TOXIC EFFECTS OF INTRAVENOUS AND ORAL PROSTAGLANDIN-E THERAPY IN PATIENTS WITH LIVER-DISEASE

BACKGROUND: Prostaglandins are cytoprotective agents that have been sh own to benefit patients with a variety of acute and chronic liver dise ases. Few data exist on the frequency of adverse effects of prostaglan dins in these patients. METHODS: We retrospectively studied 105 patien ts with liver disease who were treated with either intravenous (IV) or oral prostaglandin E (PGE). Forty-four patients with primary nonfunct ion after liver transplantation and 36 patients with fulminant hepatic failure received IV PGE(1) for 4.5 +/- 2.6 and 12.6 +/- 10.9 days, re spectively. Twenty-five patients with recurrent hepatitis B viral infe ction after liver transplantation received oral PGE(1) for 105 +/- 94 days or PGE(2) for 464 +/- 399 days. RESULTS: Twenty-six of 80 patient s (33%) receiving IV PGE(1) developed gastrointestinal and/or cardiova scular side effects and 8% developed arthritis. Twenty-three of 25 pat ients (92%) who received high-dose oral PGE(1) or PGE(2) incurred arth ritis and/or gastrointestinal adverse effects. Twenty-five patients re ceived prolonged PGE therapy (oral >60 days; IV >28 days). Of this gro up, 23 (92%) developed clubbing and cortical hyperostosis resembling h ypertrophic osteoarthropathy. All adverse effects were dose related an d resolved with reduction or cessation of therapy. CONCLUSION: PGE the rapy resulted in a wide spectrum of multisystem adverse effects which were reversible with reduction or cessation of therapy. Although the a dministration of PGE was safe and generally well tolerated, close medi cal supervision is necessary to avoid serious side effects.