Delayed chronic diarrhea and weight loss possibly due to ticlopidine therapy

OBJECTIVE: To report a case of delayed-onset chronic diarrhea, anorexia, and weight loss possibly complicating the use of ticlopidine. CASE SUMMARY: A 48-year-old white man presented with unremitting diarrhea associated with anorexia and marked weight loss. His history was significant for transient ischemic attack, resistant hypertension, homocystinemia, and chronic renal insufficiency. The patient had tolerated ticlopidine therapy for 2 years without problems, and there had been no changes in his drug regimen for several months. No abnormality was found on detailed digestive system evaluation and all symptoms and signs promptly resolved after ticlopidine therapy was discontinued. DISCUSSION: The occurrence of diarrhea early during ticlopidine therapy should make the clinician consider the drug as the most likely cause. However, the appearance of chronic diarrhea, anorexia and weight loss years after a patient had tolerated the drug is less typical for ticlopidine. In such situations, if no other cause can be identified, cautious withdrawals of the drug should be considered. We believe that all the patient's symptoms reported here were likely due to ticlopidine. CONCLUSIONS: Clinicians should be aware that the gastrointestinal adverse effects of ticlopidine may surface years after therapy is begun. The cause of ticlopidine-induced diarrhea remains unknown.