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Prolonged cholestasis after raloxifene and fenofibrate interaction: A case report
M Isabel Lucena1, Raúl J Andrade, Luis Vicioso
1Department of Clinical Pharmacology, Facultad de Medicina, E-29071-Malaga, Spain. lucena@uma.es
Determining the cause of drug-induced liver injury is difficult. This case study explores a potential drug interaction between raloxifene and fenofibrate causing chronic cholestasis, highlighting vascular endothelial growth factor
Area of Science:
- Hepatology
- Pharmacology
- Toxicology
Background:
- Drug-induced liver injury (DILI) presents diagnostic challenges, especially with polypharmacy.
- Raloxifene and fenofibrate are commonly prescribed medications with known hepatic safety profiles.
Observation:
- A patient on long-term raloxifene therapy developed acute cholestasis after initiating fenofibrate.
- The cholestatic condition progressed to a chronic state.
Findings:
- Metabolic interactions between raloxifene and fenofibrate may trigger hepatotoxicity.
- Overexpression of vascular endothelial growth factor (VEGF) in liver biopsy suggests a role for angiogenesis in persistent toxic cholestasis.
Implications:
- This case underscores the importance of considering drug-drug interactions in DILI etiology.
- VEGF-mediated angiogenesis may be a therapeutic target for managing chronic drug-induced cholestasis.
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