A pill to clear coffee faster sent a user's liver tests soaring

About a month after starting a new pill, a coffee drinker went in for scheduled bloodwork. The pills had solved a familiar problem. Coffee kept them up at night, and the pills let them drink it anyway. The Amazon reviewer wrote they "worked great!!"

The results came back with very high levels of liver enzymes, proteins in the blood that can signal early liver damage. As the reviewer wrote, "My doctor told me to stop taking anything in pill form, even Tylenol." The reviewer began hunting for the culprit.

This is a story about rutaecarpine, a chemical sold as a supplement that promises something many people want. A model described in the investigation suggests it could rev up the liver so the body clears caffeine in about four hours instead of about eight, potentially allowing a late afternoon coffee and a normal bedtime. The catch is in the method, because the way it works is by provoking the liver.

Rutaecarpine comes from the fruit of a tree in China. In rats, the liver reacts to it as an intruder and goes into overdrive, making much more of a caffeine clearing enzyme called CYP1A2. Think of that enzyme as part of the liver's cleanup crew for caffeine and other chemicals. In people, one study found the enzyme rose to three times its normal level three hours after a dose.

The liver provocation could be connected to what happened next, but that is unproven. After reading that rutaecarpine could cause severe liver damage, the reviewer stopped taking it. A week later, a retest showed liver enzymes had fallen by half. After another week back on a normal pill routine, but without the supplement, the enzymes were back to normal.

The report is only one of about 300 Amazon reviews, and only three mention liver problems. Details in one severe case lead the blog author who investigated these claims to suspect another cause. A study in mice found no damage after seven days, and even found mild protection for the liver, possibly because a small stress triggers the organ's defenses. Some users report taking it for months to a year without issues, and traditional Chinese practice, where the fruit extract is known as Evodia, calls for using it only for short stretches rather than without a break.

But the pattern fits a familiar type of drug injury. A medicine can seem trouble-free for many people during brief use, yet cause liver injury in some people after weeks of steady use, with wide differences from person to person. The blog author took 100 milligrams for three days and had normal liver enzymes, which proves little either way.

For a nightly coffee habit, that uncertainty is the takeaway.