Cholestatic hepatitis ticlopidine

Grieco, A., Vecchio, F.M., Greco, A.V., Gasbarrinl, G. Cholestatic hepatitis due to ticlopidine clinical and histological recovery after drug withdrawal. Case report and review of the literature. Europ. J. Gastroenterol. Hepatol. 1998 10 713-715... 

Leone, N., Giordanino, C., Baronio, M., Morgando, A., David, E., Rlz-zetto, M. Ticlopidine-induced cholestatic hepatitis successfully treated with corticosteroids A case report. Hepatol. Res. 2004 28 109-112... 

Skurnik, Y.D., Tchemiak, A., Edlan, K., Sthoeger, Z. Ticlopidine-induced cholestatic hepatitis. Ann. Pharmacother. 2003 37 371-375... 

In a retrospective analysis, the anticoagulant effects of acenocoumarol were modestly reduced by ticlopidine in 80% of patients, whereas, in a small prospective study, the anticoagulant effects of warfarin were unchanged by ticlopidine. As with other antiplatelet drugs, combined use might possibly increase bleeding risk. Cholestatic hepatitis has been reported in some patients given warfarin and ticlopidine. 

In a Japanese study, 4 out of 132 patients (3%) given both warfarin and ticlopidine after cardiovascular surgery developed cholestatic hepatitis. ... 

It seems possible that ticlopidine inhibits the metabolism of R-warfarin, but the interaction with acenocoumarol is not understood. Ticlopidine alone can cause raised liver enzymes and cholestatic hepatitis, and whether these cases represent an interaction is unclear. 

Liver Acute cholestatic hepatitis has been attributed to ticlopidine in a 68-year-old woman [194 ]. 

Agranulocytosis, neutropenia, thrombocytopenia, and erythroleu-kaemia have been reported during therapy with ticlopidine. Elevation of liver function tests are unusual with ticlopidine therapy, but occasionally cholestatic jaundice or hepatitis have been reported. Drug may increase total serum cholesterol, as well as LOL- and VLDL-cholesterol and other lipoproteins, without effecting HDL-cholesterol (1). 

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