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Related Experiment Videos

Ramipril-associated hepatotoxicity.

Elaine Yeung1, Florence S Wong, Ian R Wanless

  • 1Departments of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.

Archives of Pathology & Laboratory Medicine
|October 22, 2003
PubMed
Summary
This summary is machine-generated.

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Ramipril can cause prolonged cholestatic hepatitis and biliary cirrhosis, a rare adverse hepatic event. Monitoring liver enzymes is recommended for patients starting this angiotensin-converting enzyme inhibitor.

Area of Science:

  • Hepatology
  • Pharmacology
  • Internal Medicine

Background:

  • Angiotensin-converting enzyme (ACE) inhibitors are widely used for cardiovascular and renal conditions.
  • Rare hepatic adverse events, including cholestasis, have been linked to some ACE inhibitors.
  • Ramipril had no previously reported cases of hepatic injury.

Observation:

  • Three middle-aged men developed hepatitis after ramipril initiation.
  • Two presented with jaundice, elevated bilirubin and alkaline phosphatase, and mild aminotransferase elevations.
  • One patient experienced hepatitis without jaundice.

Findings:

  • Liver biopsies revealed cholestasis, duct necrosis, bile extravasation, ductular proliferation, and portal inflammation.
  • Cholestasis resolved in one patient but persisted for 14 months in another, leading to biliary cirrhosis.

Related Experiment Videos

  • Ramipril-induced liver injury shares similarities with other ACE inhibitors but presents unique biopsy findings.

    • Implications:

    • Ramipril use can lead to prolonged cholestatic hepatitis and potentially biliary cirrhosis.
    • Close monitoring of liver enzymes is advised for patients initiating ramipril therapy.
    • This study highlights a previously unreported adverse hepatic event associated with ramipril.