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In this report, a man in his 70s developed hepatotoxicity, lower limb weakness, poor coordination and reduced mobility following 6\u2009months of perhexiline use, leading to recurrent falls and multiple hospitalisations. Extensive testing ruled out other causes of the patient\u2019s symptomatology. During his third hospital presentation, elevated serum perhexiline levels confirmed toxicity. Cessation of perhexiline led to a marked improvement in liver function, mobility and function, allowing for the patient to be discharged home. This case underscores the critical role of therapeutic drug monitoring and the need to consider adverse drug reactions in vulnerable older patients.<\/jats:p>","DOI":"10.1136\/bcr-2024-263851","type":"journal-article","created":{"date-parts":[[2025,1,19]],"date-time":"2025-01-19T20:50:31Z","timestamp":1737319831000},"page":"e263851","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Perhexiline-induced toxicity in a geriatric patient presenting with peripheral neuropathy, hepatotoxicity and recurrent falls"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1944-743X","authenticated-orcid":false,"given":"Nicholas Joseph","family":"Waters","sequence":"first","affiliation":[{"name":"Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Mouchaileh","sequence":"additional","affiliation":[{"name":"Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Low","sequence":"additional","affiliation":[{"name":"Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Ting","sequence":"additional","affiliation":[{"name":"Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,19]]},"reference":[{"key":"2025082700383098000_18.1.e263851.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2006.02698.x"},{"key":"2025082700383098000_18.1.e263851.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.15.1858"},{"key":"2025082700383098000_18.1.e263851.3","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s40264-021-01144-1","article-title":"The Extent of Medication-Related Hospital Admissions in Australia: A Review from 1988 to 2021","volume":"45","author":"Lim","year":"2022","journal-title":"Drug Saf"},{"key":"2025082700383098000_18.1.e263851.4","unstructured":"World Health Organization . 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