A very typical case of severe cholestasis due to anabolic steroid use. Because the steroids were being used without medical supervision, the dose and actual duration of use of each preparation was unclear, but cholestasis usually arises within 4 to 12 weeks of starting a C-17 alkylated androgenic steroid. The jaundice can be severe and prolonged and accompanied by severe pruritus and marked weight loss. The serum enzymes are typically minimally elevated except for a short period immediately after stopping therapy. The pattern of enzyme elevations can be hepatocellular, cholestatic or mixed. Liver biopsy shows a “bland” cholestasis with minimal inflammation and hepatocellular necrosis. Ma Huang has also been implicated in cases of drug induced liver injury, but is associated with an acute hepatocellular pattern of injury.
One notable problem with purchasing items online, particularly drugs, is that you never know if what you’re buying is the real deal. As a research study recently showed, at least one Web site is actually selling one of the original SARMs, known as S4. 1 The author purchased two bottles of S4 from a Web-based company that declared its product to be “99 percent pure.” The shipping box said it contained a mixture of green tea extracts and skin moisturizer. Analysis proved that the bottles did contain actual S4—plus 10 percent impurities, suggesting a crude “home brew” rather than a pharmaceutical-grade drug.
The effect of chronic oral contraceptive (OC) usage on the disposition of theophylline was examined. Aminophylline solution (4 mg/kg) was given orally to 8 healthy female nonusers and to 8 healthy women who were chronic (6 months) OC users. The OC user group had a significantly lower total plasma clearance of theophylline than women not using OCs ( +or- vs. +or- ml/h/kg). The t1/2 was also significantly prolonged in the OC group ( +or- vs. +or- hours) while the volume of distribution was similar between the 2 groups. The serum ethinyl estradiol (EE) concentrations after oral OC administration were measured simultaneously. The apparent clearance of EE was about 30% lower in the OC users. A significant positive correlation was found between the apparent EE clearance and the plasma clearance of theophylline. The effects of OCs are predominantly due to chronic use with decreased elimination of both theophylline and EE.