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Hepatic Failure in a Patient Taking Rosiglitazone

Lisa M. Forman, MD; David A. Simmons, MD; and Robert H. Diamond, MD
[+] Article and Author Information

From the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.


Requests for Reprints: Robert H. Diamond, MD, Division of Gastroenterology, Hospital of the University of Pennsylvania, 600 CRB, 415 Curie Boulevard, Philadelphia, PA, 19104. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Forman: Division of Gastroenterology, Hospital of the University of Pennsylvania, 34th and Spruce Streets, Philadelphia, PA 19104.

Dr. Simmons: Division of Endocrinology, Diabetes, and Metabolism, Hospital of the University of Pennsylvania, 34th and Spruce Streets, Philadelphia, PA 19104.

Dr. Diamond: Division of Gastroenterology, Hospital of the University of Pennsylvania, 600 CRB, 415 Curie Boulevard, Philadelphia, PA 19104.

Author Contributions: Conception and design: L.M. Forman, R.H. Diamond.

Analysis and interpretation of the data: L.M. Forman, D.A. Simmons, R.H. Diamond.

Drafting of the article: L.M. Forman, D.A. Simmons, R.H. Diamond.

Critical revision of the article for important intellectual content: L.M. Forman, D.A. Simmons, R.H. Diamond.

Final approval of the article: L.M. Forman, D.A. Simmons, R.H. Diamond.

Provision of study materials or patients: D.A. Simmons, R.H. Diamond.

Administrative, technical, or logistic support: R.H. Diamond.

Collection and assembly of data: L.M. Forman, R.H. Diamond.


Ann Intern Med. 2000;132(2):118-121. doi:10.7326/0003-4819-132-2-200001180-00005
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Background: Rosiglitazone maleate is the second approved oral hypoglycemic agent of the thiazolidinedione class. The first, troglitazone, has been associated with liver failure, occasionally resulting in liver transplantation or death. There have been no reports to date of rosiglitazone-associated elevations in the alanine aminotransferase level or hepatotoxicity.

Objective: To report the clinical characteristics of liver failure developing in a patient receiving rosiglitazone.

Design: Case report.

Setting: University hospital.

Patient: 69-year-old man taking rosiglitazone, 4 mg/d.

Intervention: Discontinuation of rosiglitazone therapy and treatment with lactulose, vitamin K, fresh frozen plasma, ventilatory assistance, and intensive care unit support.

Measurements: Blood test monitoring, including toxicology screening, liver function tests, coagulation studies, serum chemistries, and complete blood counts.

Results: After 21 days of rosiglitazone therapy, hepatic failure developed. Other causes of hepatic failure, such as viruses and toxins, were excluded, although it is possible that congestive heart failure was also a causative factor. The patient recovered fully with supportive care.

Conclusion: Rosiglitazone may be associated with hepatic failure.

Figures

Grahic Jump Location
Figure.
The patient's clinical course.ALT(circles)INR(squares)

Changes in the patient's alanine aminotransferase ( ) level and international normalized ratio ( ) after rosiglitazone therapy are shown. The dotted line represents the time from the start of rosiglitazone therapy to the patient's hospital admission.

Grahic Jump Location

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Summary for Patients

Liver Damage in a Person Taking the Diabetes Drug Rosiglitazone

The summary below is from the full report titled “Hepatic Failure in a Patient Taking Rosiglitazone.” It is in the 18 January 1999 issue of Annals of Internal Medicine (volume 131, pages 118-121). The authors are L.M. Forman, D.A. Simmons, and R.H. Diamond.

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