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Hepatitis during chloroguanide prophylaxis

L M Oostweegel1, J H Beijnen, J W Mulder

  • 1Department of Pharmacy and Pharmacology, Slotervaart Hospital/Netherlands Cancer Institute, Slotervaart Hospital, Amsterdam, The Netherlands.

The Annals of Pharmacotherapy
|October 30, 1998
PubMed
Summary
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This case report details a patient who developed severe cholestatic hepatitis, a form of liver damage, attributed to the use of chloroguanide for malaria prophylaxis. This highlights the potential for drug-induced liver injury from this medication.

Area of Science:

  • Hepatology
  • Pharmacology
  • Tropical Medicine

Background:

  • Chloroguanide is an antimalarial drug used for prophylaxis.
  • Drug-induced liver injury (DILI) is a significant concern in pharmacotherapy.
  • Cholestatic hepatitis presents with impaired bile flow and liver enzyme abnormalities.

Observation:

  • A patient presented with jaundice and fever after returning from Indonesia.
  • The patient was on chloroguanide prophylaxis (200 mg daily for 6 weeks).
  • Liver function tests revealed cholestatic liver disease, confirmed by biopsy as drug-induced hepatitis.

Findings:

  • The case is the first reported instance of cholestatic hepatitis linked to chloroguanide prophylaxis.
  • Hepatotoxicity was likely a combined allergic and idiosyncratic reaction to chloroguanide.

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  • Elevated liver enzymes (ALP, AST, ALT, GGT) indicated significant liver damage.

    • Implications:

    • Clinicians should consider chloroguanide as a potential cause of drug-induced hepatitis.
    • This case underscores the risk of considerable morbidity associated with chloroguanide prophylaxis.
    • Awareness of potential DILI is crucial for patient safety in malaria-endemic regions.