Hepatic failure in a patient taking rosiglitazone.
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.


METHODS
Case report.


METHODS
University hospital.


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


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


METHODS
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.


CONCLUSIONS
Rosiglitazone may be associated with hepatic failure.
Forman
L M
LM
Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Simmons
D A
DA
Diamond
R H
RH
D000368:Aged; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D004347:Drug Interactions; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007511:Ischemia / Q000150:complications; D008099:Liver / Q000098:blood supply; D017093:Liver Failure / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008991:Monitoring, Physiologic; D017035:Pravastatin / Q000627:therapeutic use; D000077154:Rosiglitazone; D013844:Thiazoles / Q000009:adverse effects*; D045162:Thiazolidinediones; D014700:Verapamil / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D013844:Thiazoles; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D014700:Verapamil; D017035:Pravastatin