title: Metformin-induced mixed hepatocellular and cholestatic hepatic injury: case report and literature review.
abstract: BACKGROUND
  Metformin is a first-line drug choice for the treatment of type 2 diabetes mellitus (DM-2). Metformin-induced hepatotoxicity has rarely been reported. We report on a case of metformin-induced mixed hepatocellular and cholestatic liver injury in an elderly patient with DM-2 as well as review and summarize case reports of metformin hepatotoxicity available in English on the PubMed database.
  
  
  METHODS
  After receiving metformin 850 mg/day for 2 weeks, a 78-year-old male presented with a 10-day history of abdominal pain, vomiting, diarrhea, and jaundice. Laboratory analysis showed severe hepatocellular and cholestatic hepatic injury. Other causes for acute liver injury were ruled out. Discontinuation of metformin treatment led to significant subjective improvement after 1 week, and all hepatic abnormalities resolved by 2 months.
  
  
  CONCLUSIONS
  Metformin is an important drug for the treatment of DM-2, which is also used for treatment of patients with fatty liver. It can, however, induce hepatocellular and cholestatic hepatic injury; both physicians and patients should be aware of this potential side effect.
authors: Liver Unit, Haifa, Israel ; Department of Gastroenterology, Haifa, Israel ; Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel.
authors: Tarek
authors: T
authors: Saadi
authors: Matti
authors: M
authors: Waterman
authors: Heba
authors: H
authors: Yassin
authors: Yaacov
authors: Y
authors: Baruch
keywords: cholestasis; hepatocellular liver injury; hepatotoxicity; metformin
references: Hepatology. 1997 Sep;26(3):664-9
references: 9303497
references: Ann Intern Med. 2004 Mar 2;140(5):W25
references: 14996697
references: Clin Pharmacol Ther. 1981 Aug;30(2):239-45
references: 7249508
references: Eur J Gastroenterol Hepatol. 2000 Jan;12(1):119-21
references: 10656221
references: Ann Pharmacother. 2010 Oct;44(10):1655-9
references: 20647417
references: N Engl J Med. 1995 Aug 31;333(9):550-4
references: 7623903
references: Lancet. 1997 Mar 8;349(9053):698-9
references: 9078205
references: Eur J Gastroenterol Hepatol. 2007 Jan;19(1):15-20
references: 17206072
references: Hepatology. 2006 Oct;44(4):850-6
references: 17006920
references: Ann Intern Med. 2002 Jul 2;137(1):25-33
references: 12093242
references: Am J Gastroenterol. 2001 Jul;96(7):2257-8
references: 11467664
references: Lancet. 1998 Sep 12;352(9131):854-65
references: 9742977
references: Endocr Pract. 2003 Jul-Aug;9(4):307-9
references: 14561576
references: Am J Geriatr Pharmacother. 2005 Dec;3(4):270-3
references: 16503324
references: Semin Liver Dis. 2002;22(2):169-83
references: 12016548
references: Am J Med. 1998 May;104(5):490-2
references: 9626034
references: Clin Pharmacol Ther. 1978 Dec;24(6):683-93
references: 710026