Intrahepatic cholestasis during nicotinic acid therapy

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Nicotinic acid, widely used to lower serum cholesterol levels, may rarely cause cholestatic jaundice.


A 61-year-old white man with hypercholesterolemia complained of marked pruritus and became jaundiced after taking 3.0 g of crystalline nicotinic acid daily for 13 months. His total serum bilirubin level was increased at 144 μmol/L (8.4 mg/dL) and his alkaline phosphatase level was markedly elevated at 35.00 μkat/L (2100 U/L). Endoscopic retrograde cholangiopan-creatography failed to demonstrate an obstructive lesion in the extrahepatic biliary system, computed tomography showed no intrahepatic dilatation, and ultrasonographic studies of the liver, gallbladder, and pancreas were normal; these factors all suggest intrahepatic cholestasis. Symptoms improved and liver function test results returned to normal within 51 days after stopping the drug.


Nicotinic acid-induced cholestatic jaundice may not be as rare as previously thought, and physicians should observe their patients for it.



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