Eiji Kutoh1. 1. Department of Internal Medicine, BMC, Beerse, Belgium. ekuto@excite.com
Abstract
BACKGROUND: Metformin hydrochloride is widely used for the treatment of type 2 diabetes mellitus (DM-2). To date, only 2 cases of possible metformin-induced hepatotoxicity (acute hepatitis) have been reported worldwide. OBJECTIVE: The aim of this article was to report a case of serious hepatotoxicity possibly associated with metformin use in an elderly patient with DM-2. METHODS: After receiving metformin 500 mg/d for 3 weeks, a 73-year-old Japanese woman weighing 33.5 kg with poorly controlled DM-2 presented with fatigue, jaundice, nausea, vomiting, anorexia, and abdominal pain. Laboratory analysis showed severe hepatotoxicity (elevated aspartate and alanine aminotransferases [AST and ALT, respectively], alkaline phosphatase [ALP], and total bilirubin concentrations). The history, clinical findings, laboratory features, and clinical course of this case, as well as the pharmacologic profile of metformin, are presented. RESULTS: Immediate hospitalization and discontinuation of metformin treatment led to improvements in liver function (decreased AST, ALT, ALP, and total bilirubin concentrations) and resolution of the presented symptoms within 3 weeks. The probability of an adverse drug reaction (ADR), as assessed using the Naranjo ADR probability scale, in this case was 4 (probable). CONCLUSIONS: In this case of an elderly woman with DM-2 who presented with symptoms of hepatotoxicity after 3 weeks of metformin treatment, metformin appeared to have caused a mixed-type (hepatocellular and cholestatic) hepatic damage. Although rare, severe hepatotoxicity might be associated with metformin use in some cases.
BACKGROUND:Metformin hydrochloride is widely used for the treatment of type 2 diabetes mellitus (DM-2). To date, only 2 cases of possible metformin-induced hepatotoxicity (acute hepatitis) have been reported worldwide. OBJECTIVE: The aim of this article was to report a case of serious hepatotoxicity possibly associated with metformin use in an elderly patient with DM-2. METHODS: After receiving metformin 500 mg/d for 3 weeks, a 73-year-old Japanese woman weighing 33.5 kg with poorly controlled DM-2 presented with fatigue, jaundice, nausea, vomiting, anorexia, and abdominal pain. Laboratory analysis showed severe hepatotoxicity (elevated aspartate and alanine aminotransferases [AST and ALT, respectively], alkaline phosphatase [ALP], and total bilirubin concentrations). The history, clinical findings, laboratory features, and clinical course of this case, as well as the pharmacologic profile of metformin, are presented. RESULTS: Immediate hospitalization and discontinuation of metformin treatment led to improvements in liver function (decreased AST, ALT, ALP, and total bilirubin concentrations) and resolution of the presented symptoms within 3 weeks. The probability of an adverse drug reaction (ADR), as assessed using the Naranjo ADR probability scale, in this case was 4 (probable). CONCLUSIONS: In this case of an elderly woman with DM-2 who presented with symptoms of hepatotoxicity after 3 weeks of metformin treatment, metformin appeared to have caused a mixed-type (hepatocellular and cholestatic) hepatic damage. Although rare, severe hepatotoxicity might be associated with metformin use in some cases.
Authors: Mira Aubuchon; Allen R Kunselman; William D Schlaff; Michael P Diamond; Christos Coutifaris; Sandra A Carson; Michael P Steinkampf; Bruce R Carr; Peter G McGovern; Nicholas A Cataldo; Gabriella G Gosman; John E Nestler; Evan R Myers; Richard S Legro Journal: J Clin Endocrinol Metab Date: 2011-08-10 Impact factor: 5.958
Authors: Cristina Carvalho; Sónia Correia; Maria S Santos; Raquel Seiça; Catarina R Oliveira; Paula I Moreira Journal: Mol Cell Biochem Date: 2007-10-02 Impact factor: 3.396