B0549 - A Rare Case of Gabapentin-Induced Hepatotoxicity

Herman Suga, DO¹, David J. Truscello, DO¹, Zainab Shahid, DO², Maulik Shah, DO³, Aarati Malliah, MD^4
1Jefferson Health New Jersey, Turnersville, NJ; ²Jefferson Health New Jersey, Turnersville, NJ; ³Jefferson Health New Jersey, Cherry Hill, NJ; ⁴Jefferson Health, Woodbury, NJ

Introduction: Gabapentin is an anti-convulsant that is also used off-label to treat neuropathic pain. It is not metabolized by the liver, and there have been few reports of hepatotoxity associated with it. We present a rare case of gabapentin-induced hepatotoxicity occurring in a young male.

Case Description/Methods: A 41-year-old male with an extensive past medical history including type 1 diabetes, end stage renal disease on hemodialysis, TIA, hypertension, and hyperlipidemia was admitted for severe hyperkalemia with K 8.2 and peaked T waves on EKG, and hyperglycemia with glucose 561. He was admitted to the intensive care unit for urgent dialysis. Lab work revealed abnormal liver function tests, with ALP 1,232 IU/L, AST 291 IU/L, and ALT 188 IU/L, and normal total bilirubin of .8 mg/dL. Prior records revealed completely normal liver function tests 6 months prior to presentation. Ultrasound of the RUQ revealed small volume of ascites but was otherwise unremarkable with no abnormality of hepatic parenchyma or biliary ducts noted. Patient reported having a below-knee amputation 3 months prior to presentation, after which he started taking gabapentin 300 mg three times per day. He denied any other medication changes. He reported taking acetaminophen occasionally, and acetaminophen level was < 10 mcg/mL. A full hepatitis panel was negative. An autoimmune workup was planned including Anti-LKM, ASMA, AMA but patient insisted on leaving prior to those labs being drawn. Gabapentin was held and patient’s liver function tests improved, with ALP 1058 IU/L, AST 158 IU/L, and ALT 149 IU/L, and remained stable. Patient discontinued gabapentin and was advised to follow up outpatient, unfortunately he was lost to follow-up.

Discussion: Although the exact mechanism of gabapentin is unknown, it is structurally related to GABA and high-affinity binding sites for gabapentin which modulate the release of excitatory neurotransmitters which participate in epileptogenesis have been found throughout the brain. Gabapentin is not hepatically metabolized, and therefore was not studied in patients with hepatic impairment during the FDA approval process. There have been very few cases of gabapentin induced liver injury. In our patient there was a clear temporal association of liver injury occurring after our patient began gabapentin therapy, and slight improvement after a few days of discontinuation. Although further studies on this topic are needed, gabapentin should be considered as a cause of drug induced liver injury.


Disclosures:


Herman Suga, DO¹, David J. Truscello, DO¹, Zainab Shahid, DO², Maulik Shah, DO³, Aarati Malliah, MD⁴. B0549 - A Rare Case of Gabapentin-Induced Hepatotoxicity, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.