Fulminant Hepatic Failure after Ingestion of Sustained-Release Nicotinic Acid

Annals of Internal MedicinePublished 1 August 1989

Gerard E. Mullin, Joel K. Greenson, Mack C. Mitchell

DOI10.7326/0003-4819-111-3-253

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Nicotinic acid is an effective, widely used treatment for hypercholesterolemia and Hepatotoxicity is a rare complication of therapy, which usually occurs with ingestion of more than 3 g of the substance per day.

Abstract

Brief Reports1 August 1989Fulminant Hepatic Failure after Ingestion of Sustained-Release Nicotinic AcidGerard E. Mullin, MD, Joel K. Greenson, MD, Mack C. Mitchell, MDGerard E. Mullin, MD, Joel K. Greenson, MD, Mack C. Mitchell, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-3-253 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNicotinic acid is an effective, widely used treatment for hypercholesterolemia (1). Hepatotoxicity is a rare complication of therapy, which usually occurs with ingestion of more than 3 g daily. In most cases, patients have jaundice, pruritus, and mild elevations in serum bilirubin, alkaline phosphatase, and aminotransferase levels, although, in some instances, more severe hepatocellular injury has occurred (2). We report the case of a patient who developed fulminant hepatic failure shortly after switching to sustained-release nicotinic acid after having taken ordinary nicotinic acid for over 1 year without side effects.Case ReportIn February 1987, after having coronary angioplasty, a...References1. SchaeferLevy ER. Pathogenesis and management of lipoprotein disorders. N Engl J Med. 1985;20:1300-10. Google Scholar2. Pardue W. Severe liver dysfunction during nicotinic acid therapy. JAMA. 1961;175:161-2. CrossrefGoogle Scholar3. WinterBoyer SJ. Hepatic toxicity from large doses of vitamin B3 (nicotinamide). N Engl J Med. 1973;289:1180-2. CrossrefMedlineGoogle Scholar4. SugermanClark AC. Jaundice following the administration of niacin. JAMA. 1974;228:202. CrossrefMedlineGoogle Scholar5. Parsons W. Studies of nicotinic acid use in hypercholesterolemia: changes in hepatic function, carbohydrate tolerance, and uric acid metabolism. Arch Intern Med. 1961;107:653-67. CrossrefMedlineGoogle Scholar6. ChristensenAchorBergeMason NRKH. Nicotinic acid treatment of hypercholesterolemia, comparison of plain and sustained action preparations, and report of two cases of jaundice. JAMA. 1961;177:546-50. CrossrefMedlineGoogle Scholar7. KohnMontes RM. Hepatic fibrosis following long acting nicotinic acid therapy: a case report. Am J Med Sci. 1969;258:94-9. CrossrefMedlineGoogle Scholar8. PattersonDewGyorkeyGraham DEFD. Niacin hepatitis. South Med J. 1983;76:239-41. CrossrefMedlineGoogle Scholar9. EinsteinBakerGalperWolfe NAJH. Jaundice due to nicotinic acid therapy. Am J Dig Dis. 1975;20:282-6. CrossrefMedlineGoogle Scholar10. Rivin A. Jaundice occurring during nicotinic acid therapy for hypercholesterolemia. JAMA. 1959;170:2088-9. CrossrefMedlineGoogle Scholar11. ClementzHolmes GA. Nicotinic acid-induced fulminant hepatic failure. J Clin Gastroenterol. 1987;5:582-4. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From The Johns Hopkins University School of Medicine, Baltimore, Maryland. For current author addresses, see end of text. 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Knopp, MDManagement of Dyslipidemias 1 August 1989Volume 111, Issue 3Page: 253-255KeywordsAcute liver failureAminotransferasesBilirubinCoronary angioplastyIngestionNiacinPhosphatasesPruritus Issue Published: 1 August 1989 PDF DownloadLoading ...

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Medicine

New England Journal of MedicineHepatic Toxicity from Large Doses of Vitamin B<sub>3</sub>(Nicotinamide)

122 Citations1973Stephen L. Winter, James L. Boyer

The following case demonstrates that nicotinamide may cause major hepatic injury and is associated with abnormalities of liver function when used in large doses in the treatment of hypercholesterolemia.

Archives of Internal MedicineStudies of Nicotinic Acid Use in Hypercholesteremia

72 Citations1961William Barclay Parsons

Numerous reports have verified reduction of serum cholesterol levels in human hypercholesterolemia by large doses of nicotinic acid, and it has become increasingly apparent that this is the most effective chemotherapeutic agent presently available for this purpose.

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JAMANicotinic Acid Treatment of Hypercholesteremia

70 Citations1961Norman A. Christensen

The most significant difference was the greater frequency and severity of side effects during treatment with the 3 sustained-action preparations, and this precluded the majority of patients from completing a 3-month period of treatment.

Journal of Clinical GastroenterologyNicotinic Acid-Induced Fulminant Hepatic Failure

57 Citations1987G L Clementz, A. W. Holmes

This case is of particular note because of the rather short period of therapy before the onset of liver injury and the severity of the hepatic failure, and the probable increased use of nicotinic acid for serum cholesterol control makes it especially important for physicians and their patients to be alert to the signs of hepatotoxicity.

Journal of the American Medical AssociationJAUNDICE OCCURRING DURING NICOTINIC ACID THERAPY FOR HYPERCHOLESTEREMIA

47 Citations1959Arthur U. Rivin

This report is submitted in order to record a case of jaundice occurring during the administration of nicotinic acid and presumably due to intrahepatic cholestasis resulting from drug toxicity.

Southern Medical JournalNiacin Hepatitis

45 Citations1983DAVID J. PATTERSON, EDWARD W. DEW +2 more

A case of severe liver injury occurring on two occasions in a patient ingesting large doses of nicotinic acid, with both massive and submassive lobular collapse and marked cholestasis is reported.

JAMASevere Liver Dysfunction During Nicotinic Acid Therapy

36 Citations1961William O. Pardue

The purpose of this communication is to report the occurrence of hypoalbuminemia, edema, and abnormal results of liver function tests in a patient during the administration of large doses of nicotinic acid.

The American Journal of the Medical SciencesHepatic Fibrosis Following Long Acting Nicotinic Acid Therapy

30 Citations1969R. M. Kohn, M. Monies

A man maintained on 3 g of aluminum nicotinate daily for four years developed impaired carbohydrate metabolism and intraliepatic obstructive jaundice with hypoalbuminemia and edema which reversed with cessation of nicotinic acid therapy.

Digestive Diseases and SciencesJaundice due to nicotinic acid therapy

26 Citations1975Norman Einstein, Alfred L. Baker +2 more

A 22-year-old woman who was admitted with pruritus and marked jaundice had taken 3 g nicotinic acid along with several other vitamin preparations daily for several years, and a liver biopsy specimen showed hepatitis with submassive necrosis, as well as cholestasis and marked bile duct proliferation.

JAMAJaundice Following the Administration of Niacin

15 Citations1974A. Arthur Sugerman

A reaction to niacin appears to be a reasonable explanation of the patient's jaundice, with findings consistent with organic brain syndrome, with psychological tests indicating intellectual deterioration and right-hemisphere damage.