title: Acute and fulminant hepatitis induced by flutamide: case series report and review of the literature.
abstract: Flutamide is a non-steroidal anti-androgenic drug, commonly used in the treatment of advanced prostate cancer, acne and hirsutism. This drug may induce various degrees of liver injury, including acute liver failure (ALF), with further need for liver transplantation. Here, we present a report of 10 consecutive patients seen in a period of 14 years, with acute liver toxicity induced by flutamide (in most cases severe hepatotoxicity): 3 men and 7 women, with a mean age of 75 and 29 years old, respectively. All men received flutamide as treatment of advanced prostate carcinoma and they developed hepatotoxicity without ALF, and three months after withdrawal of the drug, they recovered completely. In contrast, in 7 young female with liver toxicity caused by flutamide as treatment of various hyperandrogenic conditions (acne and hirsutism), ALF was observed in 5 patients, all of them requiring urgent liver transplantation, with excellent outcome and survival in 4 of them. Based on the above, we believe that flutamide treatment should be preferentially avoided in young female patients with benign pathologies, or if it is used, patients should be warned of its potential severe complications. Also, serial liver tests should be closely monitored and, in case of elevations, the drug should be immediately withdrawn.
authors.affiliation: Department of Gastroenterology, Hospital Clínico Universidad de Chile, North Campus, Santiago, Chile. jbrahm@redclinicauchile.cl
authors.forename: Javier
authors.initials: J
authors.lastname: Brahm
authors.forename: Magdalena
authors.initials: M
authors.lastname: Brahm
authors.forename: Roberto
authors.initials: R
authors.lastname: Segovia
authors.forename: Ricardo
authors.initials: R
authors.lastname: Latorre
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Zapata
authors.forename: Jaime
authors.initials: J
authors.lastname: Poniachik
authors.forename: Erwin
authors.initials: E
authors.lastname: Buckel
authors.forename: Luis
authors.initials: L
authors.lastname: Contreras
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005485:Flutamide / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005485:Flutamide