The US Food and Drug Administration Adverse Event Reporting System database contains 95 reports of liver injury suspected to be a result of GA, including 51 cases in which GA was the only medication administered.2 The mechanism of hepatotoxicity is unclear as GA is not known to be metabolized in the liver.

Although GA was not found to cause hepatotoxicity in clinical trials, these cases raise the question of whether liver function should be monitored in patients who are initiated on GA. It seems prudent to inform patients about symptoms of hepatotoxicity and advise them to seek immediate attention if these symptoms develop.