Atorvastatin-induced prolonged cholestasis with bile duct damage

Clin Drug Investig. 2010;30(3):205-9. doi: 10.2165/11531660-000000000-00000.


We report a case of acute-onset, long-lasting cholestasis induced by atorvastatin. This antihyperlipidaemic drug was taken for 40 days by a 72-year-old male as a treatment for his mixed dyslipidaemia. At that point, the patient presented with asthenia, nausea, painless icterus, acholic stools and hyperchromic urine with biochemical analyses showing a dramatic increase in bilirubin (total bilirubin 22 mg/dL; direct bilirubin 21 mg/dL) and alkaline phosphatase (up to 4-fold over the normal level) with less marked increases in transaminases. Liver histology showed a pattern of cholestasis with evident signs of cholangiolitis and damage of the interlobular bile ducts. Serum transaminase and bilirubin levels returned to normal within 5 months after atorvastatin withdrawal while alkaline phosphatase normalized after only 8 months. Scores on both the Maria and Victorino clinical scale for the diagnosis of drug-induced hepatitis and the Naranjo Adverse Drug Reaction Probability Scale indicated that atorvastatin was the probable cause of prolonged cholestasis in this patient. This is a rare case of cholestasis probably caused by atorvastatin and unusually characterized by bile duct damage.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anticholesteremic Agents / adverse effects*
  • Anticholesteremic Agents / therapeutic use
  • Atorvastatin
  • Bile Ducts / drug effects*
  • Bile Ducts / pathology
  • Cholagogues and Choleretics / therapeutic use
  • Cholangitis / chemically induced*
  • Cholangitis / drug therapy
  • Cholestasis / chemically induced*
  • Cholestasis / drug therapy
  • Dyslipidemias / drug therapy
  • Heptanoic Acids / adverse effects*
  • Heptanoic Acids / therapeutic use
  • Humans
  • Male
  • Pyrroles / adverse effects*
  • Pyrroles / therapeutic use
  • Ursodeoxycholic Acid / therapeutic use


  • Anticholesteremic Agents
  • Cholagogues and Choleretics
  • Heptanoic Acids
  • Pyrroles
  • Ursodeoxycholic Acid
  • Atorvastatin