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Dapagliflozin-Associated Hepatotoxicity With a Positive Rechallenge.

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Summary

Sodium glucose cotransporter 2 inhibitors are generally safe. This case study highlights a suspected liver injury caused by dapagliflozin, a medication for diabetes, heart failure, and kidney disease, which resolved after discontinuation.

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Area of Science:

  • Pharmacology
  • Hepatology
  • Internal Medicine

Background:

  • Sodium glucose cotransporter 2 (SGLT2) inhibitors are widely prescribed for type 2 diabetes, heart failure, and chronic kidney disease.
  • These medications are generally well-tolerated, with a favorable safety profile.
  • Liver injury is a rare but potential adverse effect of certain medications.

Observation:

  • A 68-year-old male presented with upper abdominal pain, myalgias, and elevated liver enzymes (transaminitis).
  • The patient had a history of unexplained hepatitis and was taking dapagliflozin.
  • Symptoms and laboratory abnormalities suggested drug-induced liver injury (DILI).

Findings:

  • The patient's liver injury, characterized by jaundice and transaminitis, was deemed highly likely to be caused by dapagliflozin.
  • A Revised Electronic Causality Assessment Method (RECAM) score of 9 (Highly likely) supported the diagnosis of dapagliflozin-induced liver injury.
  • Discontinuation of dapagliflozin led to the resolution of laboratory findings and clinical symptoms.

Implications:

  • This case underscores the importance of considering drug-induced liver injury in patients presenting with unexplained hepatitis, especially when initiating new medications.
  • Hepatologists and clinicians should maintain a high index of suspicion for SGLT2 inhibitor-induced liver injury.
  • Further research may be warranted to elucidate the mechanisms of SGLT2 inhibitor-induced hepatotoxicity and identify predictive factors.