“Did This Drug Cause My Patient's Hepatitis?” and Related Questions
Authors: David W. Nierenberg
Journal: Annals of Internal Medicine (2002)

Editorials19 March 2002“Did This Drug Cause My Patient's Hepatitis?” and Related QuestionsDavid W. Nierenberg, MDDavid W. Nierenberg, MDDartmouth Medical School; Hanover, NH 03755Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-136-6-200203190-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What should the busy internist do when his or her patient, while taking several medications, suddenly develops a new clinical problem, such as hepatitis? Is the acute hepatitis drug related? If so, which drug is to blame?The case report by May and colleagues in this issue (1) describes a 49-year-old electrician who developed acute scleral icterus and moderate biochemical hepatitis (total bilirubin level, 8.0 times the upper limit of normal; alanine aminotransferase [ALT] level, 6.8 times the upper limit of normal). The patient had been receiving several medications for years; he began taking pioglitazone, first at a low dosage ...References1. May LD, Lefkowitch JH, Kram MT, Rubin DE. Mixed hepatocellular–cholestatic liver injury after pioglitazone therapy. Ann Intern Med. 2002;136:449-52. LinkGoogle Scholar2. Nierenberg D, Melmon K. Introduction of clinical pharmacology and rational therapeutics.. In: Melmon KL, Morrelli HF, Carruthers SG, Nierenberg DN, eds. Melmon and Morrelli's Clinical Pharmacology: Basic Principles in Therapeutics. 4th ed. New York: McGraw-Hill; 2000:36-40. Google Scholar3. Clinical Pharmacology Online, 2001. Tampa: Gold Standard Multimedia Inc. Available at www.gsm.com. Accessed January 2002. Google Scholar4. . Pioglitazone (Actos). Med Lett Drugs Ther. 1999;41:112. [PMID: 10987011] MedlineGoogle Scholar5. Gillies PS, Dunn CJ. Pioglitazone. Drugs. 60 2000:333-43. [PMID: 10983737] CrossrefMedlineGoogle Scholar6. Maeda K. 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[PMID: 10068372] LinkGoogle Scholar12. Prendergast KA, Berg CL, Wisniewski R. Troglitazone-associated hepatotoxicity treated successfully with steroids [Letter]. Ann Intern Med. 2000;133:751. [PMID: 11074925] LinkGoogle Scholar13. Jagannath S, Rai R. Rapid-onset subfulminant liver failure associated with troglitazone [Letter]. Ann Intern Med. 2000;132:677. [PMID: 10766693] LinkGoogle Scholar14. Booth AM, Caldwell SH, Iezzoni JC. Troglitazone-associated hepatic failure [Letter]. Am J Gastroenterol. 2000;95:557-8. [PMID: 10685776] CrossrefMedlineGoogle Scholar15. Schiano T, Dolehide K, Hart J, Baker AL. Severe but reversible hepatitis induced by troglitazone. Dig Dis Sci. 2000;45:1039-42. [PMID: 10795774] CrossrefMedlineGoogle Scholar16. Scheen AJ. Thiazolidinediones and liver toxicity. Diabetes Metab. 2001;27:305-13. [PMID: 11431595] MedlineGoogle Scholar17. Al-Salman J, Arjomand H, Kemp DG, Mittal M. Hepatocellular injury in a patient receiving rosiglitazone. A case report. Ann Intern Med. 2000;132:121-4. [PMID: 10644273] LinkGoogle Scholar18. Forman LM, Simmons DA, Diamond RH. Hepatic failure in a patient taking rosiglitazone. Ann Intern Med. 132 2000:118-21. [PMID: 10644272] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dartmouth Medical School; Hanover, NH 03755Corresponding Author: David W. Nierenberg, MD, Section of Clinical Pharmacology, Departments of Medicine and Pharmacology–Toxicology, Dartmouth–Hitchcock Medical Center, 1 Medical Center Drive, Hinman Box 7506, Lebanon, NH 03756; e-mail, David.[email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMixed Hepatocellular–Cholestatic Liver Injury after Pioglitazone Therapy Louis D. May , Jay H. Lefkowitch , Michael T. Kram , and David E. Rubin Did This Drug Cause My Patient's Hepatitis? Neil Kaplowitz , James H. Lewis , and Paul B. Watkins Did This Drug Cause My Patient's Hepatitis? David W. Nierenberg Metrics Cited ByVector Analysis to Detect Hepatotoxicity Signals in Drug DevelopmentRating the severity of the medical consequences of drug-induced liver injuryAntiretroviral-associated hepatotoxicityHepatitis colestásica inducida por metforminaCausality assessment in drug-induced hepatotoxicityPitfalls of Assessing Hepatotoxicity in Trials and Observational CohortsClinical Perspectives on Xenobiotic‐Induced HepatotoxicityTerbinafine-Associated HepatotoxicityDrug-induced liver diseaseDid This Drug Cause My Patient's Hepatitis?Neil Kaplowitz, MD, James H. Lewis, MD, and Paul B. Watkins, MDThe Liver, Liver Disease, and Diabetes Mellitus 19 March 2002Volume 136, Issue 6Page: 480-483KeywordsAcute liver failureAdverse reactionsAlanine aminotransferaseDrug therapyDrugsFood and Drug AdministrationHepatitisHepatitis ALiverToxicity ePublished: 19 March 2002 Issue Published: 19 March 2002 CopyrightCopyright © 2002 by American College of Physicians. 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