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Thioctic acid-induced acute cholestatic hepatitis
Ezequiel Ridruejo1, Teresa Castiglioni, Marcelo O Silva
1Hepatology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina. eridruejo@gmail.com
The Annals of Pharmacotherapy
|June 16, 2011
Summary
Thioctic acid (alpha-lipoic acid) can cause severe cholestatic hepatitis, a rare side effect in patients with diabetes. This case highlights the potential liver toxicity of this commonly used supplement.
Area of Science:
- Hepatology
- Pharmacology
- Endocrinology
Background:
- Alpha-lipoic acid (thioctic acid) is widely used for diabetic peripheral neuropathy and glycemic control.
- It is generally considered safe with no prior reports of significant liver toxicity.
Observation:
- A 63-year-old male with diabetes and renal failure developed severe cholestatic hepatitis after initiating thioctic acid therapy.
- Liver enzymes normalized upon discontinuation and recurred upon re-challenge, strongly suggesting drug-induced liver injury.
Findings:
- The patient exhibited elevated AST, ALT, ALP, and GGT levels, indicative of cholestatic liver damage.
- Causality assessment scales indicated a probable association between thioctic acid and the observed drug-induced liver injury.
Implications:
- This case is the first to report probable liver toxicity associated with thioctic acid.
- Clinicians should consider thioctic acid as a potential cause of drug-induced liver injury in susceptible patients.
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