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Zhu B, Liu B, Tang G, Jin P, Liu D. Two cases report of febuxostat-induced acute liver injury: acute heart failure as a probable risk factor? Drug Chem Toxicol 2024; 47:55-59. [PMID: 36789513 DOI: 10.1080/01480545.2023.2178451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
Drug induced liver injury, as a sub-type of hepatotoxicity, is rare but practical problem, producing challenges for clinicians. Within the recent two months, two patients with heart failure develop febuxostat-induced acute liver injury during hospital stay. To the best of our knowledge, very few cases of febuxostat-induced hepatotoxicity have been reported up to now. In this paper, two unusual cases of febuxostat-induced acute liver injury are herein described. The medical history, drug treatment, clinical symptoms, liver function tests, diagnosis and prognosis are fully given in this paper. It should be noticed that, two liver injury happen in patients of heart failure with reduced ejection fraction. Whether heart failure is a risk factor of febuxostat related liver injury, deserves further research. This paper reminds the clinicians that more attention should be paid to the acute liver injury caused by febuxostat, and liver function tests are suggested especially for patients of heart failure.
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Affiliation(s)
- Bolin Zhu
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, P. R. China
| | - Bing Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Guodong Tang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Pengfei Jin
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, P. R. China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Al-Shargi A, El Kholy AA, Adel A, Hassany M, Shaheen SM. Allopurinol versus Febuxostat: A New Approach for the Management of Hepatic Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease. Biomedicines 2023; 11:3074. [PMID: 38002074 PMCID: PMC10669273 DOI: 10.3390/biomedicines11113074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) includes patients with hepatic steatosis and at least one of five cardiometabolic risk factors. Xanthine oxidase (XO) represents a treatment target for MASLD. We aimed to evaluate the effect of two xanthine oxidase inhibitors, allopurinol and febuxostat, plus lifestyle modifications compared to lifestyle modifications alone on improving steatosis. Ninety MASLD patients were assigned to one of three groups for three months. Patients with hyperuricemia were given either allopurinol 100 mg or febuxostat 40 mg daily, along with lifestyle modifications. The third control group was only given lifestyle modifications, excluding all patients with hyperuricemia due to ethical concerns. The primary outcome was to measure the change in the controlled attenuation parameter (CAP) score as an indicator of steatosis from baseline after three months. The secondary outcome was to measure the change in serum uric acid (SUA) three months from baseline. The study found that the CAP score decreased significantly in the allopurinol group (p = 0.009), but the decline in the febuxostat or lifestyle groups was non-significant (p = 0.189 and 0.054, respectively). The SUA levels were significantly reduced in both the allopurinol and febuxostat groups (p < 0.001), with no statistical difference between the two groups (p = 0.496).
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Affiliation(s)
- Amani Al-Shargi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 4393005, Egypt; (A.A.E.K.); (S.M.S.)
| | - Amal A. El Kholy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 4393005, Egypt; (A.A.E.K.); (S.M.S.)
| | - Abdulmoneim Adel
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo 4260010, Egypt; (A.A.); (M.H.)
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo 4260010, Egypt; (A.A.); (M.H.)
| | - Sara M. Shaheen
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 4393005, Egypt; (A.A.E.K.); (S.M.S.)
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Zhao S, Li P, Wen X, Yang J. Study on the hepatobiliary behavior of Ermiao wan formula by microdialysis- LC-qTOF-MS. J Pharm Biomed Anal 2020; 189:113419. [PMID: 32599487 DOI: 10.1016/j.jpba.2020.113419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/02/2020] [Accepted: 06/07/2020] [Indexed: 01/31/2023]
Abstract
An improved bile microdialysis sampling technique was established and coupled with liquid chromatography quadrupole time-of-flight mass spectrometry (LC-qTOF-MS) analysis. This method was successfully applied to investigate the metabolic profiles of Ermiao wan (EMW) formula in the bile of Sprague-Dawley (SD) rats. Based on accurate mass information and fragment patterns, 23 alkaloids and lactones metabolites were tentatively identified. Their metabolic pathway involved in glucuronidation, sulfation, hydroxylation and hydrolysis. Because of the high time resolution of microdialysis, the metabolic profiles of EMW were also investigated. Jatrorrhizine, columbamine and other components showed a "double-peak" profiles, suggesting the existence of enterohepatic circulation. The developed microdialysis sampling/ LC-qTOF-MS method provides a simple and efficient research tool for understanding and clarifying the mechanism of hepatobiliary excretion of complex components.
