Probable hepatotoxicity associated with the use of metformin in type 2 diabetes

Abstract

This is a case report of a 44-year-old obese female who developed subclinical hepatic injury 4 weeks after starting metformin for type 2 diabetes. She had a rise in her alanine aminotransferase which peaked at 5 months (738 U/l) and rapidly declined within days of discontinuing her metformin. No other positive evidence of alternative causes for the hepatic injury was found. The likelihood of metformin-induced injury was 7 on the Naranjo scale of adverse drug reactions. A brief review of the 11 previously reported cases in the English medical literature is also made.

Drug-Induced Liver Injury Associated with the Use of Everolimus in a Liver Transplant Patient

“…Though metformin was initially listed as a drug with “no-DILI concern,” there have been close to twenty case reports in the literature of hepatotoxicity with metformin after 4 to 8 weeks of use [ 14 ]. Minor elevations in liver enzymes have been reported to occur during metformin therapy in less than 1% of patients and typically the timing of the injury occurs soon after the agent is started, not during long term therapy [ 11 ].…”

A Pediatric Suicide Attempt by Ingestion of Metformin, Glimepiride and Sulpiride: A Case Report and Literature Review

“…[11]. It is generally considered a safe drug but is rarely associated (0.06 cases per 1000 patient years) with lactic acidosis, inhibits oxygen consumption and impairs mitochondrial function in liver and other tissues especially in dehydrated patients or in the presence of multiple morbidities [12,13].…”

A Rare Outcome Induced by Metformin Intoxication: Severe Lactic Acidosis and Hepatotoxicity

“…Nammour reported a case with metformin-induced cholestatic hepatitis, treated with discontinuation of the drug, and liver enzymes normalized except for a persistently increased level of alkaline phosphatase, most likely related to a prolonged cholestatic effect of metformin [7]. Hashmi suggested that in published cases with metformin-induced hepatotoxicity the number of reported cases on this subject was underestimated, probably due to the lack of a consistent terminology [8]. Because metformin is not metabolized in the liver, it has been considered safe from a hepatic standpoint; however, metformin hepatotoxicity has rarely been reported [9,10].…”