title: Prolonged cholestasis after raloxifene and fenofibrate interaction: A case report.
abstract: Assigning causality in drug-induced liver injury is challenging particularly when more than one drug could be responsible. We report a woman on long-term therapy with raloxifen who developed acute cholestasis shortly after starting fenofibrate. The picture evolved into chronic cholestasis. We hypothesized that an interaction at the metabolic level could have triggered the presentation of hepatotoxicity after a very short time of exposure to fenofibrate in this patient. The findings of an overexpression of vascular endothelial growth factor in the liver biopsy suggest that angiogenesis might play a role in the persistence of toxic cholestasis.
authors.affiliation: Department of Clinical Pharmacology, Facultad de Medicina, E-29071-Malaga, Spain. lucena@uma.es
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Lucena
authors.forename: Raúl J
authors.initials: RJ
authors.lastname: Andrade
authors.forename: Luis
authors.initials: L
authors.lastname: Vicioso
authors.forename: F Jesús
authors.initials: FJ
authors.lastname: González
authors.forename: Ketevan
authors.initials: K
authors.lastname: Pachkoria
authors.forename: Beatriz
authors.initials: B
authors.lastname: García-Muñoz
mesh_terms: D001706:Biopsy; D002779:Cholestasis / Q000139:chemically induced* / Q000175:diagnosis*; D005260:Female; D011345:Fenofibrate / Q000494:pharmacology*; D006801:Humans; D000960:Hypolipidemic Agents / Q000494:pharmacology*; D008099:Liver / Q000187:drug effects*; D008875:Middle Aged; D020849:Raloxifene Hydrochloride / Q000494:pharmacology*; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology*
chemical_list: D000960:Hypolipidemic Agents; D020845:Selective Estrogen Receptor Modulators; D020849:Raloxifene Hydrochloride; D011345:Fenofibrate