Tuberculosis (TB) is a chronic bacterial infection caused by Mycobacterium tuberculosis complex, most commonly by Mycobacterium tuberculosis, and is usually characterized pathologically by the formation of granulomas. The cornerstone of TB management is a 6- month course of using anti-TB drugs where isoniazid, rifampicin, pyrazinamide, and ethambutol are taken for 2 months in the intensive phase followed by a fourth month use of isoniazid and rifampicin in the continuous phase of managing protocols of the disease. One of the adverse effects affecting TB treatment outcome is anti-TB drug induced hepatotoxicity. Among the first-line anti-TB drugs, isoniazid, rifampicin, and pyrazinamide are known to cause hepatotoxicity, but pyrazinamide attribute to a higher percentage for the drug induced liver toxicity compared to the other drugs. The treatment regimen of tuberculosis can be tailored on patient’s needs, mycobacterial tuberculosis resistance pattern, and location of the disease. Even though the first-line anti-TB drugs are effective, their liver toxicity may lead to drug interruption; which can in turn be the cause for the development of Multidrug Resistant Tuberculosis (MDR-TB). The simultaneous use of a number of drugs for a prolonged period of time, for the treatment of TB, further complicates the drug-induced toxicity problem.