Sall D, Wang J, Rashkin M, Welch M, Droege C, Schauer D
Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
Clin Obes. 2014 Dec;4(6):342-7. doi: 10.1111/cob.12075. Epub 2014 Sep 29.
Orlistat was approved by the Food and Drug Administration in 1998 and has been shown to be superior to placebo in achieving weight loss. It is generally well tolerated. However, severe liver injury has been reported. We present a case of hepatic failure in a patient taking orlistat. A 54-year-old African-American woman with hypertension presented with hepatic failure. She had noticed increasing fatigue, jaundice and confusion. She used alcohol sparingly and denied tobacco or illicit drug use, but had been taking over-the-counter orlistat for the past two months. Physical examination revealed scleral icterus, jaundice, asterixis and slow speech. Laboratory testing showed markedly abnormal liver function tests with coagulopathy. Acute viral and autoimmune serologies were negative, as was toxicology screen. Liver biopsy showed necrotic hepatic parenchyma likely secondary to drug toxicity. Based upon her clinical presentation and time course, the pattern of liver injury seen on liver biopsy and lack of an alternative plausible explanation, her liver failure was most likely associated with orlistat use. She continued to deteriorate and ultimately underwent orthotopic liver transplantation. Fourteen cases of severe liver injury associated with orlistat use have been reported, four of which are detailed in the literature. This is the second published case of liver failure associated with over-the-counter orlistat usage. Clinicians should be aware of the growing number of cases associating liver injury and orlistat use and carefully monitor their patients on this medication for signs of hepatic dysfunction.
奥利司他于1998年获美国食品药品监督管理局批准，已证明在实现体重减轻方面优于安慰剂。它总体耐受性良好。然而，已有严重肝损伤的报道。我们报告一例服用奥利司他的患者发生肝衰竭的病例。一名患有高血压的54岁非裔美国女性出现肝衰竭。她注意到疲劳、黄疸和意识模糊日益加重。她少量饮酒，否认吸烟或使用非法药物，但在过去两个月一直在服用非处方奥利司他。体格检查发现巩膜黄疸、皮肤黄疸、扑翼样震颤和言语迟缓。实验室检查显示肝功能检查明显异常并伴有凝血功能障碍。急性病毒和自身免疫血清学检查均为阴性，毒理学筛查也是如此。肝活检显示肝实质坏死，可能继发于药物毒性。根据她的临床表现、病程、肝活检所见的肝损伤模式以及缺乏其他合理的解释，她的肝衰竭很可能与使用奥利司他有关。她病情持续恶化，最终接受了原位肝移植。已报告14例与使用奥利司他相关的严重肝损伤病例，其中4例在文献中有详细记载。这是第二例发表的与非处方奥利司他使用相关的肝衰竭病例。临床医生应意识到与肝损伤和奥利司他使用相关的病例数量不断增加，并仔细监测服用此药的患者是否有肝功能障碍的迹象。
