Hepatotoxicity associated with carvedilol

OBJECTIVE: To report a severe episode of pruritus and elevated serum transaminases in a patient who was receiving carvedilol. CASE SUMMARY: A 40-year-old white man who had been taking carvedilol for the treatment of cardiomyopathy presented to the emergency department with pruritus over his entire body. Laboratory tests showed elevated serum transaminases. Carvedilol was discontinued and the patient received hydroxyzine hydrochloride to relieve symptoms. Liver function test results returned to normal in three weeks. Approximately one year later the patient was started on metoprolol and within 10 days again developed pruritus. The patient was told to discontinue the metoprolol immediately. At the time the metoprolol was stopped the liver function test results were normal. DISCUSSION: To the best of our knowledge, the adverse reaction presented in this case report is rare. The etiology of this adverse reaction remains unknown but suggests a possible adverse reaction that may recur if the patient is switched to another beta-adrenergic blocker. The liver function test abnormalities appear to return to normal on discontinuation of carvedilol. CONCLUSIONS: Carvedilol may cause pruritus and elevated liver function test results. This reaction may recur if the patient is changed to an alternative beta-adrenergic blocker. Patients taking carvedilol should be monitored for signs and symptoms of hepatotoxicity. If elevated liver function test results are noted, carvedilol should be discontinued.