tests one month after starting semaglutide. The clinical workup was thorough:

- Non-invasive liver screen: negative

- Viral hepatitis studies: negative

- Ultrasound and CT imaging: no structural cause identified

- Liver biopsy: findings consistent with drug-induced liver injury

The patient experienced transient liver failure but improved with supportive treatment and withdrawal of semaglutide. No other cause for the liver injury was identified, supporting semaglutide as the causative agent.

Why it matters

Semaglutide is now one of the most widely used medications globally, prescribed for type 2 diabetes and obesity. Its use has expanded dramatically since 2021, including through unregulated channels for weight loss. While liver injury appears to be rare, the sheer number of users means even rare adverse events will affect many people. Clinicians and patients need to be aware that liver injury is a possible complication, especially since early recognition and drug withdrawal can prevent progression to severe liver failure.

How the study worked

This is a single case report with a brief review of the literature. The patient underwent comprehensive diagnostic evaluation including liver function tests, non-invasive liver screening, viral studies, ultrasound, CT imaging, and liver biopsy to exclude alternative diagnoses and confirm drug-induced liver injury.

What this study cannot tell us

This is a single case report — the lowest level of clinical evidence. While the temporal relationship (onset one month after starting semaglutide) and the thorough exclusion of other causes support a causal link, a single case cannot establish the frequency of this adverse event or prove definitive causation. The specific mechanism of liver injury is unknown. Individual patient factors may have contributed.

How to read the evidence

This is a single case report, representing the lowest level of clinical evidence. While it documents an important adverse event with thorough diagnostic workup, a single case cannot establish frequency, definitive causation, or generalizability. It serves as a safety signal for clinician awareness.

When this study was published

Published in 2025, this is a very recent case report that is directly relevant to the current surge in semaglutide prescriptions worldwide for both diabetes and weight management.

The bigger picture

As GLP-1 receptor agonists become some of the most prescribed medications worldwide, post-market surveillance for rare adverse effects becomes increasingly important. Drug-induced liver injury is notoriously difficult to predict from clinical trials, as it may occur in only 1 in 10,000 or fewer patients. This case adds to the emerging safety literature for semaglutide and reinforces the need for monitoring liver function in patients starting GLP-1 RA therapy, particularly those obtaining the medication through unregulated channels without proper medical oversight.

Questions still open

• How common is clinically significant liver injury among the millions of people currently taking semaglutide?
• Should routine liver function monitoring be recommended for patients starting semaglutide, similar to protocols for other drugs known to cause liver injury?
• Does the risk of liver injury differ between the diabetes dose and the higher weight-loss dose of semaglutide?

Common questions

Read the original research

Semaglutide-associated drug-induced liver injury: a case report and review of the literature.

Oxford medical case reports, 2025(9), omaf177

Citation

Kempster, Ian; Fernandes, Darren; Saeed, Mohammed S; Sharratt, Caroline; Benfield, Sara. (2025). Semaglutide-associated drug-induced liver injury: a case report and review of the literature.. Oxford medical case reports, 2025(9), omaf177. https://doi.org/10.1093/omcr/omaf177