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Second-generation thiazolidinediones and hepatotoxicity
Todd R Marcy1, Mark L Britton, Steve M Blevins
1Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117-1223, USA. todd-marcy@ouhsc.edu
The Annals of Pharmacotherapy
|July 22, 2004
Summary
Pioglitazone may cause liver injury, as seen in a case report. While less severe than troglitazone, monitoring liver enzymes is crucial for patients on pioglitazone or rosiglitazone.
Area of Science:
- Pharmacology
- Hepatology
- Endocrinology
Background:
- Thiazolidinediones (TZDs) like pioglitazone are used for type 2 diabetes.
- Troglitazone, an earlier TZD, was withdrawn due to severe hepatotoxicity.
- Concerns exist regarding the liver safety of newer TZDs, including pioglitazone and rosiglitazone.
Observation:
- A 39-year-old woman developed symptoms of liver dysfunction (fatigue, dark urine, nausea) while on pioglitazone.
- Pioglitazone was discontinued, leading to symptom resolution and normalization of liver enzymes within 2.5 months.
- Abnormal liver function tests included elevated ALT, AST, alkaline phosphatase, and bilirubin.
Findings:
- The Naranjo scale suggests a probable causal link between pioglitazone and the observed liver injury.
- Reported cases of hepatotoxicity with rosiglitazone and pioglitazone are fewer and less severe than with troglitazone.
- Most patients improve after TZD discontinuation, with liver enzyme normalization occurring within weeks to months.
Implications:
- Routine monitoring of liver enzymes is recommended for patients taking pioglitazone or rosiglitazone.
- Patients with a history of TZD-induced hepatotoxicity should avoid these medications.
- Further research may clarify the risk-benefit profile of TZDs concerning liver safety.