Biomedical Center, Tokyo, Japan; Department of Internal Medicine, Higashi Totsuka Memorial Hospital, Yokohama, Kanagawa, Japan.
Diabetes Metab. 2014 Feb;40(1):82-84. doi: 10.1016/j.diabet.2013.09.009. Epub 2013 Oct 25.
Unlike other dipeptidyl peptidase 4 (DPP-4) inhibitors, the excretion of linagliptin is mainly through a biliary route. Despite this fact, liver injury with linagliptin has thus far not been reported in the literature. However, this report describes the first case of probable linagliptin-induced liver toxicity.
The clinical history, diagnosis, investigations and drug treatment of the patient are reviewed here.
A 58-year-old Japanese woman presented with fatigue, nausea, jaundice and marked elevations of hepatic enzymes 4weeks after starting linagliptin 5mg/day as monotherapy. No other medications were taken, and imaging studies revealed no other obvious causes of hepatic injury. Tests for viral serology and antinuclear antigen were negative. Symptoms disappeared and the levels of hepatic parameters (serum aminotransferases and biliary enzymes) slowly recovered after discontinuation of linagliptin. The slow recovery process may have been due to the very long half-life of the drug. The patient's Naranjo scale score was 6 and RUCAM score was 7.
Although linagliptin currently carries no liver warnings, it may be necessary to monitor hepatic function in some patients upon administration of this drug until further evidence is obtained.
与其他二肽基肽酶 4（DPP-4）抑制剂不同，利格列汀的排泄主要通过胆汁途径。尽管如此，迄今为止，文献中尚未报道利格列汀引起的肝损伤。然而，本报告描述了首例可能由利格列汀引起的肝毒性。
在此回顾了患者的临床病史、诊断、检查和药物治疗情况。
一位 58 岁日本女性在开始利格列汀 5mg/天单药治疗 4 周后出现疲劳、恶心、黄疸和肝酶显著升高。未服用其他药物，影像学检查未发现其他明显的肝损伤原因。病毒血清学和抗核抗体检测均为阴性。停用利格列汀后，症状消失，肝参数（血清转氨酶和胆汁酶）水平缓慢恢复。缓慢的恢复过程可能是由于药物的半衰期非常长。患者的 Naranjo 量表评分为 6 分，RUCAM 评分为 7 分。
尽管利格列汀目前没有肝脏警告，但在给某些患者使用该药时，可能需要监测肝功能，直到获得更多证据。
