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Published on: February 10, 2015
Atorvastatin-induced prolonged cholestasis with bile duct damage
Manuela Merli1, Maria Consiglia Bragazzi, Federica Giubilo
1Division of Gastroenterology, Department of Clinical Medicine, University of Rome 'Sapienza', Rome, Italy.
Clinical Drug Investigation
|February 17, 2010
Summary
Atorvastatin, a cholesterol-lowering drug, can cause prolonged cholestasis (bile flow obstruction) and bile duct damage. This rare drug-induced liver injury resolved after discontinuing the medication.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Gastroenterology
Background:
- Drug-induced liver injury (DILI) is a significant clinical concern.
- Statins, including atorvastatin, are widely prescribed for hyperlipidaemia.
- Cholestasis is a less common manifestation of DILI.
Observation:
- A 72-year-old male developed acute, prolonged cholestasis after 40 days of atorvastatin use for mixed dyslipidaemia.
- Symptoms included jaundice, asthenia, nausea, acholic stools, and hyperchromic urine.
- Biochemical tests revealed markedly elevated bilirubin and alkaline phosphatase levels, with moderate transaminase increases.
Findings:
- Liver histology demonstrated cholestasis with cholangiolitis and interlobular bile duct damage.
- Atorvastatin was identified as the probable cause using validated clinical scales (Maria and Victorino, Naranjo).
- Biochemical parameters normalized within 5-8 months post-atorvastatin withdrawal.
Implications:
- This case highlights a rare but severe form of DILI potentially caused by atorvastatin, characterized by prolonged cholestasis and bile duct injury.
- Physicians should consider atorvastatin as a potential etiology in patients presenting with unexplained cholestasis.
- Further research into the mechanisms of statin-induced cholestasis and bile duct damage is warranted.
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