Probable Ticlopidine-Induced Cholestatic Hepatitis

Abstract

Routine monitoring of serum liver enzyme concentrations is not recommended. However, patients should be instructed to watch for signs and symptoms of liver injury. Should they occur, patients should stop taking the ticlopidine and consult their physician immediately.

Delayed‐Onset Ticlopidine‐Induced Cholestatic Jaundice

“…case reports of ticlopidine-induced cholestatic jaundice. [6][7][8][9][10][11][12][13][14][15][16][17] Most patients had documented liver test abnormalities 1-3 months after starting therapy, including elevations in aspartate aminotransferase, alanine aminotransferase, ␥glutamyl aminotransferase, alkaline phosphatase, and total and direct bilirubin. Symptoms of liver injury also were reported, including jaundice, dark urine, nausea, decreased appetite, and lightcolored stools.…”

“…On discontinuing ticlopidine, symptoms and liver test abnormalities usually resolve over 1-3 months. 6,10,[11][12][13]17 Angiotensin-converting enzyme inhibitors, specifically captopril, also are associated with cholestatic jaundice. Onset of symptoms may be 1 week-10 months after starting captopril.…”

“…All patients reported in the literature had documented liver function test abnormalities and symptoms of liver injury and were receiving ticlopidine at the time of the reaction. [6][7][8][9][10][11][12][13][14][15][16][17] Our patient is unusual in that he discontinued ticlopidine, had documented normal liver tests about 2 weeks later, and developed jaundice and liver test abnormalities approximately 4 weeks later. He had no changes in other drugs during that time.…”

Successful Use of Clopidogrel for Cerebrovascular Accident in a Patient with Suspected Ticlopidine-Induced Hepatotoxicity

“…2 Both ticlopidine and clopidogrel are associated with alterations in liver function tests, and a number of cases of hepatotoxicity associated with ticlopidine use have been reported in the literature. [3][4][5][6][7][8] There is little information available as to whether clopidogrel is a suitable alternative for patients experiencing toxicity associated with ticlopidine use. We report a case of successful use of clopidogrel in a patient who developed suspected ticlopidine-induced hepatotoxicity during therapy for a cerebrovascular accident.…”