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Fipexide-induced fulminant hepatitis. Report of three cases with emergency liver transplantation
F Durand1, D Samuel, J Bernuau
1Hepatobiliary, Surgery and Liver Transplantation Research Unit, South Paris University, Hôpital Paul Brousse, Villejuif, France.
Abstract:
Fipexide belongs to a new class of cognition activators and is noted for its lack of amphetamin-like side effects. We describe three patients who developed fulminant hepatic failure less than 2 months after beginning fipexide administration. The mean interval from the onset of jaundice to the onset of encephalopathy was 8 days. Emergency liver transplantation was undertaken when factor V was 20% of normal or less and coma developed. All patients were transplanted less than 1 week after the onset of encephalopathy. Two survived and one died immediately after transplantation. Histologic examination of the livers revealed massive liver cell necrosis, predominantly centrilobular, and a moderate inflammatory infiltrate within the portal spaces. We conclude that fipexide can induce massive liver cell necrosis and fulminant liver failure. As a result of this life-threatening complication, reconsideration of the indications for this drug is warranted.
Insights
Fipexide, a cognition activator, has been linked to severe liver damage. Three patients experienced fulminant hepatic failure, necessitating emergency liver transplantation, highlighting a critical safety concern.
Area of Science:
- Hepatology
- Pharmacology
Background:
- Fipexide is a novel cognition activator.
- It was previously noted for its lack of amphetamine-like side effects.
Observation:
- Three patients developed fulminant hepatic failure within two months of starting fipexide.
- The interval from jaundice to encephalopathy was a mean of 8 days.
- Emergency liver transplantation was performed for Factor V levels <= 20% and coma.
Findings:
- Fipexide administration was associated with massive liver cell necrosis.
- Histology showed centrilobular necrosis and portal inflammation.
- Two of three transplanted patients survived.
Implications:
- Fipexide can induce severe, life-threatening liver failure.
- Reconsideration of fipexide's clinical indications is warranted due to this risk.
- This highlights the importance of monitoring liver function in patients taking fipexide.