Possible hepatotoxicity of Doxidan

Area of Science:

• Hepatology
• Pharmacology
• Toxicology

Background:

• Chronic constipation is a common condition often treated with stimulant laxatives.
• Doxidan, a combination of danthron and dioctyl calcium sulfosuccinate, is used for constipation relief.
• Drug-induced liver injury (DILI) and hematologic abnormalities are potential adverse effects of medications.

Purpose of the Study:

• To report a case of liver injury and leukopenia associated with Doxidan.
• To investigate the potential role of dioctyl calcium sulfosuccinate in potentiating danthron toxicity.
• To examine the immunopathological findings in the liver biopsy.

Main Methods:

• Case report of a patient with chronic constipation.
• Clinical and laboratory evaluation including liver function tests and complete blood count.
• Review of medication history and drug formulation.
• Liver biopsy with immunofluorescence studies.

Main Results:

• The patient developed significant liver injury and leukopenia after Doxidan ingestion.
• Evidence suggests dioctyl calcium sulfosuccinate may enhance danthron-induced toxicity.
• Liver biopsy revealed IgE deposition in Kupffer cells, indicating an immune-mediated component.

Conclusions:

• Doxidan (danthron and dioctyl calcium sulfosuccinate) can cause severe liver injury and leukopenia.
• Dioctyl calcium sulfosuccinate might play a role in potentiating the toxicity of danthron.
• The liver injury appears to involve IgE deposition in Kupffer cells, though the precise mechanism requires further investigation.