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Affiliation(s)
- Shuling Zhao
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Longmian Road, Nanjing, Jiangsu, 211198, China.
| | - Ping Li
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Longmian Road, Nanjing, Jiangsu, 211198, China.
| | - Xiaodong Wen
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Longmian Road, Nanjing, Jiangsu, 211198, China.
| | - Jie Yang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, 639 Longmian Road, Nanjing, Jiangsu, 211198, China.
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Oh YJ, Moon KW. Combined Use of Febuxostat and Colchicine Does Not Increase Acute Hepatotoxicity in Patients with Gout: A Retrospective Study. J Clin Med 2020; 9:jcm9051488. [PMID: 32429082 PMCID: PMC7290683 DOI: 10.3390/jcm9051488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/16/2022] Open
Abstract
Colchicine has been effectively used to prevent acute flares in patients with gout, but drug-related adverse events have frequently occurred. We investigated whether colchicine therapy with febuxostat is associated with hepatotoxicity in gout patients. Gout patients treated with (n = 121) or without (n = 57) colchicine were enrolled upon initiating febuxostat as a urate-lowering treatment, and clinical and laboratory data at diagnosis were compared. Logistic regression analysis was performed to evaluate the risk factors related to hepatotoxicity. Median age of the with-colchicine and without-colchicine groups was 51.0 (37.0–62.0) and 56.0 (43.5–68.5) years, respectively. During the three months of febuxostat prescription, the prevalence of hepatotoxicity was 13/121 (10.9%) in the with-colchicine group and 4/57 (7.0%) in the without-colchicine group, without statistical significance. The rate of colchicine use was not different between the study subjects with or without hepatotoxicity (76.5% vs. 67.1%, p = 0.587). Pre-existing liver disease was significantly associated with increased risk of hepatotoxicity after febuxostat treatment (odds ratio, 4.083; 95% confidence interval, 1.326–12.577; p = 0.014). Colchicine may be safely used as a prophylactic agent for gout patients with febuxostat. However, upon initiating febuxostat, it is recommended to monitor the development of acute liver injury in gout patients with underlying liver disease.
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Affiliation(s)
| | - Ki Won Moon
- Correspondence: ; Tel.: +82-33-258-9470; Fax: +82-33-258-2455
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Pohl H, Vallelian F, Herfs G. [Light and Shadow of Hyperuricemia - Neuroprotection, Comorbidities and Therapeutic Strategies]. PRAXIS 2019; 108:527-533. [PMID: 31185840 DOI: 10.1024/1661-8157/a003253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Light and Shadow of Hyperuricemia - Neuroprotection, Comorbidities and Therapeutic Strategies Abstract. Hyperuricemia can lead to gout but also favor the appearance of comorbidities like hypertension, kidney insufficiency, type 2 diabetes, myocardial infarction and strokes. Uric acid does not only have, however, negative impact on the body, but seems to influence positively certain inflammatory and degenerative neurological diseases. The inflammatory reaction at the center of a gout attack is mediated by interleukin 1. Therefore, antagonists against interleukin 1 or IL-1 receptors can be used for treatment if colchicine, steroids or nonsteroidal anti-inflammatory drugs are ineffective or contraindicated. First-line drug for urate-lowering therapy is allopurinol that positively influences comorbidities as well.
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Affiliation(s)
- Heiko Pohl
- 1 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
| | | | - Gregor Herfs
- 1 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
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Irsay L, Checiches A, Perja D, Borda IM, Dogaru G, Ungur R, Ciubean A, Ciortea V. Pharmacological pain management in patients with chronic hepatic disease. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The liver has a central role in the pharmacokinetics (absorption, distribution, elimination, etc.) of drugs. With hepatic insufficiency, the metabolism of drugs decreases, which accumulates metabolically or toxic active products. Some medicines can aggravate a pre-existing liver disease. Medicines used in this group of patients (especially diuretics and centrally acting preparations) can often cause impaired renal function or hepatic encephalopathy. The general principles of assessment, pain management and analgesia should be prescribed taking into account the Word Health Organization (WHO) recommendations for these patients, with careful and frequent monitoring of patient progress during treatment administration.
Key words: hepatotoxicity, hepatic dysfunction, cirrhosis, pain medication,
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Affiliation(s)
- László Irsay
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
| | | | - Dănuț Perja
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
| | | | - Gabriela Dogaru
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Rodica Ungur
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Alina Ciubean
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Viorela Ciortea
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
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