Liver Failure Requiring Transplantation After Orlistat Use

Wilson, Nikita S.; Shah, Nirish; Manitpisitkul, Wana; Twadell, William; Barth, Rolf N.; Philosophe, Benjamin; Fayek, Sameh

doi:10.1592/phco.31.11.1145

Cited by 6 publications

(3 citation statements)

References 14 publications

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“…It is important to note that orlistat has predominant gastrointestinal side effects. Moreover, the postmarketing review by the US FDA identified 13 cases of severe liver injury associated with orlistat [40]. Therefore, orlistat interventions in patients with advanced liver disease should be performed with caution.…”

Section: Lifestyle Modifications and Antiobesity Medicationsmentioning

confidence: 99%

Nonalcoholic fatty liver disease and bariatric surgery

Stephen

Baranova

Younossi

2012

Expert Review of Gastroenterology & Hepatology

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Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. Treatment recommendations for NAFLD are aimed towards weight reduction, thereby reducing insulin resistance. Unfortunately, lifestyle modifications have not yielded long-term success, while durable weight loss is routinely achieved with bariatric surgery. This article reviews the effects of bariatric surgery on patients with NAFLD. In these patients, postsurgical evaluations of liver histology by repeat liver biopsy are hindered by the risk of the procedure and the inherent sample variability, which makes the impact of bariatric surgery on NAFLD difficult to quantify. In longitudinal studies of NAFLD, the biopsy-based evaluations should be augmented by repeated measurements of the noninvasive biomarkers that may provide an insight into the changes in the physiological state of the liver after bariatric or other types of interventions. Nevertheless, currently available tests are not able to provide this type of in-depth outcome measures for these patients.

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Section: Lifestyle Modifications and Antiobesity Medicationsmentioning

confidence: 99%

Nonalcoholic fatty liver disease and bariatric surgery

Stephen

Baranova

Younossi

2012

Expert Review of Gastroenterology & Hepatology

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“…Worsening liver failure occurred over a period of 8 weeks and ultimately required liver transplantation. Although the liver copper concentration was elevated in this case, additional work-up was negative for Wilson's disease and orlistat was deemed to be the most likely aetiology of liver failure (20). In all above-mentioned cases, other plausible aetiologies of liver failure such as viral infection, autoimmune and vascular diseases were ruled out.…”

Section: Discussionmentioning

confidence: 72%

Orlistat‐induced fulminant hepatic failure

et al. 2014

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Orlistat was approved by the Food and Drug Administration in 1998 and has been shown to be superior to placebo in achieving weight loss. It is generally well tolerated. However, severe liver injury has been reported. We present a case of hepatic failure in a patient taking orlistat. A 54-year-old African-American woman with hypertension presented with hepatic failure. She had noticed increasing fatigue, jaundice and confusion. She used alcohol sparingly and denied tobacco or illicit drug use, but had been taking over-the-counter orlistat for the past two months. Physical examination revealed scleral icterus, jaundice, asterixis and slow speech. Laboratory testing showed markedly abnormal liver function tests with coagulopathy. Acute viral and autoimmune serologies were negative, as was toxicology screen. Liver biopsy showed necrotic hepatic parenchyma likely secondary to drug toxicity. Based upon her clinical presentation and time course, the pattern of liver injury seen on liver biopsy and lack of an alternative plausible explanation, her liver failure was most likely associated with orlistat use. She continued to deteriorate and ultimately underwent orthotopic liver transplantation. Fourteen cases of severe liver injury associated with orlistat use have been reported, four of which are detailed in the literature. This is the second published case of liver failure associated with over-the-counter orlistat usage. Clinicians should be aware of the growing number of cases associating liver injury and orlistat use and carefully monitor their patients on this medication for signs of hepatic dysfunction.

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“…Orlistat is an intestinal lipase inhibitor drug that is recommended in obese patients along with a hypocaloric diet (1). Although the most frequent secondary effect is steatorrhea, fulminant liver failure has also been associated with this drug, which has required liver transplantation in 3 patients (2)(3)(4). We present the case of a 42-year-old obese male who was being treated for hypertension, of 183 cm in height and 131 kg in weight with a BMI of 39.12.…”

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confidence: 99%