Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
권호 표지

Preliminary Evaluation of Levocetirizine and Cetirizine Induced Liver Injury

임상 자료를 활용한 레보세티리진과 세티리진이 유도한 간손상 평가

  • Sung, Eun Ji (Department of Pharmacy, Seoul National University Hospital) ;
  • Moon, Mira (Department of Pharmacy, Seoul National University Hospital) ;
  • Cho, Yoon Sook (Department of Pharmacy, Seoul National University Hospital) ;
  • Lee, Hye Suk (Department of Pharmacy, Seoul National University Hospital) ;
  • Kim, Hyang Sook (Department of Pharmacy, Seoul National University Hospital) ;
  • Lee, Ju-Yeun (College of Pharmacy, Hanyang Univesity)
  • Received : 2014.04.06
  • Accepted : 2014.07.03
  • Published : 2014.09.30
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Abstract

Objectives: The aim of this study was to identify the causal relationship between use of levocetrizine or cetrizine, and liver injury, by comparing frequency and pattern of hepatotoxicity in levocetrizine or cetrizine prescribed patients. Methods: This is a retrospective observational study, using data retrieved from electronic medical record system. Among 1164 patients prescribed levocetrizine or cetrizine during study period (Jul, 2009 - Jun, 2010) at Seoul National University Hospital, 543 patients with more than 4- time liver function test (LFT) results were included in final analysis. Liver injury was defined as greater than 3 times elevated level of alanine aminotransferase or 2 times elevated level of alkaline phosphatase or total bilirubin, compared to upper limit of normal, in patient with normal liver function at baseline. The frequency and pattern of liver injury were assessed. Results: Incidence of liver injury in patients prescribed with levotcetrizine or cetrizine were 1.48% and 2.94%, respectively. With few exceptions, most injuries were shown to be hepatocellular type. Rapid recovery was observed after drug cessation and long term use tends to be associated with incidence of liver injury. In patient with digestive system disorder, rate of liver injury was significantly higher (p=0.011). Conclusion: The result of this study implies potential need of liver toxicity monitoring, especially in patients taking long term levecetrizine or cetrizine or in patient with digestive system disorder. However, prospective large scale observational study is needed to confirm liver injury associated with the use of levocetirizine or cetirizine.

Keywords

References

  1. Reuben A, Koch DG, Lee WM. Acute liver failure: results of a U.S. multicenter, prospective study. Hepatology 2010;52(6):2065-76. https://doi.org/10.1002/hep.23937
  2. UpToDate, Drugs and liver: Metabolism and mechanisms of injury. Available from: http://www.uptodate.com/contents/ drugs-and-the-liver-metabolism-and-mechanisms-of-injury (Accessed on October 15, 2013)
  3. Kaplowitz N. Drug-induced liver injury, Clin Infect Dis 2004;38:S44-S48. https://doi.org/10.1086/381446
  4. Baltes E, Coupez R, Giezek H, et al. Absorption and disposition of levocetirizine, the eutomer of cetirizine, administered alone or as cetirizine to healthy volunteers. Fundam Clin Pharmacol 2001;15(4):269-77. https://doi.org/10.1046/j.1472-8206.2001.00035.x
  5. Bartra J, Valero AL, del Cuvillo A, et al. Interactions of the H1 antihistamines. J Investig Allergol Clin Immunol 2006;16(1):29-36.
  6. Bloebaum RM, Grant JA. Levocetirizine: the allergist's arsenal grows larger. Expert Opin Pharmacother 2004;5(7):1581-8. https://doi.org/10.1517/14656566.5.7.1581
  7. National Health Insurance Service, Increase in 'seasonal allergic rhinitis' patients every September, 2011. Available from: http://www.nhis.or.kr/cms/board/board/Board.jsp?act= VIEW&communityKey=B0039&boardId=22333(Accessed on October 30, 2013)
  8. Fong DG, Angulo P, Burgart LJ, et al. Cetirizine-induced cholestasis. J Clin Gastroenterol 2000;31:250-3. https://doi.org/10.1097/00004836-200010000-00016
  9. Jurawan R, Smith A. Severe hepatitis in a primary sclerosing cholangitis patient receiving recent cetirizine therapy. N Z Med J 2010;123(1309):106-7.
  10. Pompili M, Basso M, Grieco A, et al. Recurrent acute hepatitis associated with use of cetirizine. Ann Pharmacother 2004;38:1844-7. https://doi.org/10.1345/aph.1E162
  11. Xyzal (levocetirizine dihydochloride) Prescribing Information. Available from: http://products.sanofi.us/xyzal/xyzal.pdf (Accessed on September 30, 2013)
  12. Ekiz F, Yuksel I, Ekiz O, et al. Levocetirizine induced hepatotoxicity in a patient with chronic urticaria. Ann Hepatol 2011;10(2):237-8.
  13. Navarro VJ. Senior JR. Drug-related hepatotoxicity. N Eng J Med 2006;354:731-9. https://doi.org/10.1056/NEJMra052270
  14. Pratt DS, Kaplan MM. Evaluation of Abnormal Liver- Enzyme Results in Asymptomatic Patients. N Eng J Med 2000;342:1266-71. https://doi.org/10.1056/NEJM200004273421707