SUN-185 Glipizide Induced Hepatotoxicity

Introduction: Sulfonylureas are known to have multiple side effects including weight gain, hypoglycemia and cardiovascular toxicity. Hepatotoxicity has been sparsely described in literature with both Glimeperide and Glybuyride. We present a case of Glipizide induced hepatoxicity which has not been previously reported in literature. Case: 71 year old female with uncontrolled DM2, HTN, HLD and aplastic anemia presented for recent worsening hyperglycemia. She has a history of chronic prednisone use after bone marrow transplant in 2016. She had been on steady dose of prednisone 1 mg which was stopped in February 2018. Type 2 DM was diagnosed in May 2017 during evaluation of polyuria and polydipsia, Hba1c 7.1%. She was initially managed conservatively with lifestyle modifications. In November 2017, her Hba1c increased to 11%. Metformin 500 mg BID was initiated. Hba1c increased to 14% in February 2018. Metformin was maximized to 1000 mg BID. Patient denied any acute illness and was compliant with metformin. No change in prednisone dose was noted. In March 2018, she was evaluated by endocrine. Fasting C peptide level was 3.5 ng/ml, Glucose 162 and GAD65Ab was negative. Patient declined insulin. She was started on glipizide 5 mg BID and Sitagliptin 100 mg Qday in addition to metformin 1000 mg BID. Patient decided to not start Sitagliptin. Four weeks later her routine labs showed elevation of AST to 89 u/l and ALT to 255 u/l which were normal previously. Patient denied any symptoms of jaundice, stool or urine color changes and no other new medications were initiated. Repeat labs within four days showed further elevation of AST and ALT to 311 u/l and 446 u/l, respectively. Glipizide was stopped and labs showed improvement in liver enzymes within three days and normalization within a week of stopping the medication. Extensive evaluation including CMV IgM, HBsAg, HBc IgM, EBV DNA, HCV PCR were negative. Patient was evaluated by Gastroenterology who suspected glipizide induced liver injury in the setting of significant improvement in liver enzymes after medication cessation. Patient declined a rechallenge with glipizide. Discussion: Hepatotoxicity is a rarely reported side effect for sulfonylureas. Previously, liver injury secondary to Glimeperide and Glyburide have been described in case reports. However, this is the first case to our knowledge with glipizide induced hepatotoxicity. Most cases have reversible liver injury but one fatal case has also been reported. The onset of hepatotoxicity with sulfonylureas can been variable ranging between 2 weeks to three years. Liver enzymes usually normalize within 7 days to a year after stopping the medication. This case highlights the importance of monitoring liver function closely after initiation of sulfonylureas.