[Verapamil-associated liver injury]

Area of Science:

• Hepatology
• Clinical Pharmacology
• Toxicology

Background:

• Verapamil is a widely used calcium channel blocker for hypertension.
• Hepatotoxicity is a rare but serious adverse effect associated with verapamil therapy.
• Previous reports of verapamil-induced liver injury are limited.

Observation:

• A 54-year-old woman presented with cholestatic liver injury and pruritus.
• Symptoms developed after initiating sustained-release verapamil (240 mg/day) for arterial hypertension.
• Complete resolution of liver abnormalities and pruritus occurred upon drug discontinuation.

Findings:

• The patient's liver injury was characterized as cholestatic.
• The adverse event was likely idiosyncratic, a rare immune-mediated reaction.
• This case adds to the scarce literature on verapamil-associated hepatotoxicity.

Implications:

• Clinicians should maintain awareness of potential verapamil-induced liver injury, even if rare.
• Early recognition and drug withdrawal are crucial for managing verapamil hepatotoxicity.
• Healthcare providers must consider verapamil as a potential cause of liver injury in hypertensive patients.