Fatal Hepatic Coma Complicating Oxymetholone Therapy in Multiple Myeloma

Abstract

Two patients with multiple myeloma died in acute liver failure. Both had been treated with the anabolic steroid oxymetholone and both subsequently developed severe cholestatic hepatitis. In one the histological lesion progressed despite cessation of oxymetholone therapy. Myeloma infiltration of the liver and peliosis hepatis were not seen. As a fatal outcome from cholestatic hepatitis due to oxymetholone is rare it is possible that an unknown potentiating factor is present in multiple myeloma that can lead to a fatal outcome. If oxymetholone therapy is to be used in such patients then close clinical and laboratory assessment of liver function should be carried out in an attempt to prevent this unusual and fatal complication.

Extracellular polysaccharides purified from Aureobasidium pullulans SM‑2001 (Polycan) inhibit dexamethasone‑induced muscle atrophy in mice

“…To date, oxymetholone has been used to treat various musculoskeletal disorders and as a reference drug for the production of muscle enhancers ( 26 , 33 – 35 ). However, it also exerts hepatotoxic effects ( 36 , 37 ) and decreases anticoagulant tolerance ( 38 ).…”

Tart Cherry (Fruit of Prunus cerasus) Concentrated Powder (TCcp) Ameliorates Glucocorticoid-Induced Muscular Atrophy in Mice

“…Oxymetholone, a typical 17α-alkylated anabolic-androgenic steroid, may inhibit the GLU-induced catabolic cachexia-related decreases in body weights due to its strong anabolic effects [ 56 ]. High doses of GLU can cause catabolic muscular atrophy which is described by the degradation and reduction of proteins, production of muscle strength, decreased fiber diameter, and resistance to fatigue [ 23 , 28 , 43 ]. In this study, decreased calf thickness was noted after five days of initial treatment with DEXA.…”

“…Previous studies have shown increased expression of atrogin-1 and MuRF1 in atrophic skeletal muscles, and mice deficient in these genes were resistant to muscle atrophy [ 5 , 70 ]. Furthermore, significant increases in atrogin-1 and MuRF1 mRNA expressions have been noticed in GLU-induced catabolic atrophy [ 16 , 28 , 43 ]. In our study, GLU control group showed a significant increase in MuRF1 and atrogin-1 mRNA expressions in gastrocnemius muscle compared with the intact vehicle control; however, TCcp (500 and 250 mg/kg) treatments dose-dependently inhibited these increases, but to a lesser degree than by oxymetholone (50 mg/kg).…”

“…Oxymetholone is approved by the United States Food and Drug Administration (US-FDA) to treat anemia and as a reference drug to develop muscle enhancers [ 24 , 27 ]. However, it has also been linked with severe hepatotoxicity [ 28 , 29 ] and decreased anticoagulant tolerance [ 30 ].…”

Renoprotective and hepatoprotective activity of Lepidium draba L. extracts on oxymetholone‐induced oxidative stress in rat

“…The L. draba, in a dose-dependent manner, in addition to improving the physiological function of the liver also restored its structure so that necrotic hepatocytes were not observed in the space of the Disse and finally the resulting HF was not observed (Figure 7c,d). In addition, the L. draba (especially at a dose of 400 mg/kg) improves the drainage of the sinusoidal space, with its anti-inflammatory effects, prevents LI, and also prevents The side effect of oxymetholone include hepatotoxicity, and cholestatic jaundice, and Peliosis hepatic has been reported scarcely (Wood & Yin, 1994;Young et al, 1977). However, OM is prescribed to treat myelofibrosis, both congenital and acquired aplastic anemia (Pavlatos et al, 2001).…”