Metformin-induced cholestatic hepatitis

Endocr Pract. 2003 Jul-Aug;9(4):307-9. doi: 10.4158/EP.9.4.307.


Objective: To report a case of metformin-induced cholestatic hepatitis.

Methods: We present a detailed case report, including laboratory and biopsy findings. In addition, similar cases from the literature are reviewed.

Results: In a 68-year-old man with newly diagnosed diabetes mellitus, metformin therapy was begun. The dosage initially was 500 mg twice daily and later was increased to 850 mg twice a day. Four weeks after met-formin treatment was initiated, jaundice, pruritus, and liver enzyme abnormalities were noted. The patient underwent an extensive work-up, including a hepatitis screen, ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography, all of which showed normal findings. A liver biopsy revealed severe cholestasis and mild portal inflammation. Treatment with metformin was discontinued, and the liver enzymes normalized except for a persistently increased level of alkaline phosphatase, most likely related to a prolonged cholestatic effect of metformin.

Conclusion: Although rare, metformin can be responsible for inducing liver damage, and patients and physicians should be aware of this side effect.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Blood Glucose / metabolism
  • Chemical and Drug Induced Liver Injury / complications*
  • Chemical and Drug Induced Liver Injury / diagnostic imaging
  • Cholangiography
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy
  • Humans
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / therapeutic use
  • Jaundice, Obstructive / chemically induced*
  • Jaundice, Obstructive / diagnostic imaging
  • Jaundice, Obstructive / pathology
  • Liver / pathology
  • Liver Function Tests
  • Magnetic Resonance Imaging
  • Male
  • Metformin / adverse effects*
  • Metformin / therapeutic use
  • Pancreas / diagnostic imaging
  • Pancreas / pathology


  • Blood Glucose
  • Hypoglycemic Agents
  • Metformin