Rapid Improvement of Icterus and Pruritus by the Oral Administration of Colestimide in Two Cases of Drug-induced Hepatitis.

Tani, Mitsunori; Hayashi, Yoshikazu; Okamoto, Satoshi; Yokohama, Shiro; Inaba, Mamoru; Kubota, Hiroshi; Nakamura, Kimihide

doi:10.2169/internalmedicine.40.1098

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…19 Bile acid binding resins such as cholestyramine are frequently used in DILI patients with severe cholestasis and pruritus. 48 These agents may also be beneficial in the "washout" of hepatotoxic drugs that have a long half-life and undergo enterohepatic circulation, such as leflunomide. 49 Various nonpharmacological treatment strategies have also been studied in DILI patients.…”

Section: Manag Ement Of S E Vere D Ilimentioning

confidence: 99%

“…However, more recent studies from DILIN have failed to demonstrate similar benefits . Bile acid binding resins such as cholestyramine are frequently used in DILI patients with severe cholestasis and pruritus . These agents may also be beneficial in the “washout” of hepatotoxic drugs that have a long half‐life and undergo enterohepatic circulation, such as leflunomide …”

Section: Management Of Severe Dilimentioning

confidence: 99%

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The diagnosis and management of idiosyncratic drug‐induced liver injury

Hassan

Fontana

2018

Liver International

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Drug-induced liver injury (DILI) is an uncommon but important cause of liver disease that can arise after exposure to a multitude of drugs and herbal and dietary supplements. The severity of idiosyncratic DILI varies from mild serum aminotransferase elevations to the development of severe liver injury that can progress to acute liver failure resulting in death or liver transplantation within days of DILI onset. Chronic liver injury that persists for more than 6 months after DILI onset is also becoming increasingly recognized in up to 20% of DILI patients. Host demographic (age, gender, race), clinical and laboratory features at DILI onset have been associated with the severity and outcome of liver injury in DILI patients. In addition to cessation of the suspect drug, other medical interventions including the use of N-acetylcysteine and corticosteroids in selected patients have shown some clinical benefit, but additional prospective studies are needed. A number of promising diagnostic, prognostic and mechanistic serum and genetic biomarkers may help improve our understanding of the pathogenesis and treatment of idiosyncratic DILI.

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Section: Manag Ement Of S E Vere D Ilimentioning

confidence: 99%

Section: Management Of Severe Dilimentioning

confidence: 99%

The diagnosis and management of idiosyncratic drug‐induced liver injury

Hassan

Fontana

2018

Liver International

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“…[119] A novel treatment strategy utilizing cholestryramine as a form of bile acid washout has been used to manage the various toxicities associated with leflunomide, including DILI. [120] While injury is usually self-limited once leflunomide is stopped, the long half-life and enterohepatic circulation have made it amenable to treatment using activated charcoal (50g every 6 hours for 24 hours) or a bile acid binding resin, such as cholestyramine, to increase the clearance of the drug and reduce plasma concentrations more rapidly.…”

Section: Specific Antidotes To Treat Dilimentioning

confidence: 99%

Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

Stine¹,

Lewis²

2015

Expert Review of Gastroenterology & Hepatology

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While the pace of discovery of new agents, mechanisms and risk factors involved in drug-induced liver injury (DILI) remains brisk, advances in the treatment of acute DILI seems slow by comparison. In general, the key to treating suspected DILI is to stop using the drug prior to developing irreversible liver failure. However, predicting when to stop is an inexact science, and commonly used ALT monitoring is an ineffective strategy outside of clinical trials. The only specific antidote for acute DILI remains N-acetylcysteine (NAC) for acetaminophen poisoning, although NAC is proving to be beneficial in some cases of non-acetaminophen DILI in adults. Corticosteroids can be effective for DILI associated with autoimmune or systemic hypersensitivity features. Ursodeoxycholic acid, silymarin and glycyrrhizin have been used to treat DILI for decades, but success remains anecdotal. Bile acid washout regimens using cholestyramine appear to be more evidenced based, in particular for lefluonomide toxicity. For drug-induced acute liver failure, the use of liver support systems is still investigational in the United States and emergency liver transplant remains limited by its availability. Primary prevention appears to be the key to avoiding DILI and the need for acute treatment. Pharmacogenomics, including HLA genotyping and the discovery of specific DILI biomarkers offers significant promise for the future. This article describes and summarizes the numerous and diverse treatment and prevention modalities that are currently available to manage DILI.

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“…Tani et al. reported two cases of drug‐induced hepatitis refractory to therapy of UDCA and prednisolone that were immediately relieved of icterus and pruritus following oral administration of colestimide 24 . These authors concluded that colestimide would be useful for patients with cholestasis in drug‐induced hepatitis, because this agent had few adverse effects and had an easier compliance for the patients.…”

Section: Clinical Application For Cholestasis Using Colestimidementioning

confidence: 99%

Colestimide: The efficacy of a novel anion‐exchange resin in cholestatic disorders

Matsuzaki

2002

J of Gastro and Hepatol

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Rapid Improvement of Icterus and Pruritus by the Oral Administration of Colestimide in Two Cases of Drug-induced Hepatitis.

Cited by 7 publications

References 7 publications

The diagnosis and management of idiosyncratic drug‐induced liver injury

The diagnosis and management of idiosyncratic drug‐induced liver injury

Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

Colestimide: The efficacy of a novel anion‐exchange resin in cholestatic disorders

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