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Intrahepatic cholestasis during nicotinic acid therapy
1Division of Endocrinology, Lutheran Medical Center, Cleveland, OH 44113.
Cleveland Clinic Journal of Medicine
|January 1, 1994
Summary
Nicotinic acid, used for high cholesterol, can rarely cause cholestatic jaundice. Physicians should monitor patients for this rare but serious side effect.
Area of Science:
- Hepatology
- Pharmacology
Background:
- Nicotinic acid is a common treatment for hypercholesterolemia.
- Cholestatic jaundice is a rare but documented adverse effect of nicotinic acid therapy.
Observation:
- A 61-year-old male developed jaundice and pruritus after 13 months of nicotinic acid use.
- Laboratory tests revealed elevated bilirubin and alkaline phosphatase levels.
- Imaging studies ruled out obstructive causes, indicating intrahepatic cholestasis.
Findings:
- Discontinuation of nicotinic acid led to symptom resolution and normalization of liver function tests within 51 days.
- The case suggests intrahepatic cholestasis as the mechanism of jaundice.
Implications:
- Nicotinic acid-induced cholestatic jaundice may be underdiagnosed.
- Clinicians should maintain a high index of suspicion for this adverse drug reaction.