—We are obliged to Ayensa et al for finding two recent references concerning carbimazole-induced cholestasis. The suggested mechanism of a hypersensitivity reaction is supported by their case report and the additional references. Histopathology has been obtained in all cases and was consistent with drug toxicity, be it still unspecific. In their own case also rechallenge was done, be it accidental.
We do not think the evidence available up to now warrants their statement that hepatitis due to methimazole is more common and severe. We expect the same incidence and the same severity for carbimazole. The "surprising" lack of reports1,2 now seems to be already equalized.
Blom H, Schreuder HB. Carbimazole-Induced Cholestatic Hepatitis-Reply. Arch Intern Med. 1986;146(7):1455. doi:10.1001/archinte.1986.00360190247048
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