0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Severe Liver Injury after Treatment with the Leukotriene Receptor Antagonist Zafirlukast

John F. Reinus, MD; Seth Persky, MD; Jill S. Burkiewicz, PharmD; David Quan, PharmD; Nathan M. Bass, MD, PhD; and Timothy J. Davern, MD
[+] Article and Author Information

Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(12):964-968. doi:10.7326/0003-4819-133-12-200012190-00011
Text Size: A A A

Background: In registration trials, zafirlukast, an asthma medication, caused asymptomatic elevated aminotransferase levels in up to 5% of participants. Until now, however, no cases of severe hepatitis attributed to zafirlukast have been reported.

Objective: To report the clinical characteristics of three patients with severe hepatitis due to zafirlukast.

Design: Case report.

Setting: One community hospital and two university hospitals.

Patients: Three middle-aged women taking zafirlukast, 20 mg twice per day.

Intervention: Discontinuation of zafirlukast therapy in three patients, steroid therapy in two patients, and orthotopic liver transplantation in one patient.

Measurements: Serum aminotransferase and bilirubin levels, standard blood tests for causes of hepatitis other than drug toxicity, and liver biopsy in two patients.

Results: Patient 1 recovered spontaneously, had a severe relapse after inadvertent rechallenge with the medication, and ultimately made a complete recovery. Patient 2 developed subfulminant hepatic failure and required liver transplantation. Patient 3 developed severe hepatitis that improved after treatment with corticosteroids. Liver tissue was available from two patients and showed histologic changes commonly associated with drug reactions.

Conclusion: Patients receiving zafirlukast may develop severe liver injury and should be observed for signs and symptoms of hepatitis.

Figures

Grahic Jump Location
Figure.
Serum alanine aminotransferase (bars) and total bilirubin (solid line) levels in patient 1.

Zafirlukast therapy was withdrawn at month 9, restarted at month 13, and withdrawn permanently at month 16. To convert U/L to nkat/L, multiply by 16.667. To convert mg/dL to µmol/L, multiply by 17.104.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Severe Liver Injury in Patients Taking the Asthma Medication Zafirlukast

Copyright ©2004 by the American College of Physicians

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)