Acute liver and renal failure during treatment with buprenorphine at therapeutic dose

M. Zuin, A. Giorgini, C. Selmi, P. M. Battezzati, C. A. Cocchi, A. Crosignani, A. Benetti, P. Invernizzi, M. Podda

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Buprenorphine is a semi-synthetic opioid derivative commonly used in the treatment of heroin addiction. Life-threatening complications have been described following overdoses while few cases of hepatotoxicity due to drug use at therapeutic doses have been recently described in hepatitis C virus carriers. In these cases, however, histological assessment was not exhaustive and no extra-hepatic organ failure was observed. We describe herein a case of acute liver and kidney failure in a patient with previously latent hepatitis C virus chronic infection following recommended doses of buprenorphine. Histology did not demonstrate any feature compatible with hepatitis C virus reactivation or liver cirrhosis and suspension of the treatment led to the resolution of both liver and kidney failure. Causality criteria fulfillment indicates a high probability of buprenorphine-induced liver toxicity. No signs of pre-existant kidney impairment or of pre- or post-renal causes were observed. Since buprenorphine is metabolized through cytochrome P450 3A4, we genotyped six genetic polymorphisms previously described in poor metabolizers but could not confirm these pharmacogenetic bases in this case. In conclusion, we surmise that buprenorphine at suggested doses can induce liver and kidney failure in susceptible individuals, possibly through direct mitochondrial toxicity.

Original languageEnglish (US)
JournalDigestive and Liver Disease
Volume41
Issue number7
DOIs
StatePublished - Jul 2009
Externally publishedYes

Fingerprint

Buprenorphine
Acute Liver Failure
Acute Kidney Injury
Liver Failure
Hepacivirus
Kidney
Renal Insufficiency
Heroin Dependence
Therapeutics
Cytochrome P-450 CYP3A
Pharmacogenetics
Therapeutic Uses
Genetic Polymorphisms
Virus Diseases
Liver Cirrhosis
Causality
Opioid Analgesics
Suspensions
Histology
Liver

Keywords

  • Drug-induced hepatotoxicity
  • Nephrotoxicity
  • Pharmacogenetics

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Zuin, M., Giorgini, A., Selmi, C., Battezzati, P. M., Cocchi, C. A., Crosignani, A., ... Podda, M. (2009). Acute liver and renal failure during treatment with buprenorphine at therapeutic dose. Digestive and Liver Disease, 41(7). https://doi.org/10.1016/j.dld.2007.12.014

Acute liver and renal failure during treatment with buprenorphine at therapeutic dose. / Zuin, M.; Giorgini, A.; Selmi, C.; Battezzati, P. M.; Cocchi, C. A.; Crosignani, A.; Benetti, A.; Invernizzi, P.; Podda, M.

In: Digestive and Liver Disease, Vol. 41, No. 7, 07.2009.

Research output: Contribution to journalArticle

Zuin, M, Giorgini, A, Selmi, C, Battezzati, PM, Cocchi, CA, Crosignani, A, Benetti, A, Invernizzi, P & Podda, M 2009, 'Acute liver and renal failure during treatment with buprenorphine at therapeutic dose', Digestive and Liver Disease, vol. 41, no. 7. https://doi.org/10.1016/j.dld.2007.12.014
Zuin, M. ; Giorgini, A. ; Selmi, C. ; Battezzati, P. M. ; Cocchi, C. A. ; Crosignani, A. ; Benetti, A. ; Invernizzi, P. ; Podda, M. / Acute liver and renal failure during treatment with buprenorphine at therapeutic dose. In: Digestive and Liver Disease. 2009 ; Vol. 41, No. 7.
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