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Fulminant Hepatic Failure after Ingestion of Sustained-Release Nicotinic Acid

Gerard E. Mullin, MD; Joel K. Greenson, MD; and Mack C. Mitchell, MD
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Requests for Reprints: Mack C. Mitchell, Jr, MD, Division of Gastroenterology, The Johns Hopkins School of Medicine, Hunterian 409, 725 North Wolfe Street, Baltimore, MD 21205.

Current Author Addresses: Drs. Mullin and Mitchell: Division of Gastroenterology, The Johns Hopkins School of Medicine, Hunterian 409, 725 North Wolfe Street, Baltimore, MD 21205.

Dr. Greenson: Department of Pathology, The Johns Hopkins School of Medicine, 725 North Wolfe Street, Baltimore, MD 21205.

Ann Intern Med. 1989;111(3):253-255. doi:10.7326/0003-4819-111-3-253
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This excerpt has been provided in the absence of an abstract.

Nicotinic acid is an effective, widely used treatment for hypercholesterolemia (1). Hepatotoxicity is a rare complication of therapy, which usually occurs with ingestion of more than 3 g daily. In most cases, patients have jaundice, pruritus, and mild elevations in serum bilirubin, alkaline phosphatase, and aminotransferase levels, although, in some instances, more severe hepatocellular injury has occurred (2). We report the case of a patient who developed fulminant hepatic failure shortly after switching to sustained-release nicotinic acid after having taken ordinary nicotinic acid for over 1 year without side effects.

Case Report: In February 1987, after having coronary angioplasty, a


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