Acute Hepatitis Induced by Cyproterone Acetate

Giordano, Nicola Giuseppe; Nardi, Paolo; Santacroce, Clorinda; Geraci, Simone; Gennari, C

doi:10.1177/106002800103500902

Cited by 21 publications

(6 citation statements)

References 14 publications

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“…The duration of the flutamide and CPA treatment to the onset of symptoms was 90 days, and times to recovery were 20 and 30 days respectively. These findings are similar to previous reports (1–11). Other causes of acute liver failure were appropriately ruled out and there was no evidence of active prostate cancer or liver metastases.…”

Section: Discussionsupporting

confidence: 93%

“…Human cytochrome P450 conversion of flutamide to reactive metabolites has been confirmed (21). The mechanism of CPA liver toxicity is also unknown; however, it has been demonstrated that it has a hepatomitogen effect on rat hepatocytes (10). Flutamide and CPA share a common metabolism by CYP 3A and their main metabolites are hydroxyl forms.…”

Section: Discussionmentioning

confidence: 99%

“…These reactions generally consist of an asymptomatic abnormality of liver function tests, although patients of acute hepatitis with fulminate course and fatal outcome have been described (1–9). CPA is thought to be well tolerated, but cases of acute hepatitis and fatal fulminate hepatic failure have been reported (10–15). Also, isolated cases of hepatocellular carcinoma associated with the use of cyproterone have been described (15–17).…”

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confidence: 99%

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Suspected cross‐hepatotoxicity of flutamide and cyproterone acetate

Miquel

Soler

Vaqué

et al. 2007

Liver International

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Flutamide and cyproterone acetate (CPA) are both oral anti-androgens commonly used to treat advanced prostatic cancer. We report a case of drug-induced hepatotoxicity after consecutive treatment with flutamide and CPA. A 78-year-old male with advanced prostatic adenocarcinoma had been treated with flutamide 750 mg/day p.o. and leuproleride acetate 22.5 mg/3 months i.m. Three months later, the patient complained of choluria and jaundice. Laboratory examination revealed severe hepatocellular insufficiency. Flutamide-induced hepatotoxicity was suspected and therefore flutamide was withdrawn. His liver function abnormalities resolved after drug discontinuation. He was subsequently started on CPA 150 mg/day and again developed hepatotoxicity with severe hepatocellular impairment, which completely recovered after drug discontinuation. Other causes of acute liver failure were appropriately ruled out in both episodes and there was no evidence of active prostate cancer or liver metastases in both episodes. The occurrence of hepatotoxicity associated with flutamide and CPA on separated occasions suggests the possibility of a common mechanism of injury. It may become necessary to reassess the common practice of switching to another anti-androgen when hepatotoxicity appears. A closer monitoring of liver enzymes might be necessary in such cases, as an increased risk of a new severe hepatotoxicity event cannot be ruled out.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Suspected cross‐hepatotoxicity of flutamide and cyproterone acetate

Miquel

Soler

Vaqué

et al. 2007

Liver International

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“…Liver biopsies have shown cholestatic hepatitis to be associated with fl utamide in some cases [38,48], and occasionally with cyproterone acetate [37] and it may be speculated that cholestasis is an androgen-related effect associated with increased blood levels of testosterone [78]. Some authors have considered the immunologically mediated reactions as the underlying pathogenic mechanism [17,68], but lack of evidence of hypersensitivity in many of the cases of Table 2.…”

Section: Discussionmentioning

confidence: 99%

Hepatotoxicity Induced by Antiandrogens: A Review of the Literature

Thole

Manso²,

Salgueiro³

et al. 2004

Urol Int

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Introduction: Hepatotoxicity is a serious adverse reaction potentially induced by all antiandrogens. We have reviewed here the published cases of hepatotoxicity induced by steroidal and nonsteroidal antiandrogens, and compared the type and characteristics of liver damage. Methods: Using two different databases: MEDLINE and IDIS (Iowa Drug Information Service), we searched for published cases of liver injury induced by antiandrogens. Analysis was made of the type of hepatotoxicity, therapeutic indication, other pharmacological treatments and evolution. Mean values of latency and recovery periods of the adverse reactions and liver function tests were also evaluated. Results: Hepatitis was the most common type of hepatotoxicity reported, and was associated with all antiandrogens. This adverse reaction does not seem to be dependent on the patients age, therapeutic indication or the dose prescribed. Hepatitis showed a longer latency period for cyproterone acetate than for flutamide. Some transaminase levels were significantly higher for flutamide than for cyproterone acetate, although the evolution was no worse in the cases reported for flutamide. We also found occasional reports of hepatocellular carcinoma and hepatic cirrhosis suspected of being induced by cyproterone acetate. Conclusion: Although there are differences in the clinical features of hepatotoxicity induced by steroidal and nonsteroidal antiandrogens, these do not predict which patients will develop hepatotoxicity during treatment or evolution. Serial liver function tests are required for early detection of liver damage.

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“…Nevertheless, the close association between initiation of steroid therapy and improvement in LFTs implies that corticosteroid may be a plausible salutary option for some patients with DILI. As of this publication only a few cases of drug-related cholestatic hepatitis managed successfully with steroids have been reported [5,17,[19][20]. A pertinent factor which led to a diagnostic dilemma in this case was the patient's denial of using any prescription drug or medication in recent past.…”

Section: Discussionmentioning

confidence: 87%

Delayed Presentation of Drug-Induced Hepatic Injury

Ahmed¹,

Onteddu²,

Jabur³

et al. 2020

Cureus

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Drug-induced hepatotoxicity is a major cause of acute liver failure (ALF) in the United States. There are many offending agents like prescription drugs and herbal remedies. However, the most common prescription medication involved worldwide is amoxicillin-clavulanate. We report an unusually delayed presentation of severe cholestatic hepatitis caused by amoxicillinclavulanate in a 20-year-old female with worsening hyperbilirubinemia that was successfully treated with corticosteroids and ursodeoxycholic acid (UDCA).

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Acute Hepatitis Induced by Cyproterone Acetate

Abstract: This case suggests the possibility of hepatotoxicity from cyproterone.

Cited by 21 publications

References 14 publications

Suspected cross‐hepatotoxicity of flutamide and cyproterone acetate

Suspected cross‐hepatotoxicity of flutamide and cyproterone acetate

Hepatotoxicity Induced by Antiandrogens: A Review of the Literature

Delayed Presentation of Drug-Induced Hepatic Injury

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