Department of Internal Medicine, University of Colorado Denver, Aurora, CO, USA.
BMC Gastroenterol. 2012 Jun 8;12:65. doi: 10.1186/1471-230X-12-65.
Liver injury due to prescription and nonprescription medications is an expanding public health concern in the United States, with drug-induced liver injury (DILI) being the single most common reason for regulatory actions instituted by the Food and Drug Administration against certain medications and supplements.
A 69-year-old Latino man was referred to Hepatology Clinic for urgent evaluation of new onset jaundice, nausea and fatigue associated with a >40-fold increase in his transaminase levels and elevated INR and alkaline phosphatase. The patient had received a new prescription for varenicline to aid with smoking cessation approximately 3 weeks prior to his evaluation in Hepatology Clinic. Within 5 days of starting the varenicline, the patient developed new onset of nausea, vomiting, malaise and deep jaundice. The varenicline was discontinued on day 5 by the patient. Hepatologic evaluation revealed no evidence of acute viral hepatitis, autoimmune, metabolic or alcohol-related liver disorders. The patient's past medical history was notable, however, for chronic hepatitis C. His liver enzymes and synthetic function completely normalized 9 weeks after discontinuation of the varenicline.
This report represents the second documented cases of drug-induced liver injury related to varenicline therapy, highlighting the need for clinician awareness regarding potential hepatotoxicity of varenicline, particularly among patients with pre-existing liver disease.
在美国，因处方和非处方药物导致的肝损伤是一个日益严重的公共卫生问题，药物性肝损伤（DILI）是食品和药物管理局（FDA）对某些药物和补充剂采取监管行动的最常见原因。
一名 69 岁拉丁裔男性因新发黄疸、恶心和疲劳，伴有转氨酶水平升高>40 倍、INR 和碱性磷酸酶升高而被转至肝病科进行紧急评估。患者在接受肝病科评估前约 3 周接受了新的维拉唑酮处方以帮助戒烟。在开始服用维拉唑酮后的第 5 天，患者出现新发恶心、呕吐、不适和深度黄疸。患者在第 5 天自行停用了维拉唑酮。肝酶检查未见急性病毒性肝炎、自身免疫性、代谢或酒精相关肝病的证据。然而，患者的既往病史值得注意，患有慢性丙型肝炎。他的肝酶和合成功能在停用维拉唑酮 9 周后完全正常。
本报告代表了第二例与维拉唑酮治疗相关的药物性肝损伤病例，强调了临床医生对维拉唑酮潜在肝毒性的认识的重要性，特别是在存在潜在肝脏疾病的患者中。
