Drug points: Prolonged cholestasis associated with irbesartan

Hariraj, Radhakrishnan; Stoner, EA; Jader, S.; Preston, David

doi:10.1136/bmj.321.7260.547

Cited by 27 publications

(5 citation statements)

References 5 publications

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“…Long-term follow-up data are yet to accrue for these antihypertensive agents. In the published cases, liver toxicity has been observed with irbesartan (cholestatic hepatitis), 80 candesartan (transient rise in aminotransferases, hepatocellular injury), [81][82][83] and losartan (hepatocellular injury). 84 Losartan is of particular interest because of its potential role in treating portal hypertension.…”

Section: Angiotensin II Receptor Inhibitorsmentioning

confidence: 99%

Hepatotoxicity of Commonly Used Drugs: Nonsteroidal Anti-Inflammatory Drugs, Antihypertensives, Antidiabetic Agents, Anticonvulsants, Lipid-Lowering Agents, Psychotropic Drugs

Chitturi¹,

George²

2002

Semin Liver Dis

194

106

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Hepatotoxic adverse drug reactions have contributed to the decline of many promising therapies, even among mainstream medication classes (bromfenac and troglitazone are recent examples). The spectrum of nonsteroidal anti-inflammatory drug-related liver toxicity continues to expand, with reports in children, interactive toxicity in persons with hepatitis C, and recognition of the toxicity of both the preferential and selective cyclooxygenase-2 inhibitors. Of the antihypertensive agents, methyldopa is now rarely prescribed and adverse effects are reported infrequently, whereas cases of liver injury associated with the angiotensin receptor and converting enzyme inhibitors are increasingly reported. Of the antidiabetic agents, acarbose, gliclazide, metformin, and human insulin have been implicated in causing liver injury. To date, the newer thiazolidinediones do not appear to share the hepatotoxic potential of troglitazone, although a few reports of acute hepatitis have accrued. Although liver injury has been associated with the "statins," the frequency of such toxicity is lower than that of the background population and the value of biochemical monitoring remains unproved. Newer concepts in anticonvulsant hepatotoxicity have been the recognition of the reactive metabolite syndrome, delineation of the risk factors for valproic acid toxicity, the potential role of carnitine in preventing valproic acid hepatotoxicity, and the toxicity of second-line antiepileptic drugs. Liver injury associated with newer psychotropic agents, particularly the selective serotonin reuptake inhibitors, is also discussed. The focus of the review is the hepatotoxicity of commonly used drugs with particular reference to recent and novel reports of toxicity. Well-known causes of liver injury such as chlorpromazine, phenytoin, and methyldopa are not discussed.

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Section: Angiotensin II Receptor Inhibitorsmentioning

confidence: 99%

Hepatotoxicity of Commonly Used Drugs: Nonsteroidal Anti-Inflammatory Drugs, Antihypertensives, Antidiabetic Agents, Anticonvulsants, Lipid-Lowering Agents, Psychotropic Drugs

Chitturi¹,

George²

2002

Semin Liver Dis

194

106

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“…It has been hypothesized that genetic factors affecting the metabolism of ARBs could predispose individuals to hepatotoxicity due to the production of reactive metabolites in the liver. This adverse reaction might also relate to the effects of angiotensin II on the excretion of blood ammonia, particularly in patients with liver cirrhosis and portal hypertension [ 12 , 13 ]. However, age, gender, race, smoking or alcohol, co-administration of other drugs, and host-related and environmental factors may also be involved in drug-related hepatotoxicity [ 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Marked Hepatotoxicity Associated With Losartan Treatment: A Case Report

Zahedi,

Sami,

Ijishakin

et al. 2023

Cureus

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Losartan is a widely prescribed angiotensin II receptor blocker (ARB) used for the management of hypertension and various cardiovascular conditions. While it is generally considered a safe medication, rare cases of hepatotoxicity have been reported in the literature. We present a case of severe hepatic injury and sub-fulminant hepatitis attributed to losartan use in a 54-year-old male patient with underlying hypertension. He presented with a two-week history of abdominal pain, progressive jaundice, dark urine, and vomiting, followed by altered sensorium. His clinical picture, serology, and imaging findings confirmed a severe hepatic injury. After ruling out all possible causes, he was diagnosed with drug-induced hepatotoxicity with losartan treatment. He started improving gradually after losartan discontinuation, N-acetylcysteine administration, and supportive management with close monitoring of liver enzymes. This case report aims to underscore the importance of recognizing losartan as one of the potential causes of hepatotoxicity.

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“…Normalization of liver enzymes took an average of 2 to 4 months after discontinuation of the drug. [ 2 – 6 , 17 , 18 ]…”

Section: Discussionmentioning

confidence: 99%

Fimasartan-induced liver injury in a patient with no adverse reactions on other types of angiotensin II receptor blockers

Park¹,

Yun²,

Eun³

et al. 2017

Medicine

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Rationale:Angiotensin II receptor blockers (ARBs) are widely used for patients with hypertension, and fimasartan is a recently approved ARBs. Fimasartan can cause headache, dizziness, itching, and coughing. There have been several reports of hepatotoxicity in ARBs. However, there have not yet been published reports of the hepatotoxicity of fimasartan.Patient concerns:A 73-year-old man with hypertension experienced liver injury after fimasartan administration. He had a previous history of taking 3 types of ARBs each for more than 2 years before taking fimasartan, and there were no side effects on ARBs except for fimasartan.Diagnoses:Other factors that could cause liver injury were excluded in diagnostic tests, and fimasartan was suspected to be the causative agent.Intervention:Fimasartan was immediately discontinued and the patient was managed with supportive care via hepatotonics.Diagnoses:Other factors that could cause liver injury were excluded in diagnostic tests, and fimasartan was suspected to be the causative agent.Outcome:The liver injury due to fimasartan was confirmed by histology and accidental redosing.Lessons:We emphasize that liver function should be monitored during fimasartan administration because fimasartan may cause hepatotoxicity in patients who have no side effects with other types of ARBs. And fimasartan-induced liver injury may appear later than other ARBs.

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Drug points: Prolonged cholestasis associated with irbesartan

Cited by 27 publications

References 5 publications

Hepatotoxicity of Commonly Used Drugs: Nonsteroidal Anti-Inflammatory Drugs, Antihypertensives, Antidiabetic Agents, Anticonvulsants, Lipid-Lowering Agents, Psychotropic Drugs

Hepatotoxicity of Commonly Used Drugs: Nonsteroidal Anti-Inflammatory Drugs, Antihypertensives, Antidiabetic Agents, Anticonvulsants, Lipid-Lowering Agents, Psychotropic Drugs

Marked Hepatotoxicity Associated With Losartan Treatment: A Case Report

Fimasartan-induced liver injury in a patient with no adverse reactions on other types of angiotensin II receptor blockers

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