Drug-Induced Liver Injury Due To Losartan

Drug-induced liver injury (DILI) is a challenging diagnosis since a wide variety of medicines can cause adverse reactions. Losartan is an angiotensin II receptor antagonist (ARA-II) approved for the treatment of arterial hypertension. The most common adverse effects are fatigue, anaemia, weakness and cough. An increase in transaminases has been reported with less frequency (<2% of cases). Although the mechanism is not fully understood, DILI onset is usually within 1–8 weeks of therapy, and hepatic enzymology usually normalizes 2–4 months after drug suspension. The authors present the case of a 66-year-old male patient with a medical history of arterial hypertension and a prior hospitalization (4 years previously) for drug-induced hepatitis, which, at the time, was attributed to a dietary supplement. Four years later, because of new onset of hypertension, losartan was reintroduced. After 3 weeks, the patient was admitted to the emergency department with complaints of acute abdominal pain associated with asthenia, nausea and increased abdominal volume that had first developed 8 days previously. After exclusion of other causes, DILI associated with losartan was assumed. This is a very rare adverse effect since only seven cases have been described in the literature.

Evaluation of drug release kinetics from polymeric nanoparticles loaded with poorly water-soluble APIs

The aim of this research was to investigate the release behavior of a combination of two poorly water-soluble active pharmaceutical ingredients (APIs) from poly (D,L-lactide-co-glycolide) (PLGA) nanoparticles. Amlodipine besylate - AML, a calcium channel blocker, and valsartan - VAL, an angiotensin II receptor antagonist drug, were used as poorly water-soluble model drugs. PLGA nanoparticles loaded with AML-VAL (1:16 w/w) were obtained by nanoprecipitation using an amphiphilic block copolymer - Pluronic F127 as stabilizer. The drugs release from the PLGA nanoparticles was determined by a dialysis membrane method under sink conditions. Nanoparticles provided a slow release for both APIs and an attenuated burst effect compared to free drug. Five kinetics models such as Zero-order, First-order, Korsmeyer-Peppas, Higuchi and Hixson-Crowell were applied to predict drug release profiles. The Higuchi and Korsmeyer-Peppas models (R2 > 0.97) best described physicochemical release phenomenon for each PLGA formulations.

Clinical and Magnifying Narrow-Band Imaging Endoscopic Finding–Olmesartan-Associated Collagenous Gastroduodenitis

Collagenous gastroduodenitis is a rare and may be associated with olmesartan, an angiotensin–II receptor antagonist used for management of hypertension. It is characterized by marked subepithelial collagen deposition with mucosal inflammatory infiltrate. The characteristic endoscopic finding of collagenous gastritis is nodular mucosa and other findings include erythema friability, erosions, ulcers and atrophy. Olmesartan-associated collagenous gastroduodenitis without colonic involvement is exceptionally rare with only one case reported in literature to date. The association may be difficult to recognize because of its clinical and histologic similarity to the clinical entity collagenous gastroduodenitis. We present a case of Olmesartan-associated collagenous gastroduodenitis, which was observed on magnifying narrow-band imaging endoscopic findings.