Candesartan cilexetil
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Cholestatic hepatitis in an elderly patient: case report An 82-year-old man with essential hypertension developed cholestatic hepatitis after starting candesartan cilexetil. The man was admitted for jaundice, pruritus and anorexia, which had developed over 2 days. Three weeks prior to admission, he had started receiving candesartan cilexetil 16 mg/day. Physical examination was notable for jaundice and laboratory investigations revealed elevated AST, ALT, GGT, ALP, LDH, and total and direct bilirubin levels. Serological tests for hepatitis A, B and C virus, cytomegalovirus, Epstein-Barr virus and antinuclear, antimitochondrial and smooth antimuscle antibodies were negative. Tests showed iron and copper metabolism were normal, as were the results of echography and abdominal CAT scan. The man’s medication was suspended on admission. Over the following 2 weeks his AST and ALT levels decreased while his total and direct bilirubin levels continued to increase. Treatment with prednisone was initiated 15 days postadmission; however, his total bilirubin level continued to increase and the prednisone dosage was increased for 1 week. Total bilirubin began to decline and the prednisone dosage was reduced and then stopped 8 weeks postadmission. At this time all liver function parameters were normal. At follow-up 6 months later, he remained free of symptoms. Author comment: Assessment of the case establishes a definitive (CIOMS scale 10 points) or probable (Maria and Victorino scale 14 points) diagnosis of candesartan-induced hepatitis. Jimenez-Saenz M, et al. Candesartan-induced cholestatic hepatitis: A case report. Gastroenterologia y Hepatologia 33: 66-67, No. 1, Jan 2010. Available from: URL: http://dx.doi.org/10.1016/j.gastrohep.2009.06.003 [Spanish; summarised from a 803009546 translation] - Spain
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Reactions 3 Apr 2010 No. 1295
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