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Metformin-induced cholestatic hepatitis.

Fadel E Nammour1, Nabil F Fayad, Steven R Peikin

  • 1Department of Medicine, Division of Gastroenterology, Cooper Hospital, University Medical Center, and Robert Wood Johnson Medical School, Camden, New Jersey 08103, USA.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|October 17, 2003
PubMed
Summary

Metformin, a common diabetes medication, can rarely cause liver damage. This case highlights metformin-induced cholestatic hepatitis, emphasizing the need for physician and patient awareness of this potential side effect.

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Area of Science:

  • Hepatology
  • Pharmacology
  • Internal Medicine

Background:

  • Metformin is a widely prescribed oral antihyperglycemic agent for type 2 diabetes mellitus.
  • Drug-induced liver injury (DILI) is an important clinical consideration in patients with abnormal liver function tests.

Observation:

  • A 68-year-old male with new-onset diabetes mellitus developed jaundice, pruritus, and abnormal liver enzymes four weeks after initiating metformin therapy.
  • Extensive investigations, including imaging and serological tests, ruled out other causes of liver dysfunction.

Findings:

  • Liver biopsy revealed severe cholestasis and mild portal inflammation, consistent with drug-induced liver injury.
  • Discontinuation of metformin led to normalization of liver enzymes, except for persistently elevated alkaline phosphatase, suggesting a prolonged cholestatic effect.

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Implications:

  • This case underscores that metformin, despite its safety profile, can induce cholestatic hepatitis, albeit rarely.
  • Clinicians should maintain a high index of suspicion for metformin-induced liver injury in patients presenting with unexplained hepatitis.
  • Awareness of this potential adverse effect is crucial for timely diagnosis and management.