Quetiapine-associated cholestasis causing lipoprotein-X and pseudohyponatraemia

Area of Science:

• Pharmacology
• Hepatology
• Clinical Case Reports

Background:

• Drug-induced liver injury is a significant clinical concern.
• Antipsychotic medications, including quetiapine, have been associated with various adverse effects.
• Cholestasis and dyslipidemia are potential, though uncommon, side effects of certain medications.

Observation:

• A case study details a patient experiencing intrahepatic cholestasis and severe hypercholesterolemia.
• The patient was concurrently treated with quetiapine, lamotrigine, and zopiclone.
• Lipoprotein electrophoresis revealed abundant lipoprotein-X, indicative of cholestasis.

Findings:

• The observed hypercholesterolemia was severe, without plasma lactescence, and associated with lipoprotein-X.
• Hyponatremia was diagnosed and treated, suspected to be factitious due to hypercholesterolemia.
• Cholestasis and hypercholesterolemia resolved gradually after quetiapine discontinuation.

Implications:

• This case highlights a potential link between quetiapine, lamotrigine, and zopiclone combination therapy and cholestatic hypercholesterolemia.
• Clinicians should consider drug-induced cholestasis in patients presenting with unexplained hypercholesterolemia and hyponatremia.
• Monitoring liver function and lipid profiles may be warranted in patients on these medications, particularly in combination.