The 2026 liver-injury cluster linked to 'retatrutide'

In June 2026 the Australian state of Victoria issued a public health alert after six people developed acute liver injury following use of products labelled retatrutide. Doctors suspect a contaminant rather than the drug itself. Nothing like it was seen in the clinical trials, which is the point: the trials used a different product.

What the Victorian health alert said

The alert was issued to health professionals and the public on 19 June 2026. Since January 2026, six people in Victoria had developed acute liver injury after using an unapproved peptide product labelled as retatrutide, sold under names including Retatrutide, Reta, R-10 and R-20. The products had been obtained online, through friends and through social media accounts. Similar cases were believed to have been reported in other Australian states.^[1]

The department said the clinical picture "suggest[s] additional contaminants may be contributing to the observed liver toxicity", and that investigation of the products' contents was under way. It told people not to use any unapproved peptide product, to dispose of any they had safely, and to seek medical attention promptly for tiredness, abdominal pain, itchy skin, dark urine, yellow eyes or skin, or easy bruising. It asked doctors to ask about peptide use in anyone with abnormal liver tests and, where possible, to obtain a sample or photographs of the product and packaging.^[1]

Since the alert, further cases have been reported. We say "at least six" because the count has moved and the original alert is the figure we can verify.

The cases reported by ABC News

ABC News reported the details of several cases the day after the alert.^[2]

A 32-year-old woman from Melbourne injected a product sold as retatrutide twice, on 24 and 28 December 2025. Within a week she was in acute liver failure. Her symptoms included jaundice, constant nausea, vomiting, severe constipation, a swollen abdomen and extreme fatigue. She spent about a month in the Royal Melbourne Hospital, where at one stage her doctors began discussing a liver transplant. Her liver recovered enough to avoid it. Six months later she was still on steroids for liver repair, had been readmitted several times, was unable to work and had moved in with her mother.^[2]

Dr Marie Sinclair, a liver transplant specialist at the Victorian Liver Transplant Unit at the Austin Hospital, was first alerted when that patient was flagged for possible transplant. She then saw a woman in her 20s who arrived at the Austin's emergency department in acute liver failure with abdominal pain, nausea, fatigue and severe jaundice; she had obtained vials online on a recommendation from her gym. Dr Sinclair also confirmed, through colleagues at other hospitals, another woman in her 20s treated for liver injury and a man in his 40s with major kidney injury from extreme dehydration after diarrhoea about 40 times a day.^[2]

Her summary: "We don't know what these things are, it's quite frankly terrifying."^[2]

What was in the vials?

The Austin Hospital submitted its patient's vials for testing; results had not been published when this page was last reviewed.^[2]

Separately, a vial of a product sold as retatrutide was provided to ABC News and tested by the University of Queensland with an accredited Melbourne laboratory. It was not linked to a specific liver case, but it showed what these products can be: about 19 mg of retatrutide in a vial labelled 10 mg, at 16.6% purity, with the rest thought to be fill material.^[3] A later series of 18 samples found one that matched its label and one that contained no retatrutide at all, with the peptide typically about a tenth of the vial's contents.^[4] The testing page has the full picture.

What "contaminant" could mean

The word covers anything in the vial that should not be there. In a hand-made peptide product that could be:

• leftovers from manufacture: solvents and protecting chemicals used to build the peptide chain, which are supposed to be removed at the end;
• wrong or incomplete peptides: shortened or altered chains that were never separated out;
• a different active substance altogether, as with the UK pens that turned out to contain insulin;
• bacterial endotoxin or living microbes from non-sterile filling;
• fill materials or "carrier" substances whose identity and purity are unknown.

Any of these might injure the liver, and the investigators have not yet said which, if any, is responsible. What the pattern does say is that the injury is happening in people using products labelled retatrutide, and it was not seen in people using the real drug.

Why the trial liver data does not reassure you about a vial

It is tempting to look up retatrutide's liver results and feel better. They are, in fact, good. In a Phase 2a substudy of 98 people with fatty liver disease, retatrutide reduced liver fat by 43% to 82% depending on dose, against no change on placebo, and most people on the higher doses ended up with normal liver fat.^[5] In the main Phase 2 obesity trial, about 1% of participants had a temporary rise in the liver enzyme ALT to more than three times the normal limit, which settled.^[6]

None of that transfers to a black-market vial, for three reasons.

1. Those results describe a different product. Pharmaceutical-grade retatrutide, made and tested under GMP, at a known dose. The Victorian cases involve products of unknown identity, strength and contents.
2. The suspected cause is not retatrutide. If a contaminant is injuring the liver, how kind the real drug is to the liver is beside the point.
3. Trial participants were monitored. Blood tests would have caught a rising ALT early. Someone using a vial at home finds out when they turn yellow.

The liver and kidney side-effects page covers what the trials found in more detail. It is about the trial product only.

Symptoms to watch for

The Victorian alert and the doctors treating these cases describe the same picture.^[1][2] If you have used any product sold as retatrutide, whenever that was, watch for:

• unusual tiredness, weakness or feeling generally unwell;
• loss of appetite, nausea or vomiting that is new or getting worse;
• pain or tenderness in the upper right of the tummy, or a swollen tummy;
• dark urine, or pale or grey stools;
• itchy skin;
• yellowing of the whites of the eyes or the skin;
• bruising more easily than usual, or bleeding that is slow to stop;
• confusion or unusual drowsiness, which is a sign of severe liver failure and an emergency.

Symptoms began within days in the reported cases, but liver injury can also build over weeks. Do not wait to see whether it passes.

What to do in the UK

• Same day, any of the symptoms above: contact your GP surgery, or call NHS 111 if the surgery is closed. Say clearly that you have injected a product sold as retatrutide and are worried about your liver. A blood test can measure liver enzymes and clotting within hours.
• Confusion, drowsiness, vomiting blood, or you cannot stay awake: call 999.
• No symptoms, but you have used a product: tell your GP anyway and ask about a liver function test. The Victorian alert recommends exactly that for anyone who has used these products.^[1]
• Keep the vial and packaging. Doctors in Australia were asked to obtain a sample or photographs, and the same could help here.
• Report it. The MHRA Yellow Card scheme accepts reports about unlicensed and fake products. Reports are how a cluster like this gets noticed.^[7] See reporting a reaction.