Fipexide-induced fulminant hepatitis. Report of three cases with emergency liver transplantation.
Fipexide belongs to a new class of cognition activators and is noted for its lack of amphetamin-like side effects. We describe three patients who developed fulminant hepatic failure less than 2 months after beginning fipexide administration. The mean interval from the onset of jaundice to the onset of encephalopathy was 8 days. Emergency liver transplantation was undertaken when factor V was 20% of normal or less and coma developed. All patients were transplanted less than 1 week after the onset of encephalopathy. Two survived and one died immediately after transplantation. Histologic examination of the livers revealed massive liver cell necrosis, predominantly centrilobular, and a moderate inflammatory infiltrate within the portal spaces. We conclude that fipexide can induce massive liver cell necrosis and fulminant liver failure. As a result of this life-threatening complication, reconsideration of the indications for this drug is warranted.
Durand
F
F
Hepatobiliary, Surgery and Liver Transplantation Research Unit, South Paris University, Hôpital Paul Brousse, Villejuif, France.
Samuel
D
D
Bernuau
J
J
Saliba
F
F
Pariente
E A
EA
Marion
S
S
Benhamou
J P
JP
Bismuth
H
H
D000293:Adolescent; D000328:Adult; D056486:Chemical and Drug Induced Liver Injury; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D010879:Piperazines / Q000009:adverse effects*; D012720:Severity of Illness Index
D010879:Piperazines; C038628:fipexide