PROBABLE TICLOPIDINE-INDUCED CHOLESTATIC HEPATITIS

OBJECTIVE: TO report a case of probable ticlopidine-induced cholestati c hepatitis. CASE SUMMARY: A 76-year-old man with no known history of liver disease developed painless jaundice approximately 3 weeks after starting ticlopidine 250 mg bid. After ticlopidine was discontinued, t he jaundice resolved and serum liver enzyme concentrations returned to ward normal. A diagnosis of probable ticlopidine-induced cholestatic h epatitis was made. The patient was not rechallenged with ticlopidine. DISCUSSION: A literature search produced 6 case reports describing 7 p atients in whom probable ticlopidine-induced cholestatic hepatitis had been diagnosed. Only 1 of these reports appeared in the North America n literature. Jaundice developed within 1 to 3 months of starting ticl opidine at less than or equal to the recommended daily dose. In all ca ses, jaundice resolved and serum liver enzyme concentrations normalize d over a period of months after drug discontinuation. CONCLUSIONS: Rou tine monitoring of serum liver enzyme concentrations is not recommende d. However, patients should be instructed to watch for signs and sympt oms of liver injury. Should they occur, patients should stop taking th e ticlopidine and consult their physician immediately.