Emtricitabine/rilpivirine/tenofovir disoproxil fumarate
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Acute allergic hepatitis (first report with rilpivirine): case report A 28-year-old man developed acute allergic hepatitis while receiving emtricitabine/rilpivirine/tenofovir disoproxil fumarate. The man, who had AIDS, presented with a 2–3 day history of generalised weakness, vomiting, nausea and fever. He had previously been receiving antiretrovirals, but 4 days before admission, his regimen had been simplified to a combination tablet of emtricitabine 200mg/rilpivirine 25mg/tenofovir disoproxil fumarate 300mg once daily. Tests revealed increased liver enzymes, including an AST level of 5931 U/L, an ALT level of 1516 U/L and an ALP level of 293 U/L. Blood urea nitrogen and serum creatinine were also elevated. A drug hypersensitivity reaction to rilpivirine was suspected. Emtricitabine/rilpivirine/tenofovir disoproxil fumarate was withdrawn. The man subsequently defervesced, his renal function normalised, and his liver enzymes improved. He began a new antiretroviral regimen, and at last follow-up postdischarge, his liver enzymes were normal. The concluding diagnosis was rilpivirine-induced acute allergic hepatitis. Author comment: "According to the Naranjo scale for adverse drug reactions, the case scored 5, predicting a probable association with rilpivirine." Ahmed Y, et al. Rare case of rilpivirine-induced severe allergic hepatitis. Journal of Antimicrobial Chemotherapy 68: 484-486, No. 2, Feb 2013. Available from: 803085954 URL: http://dx.doi.org/10.1093/jac/dks400 - USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of acute allergic hepatitis associated with rilpivirine. The WHO ADR database did not contain any reports of drug-induced liver injury associated with rilpivirine.
0114-9954/10/1448-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 20 Apr 2013 No. 1448
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