Title:Liver Injury Associated with Antidepressants
VOLUME: 8 ISSUE: 3
Author(s):Susie H. Park and Risa Ishino
Affiliation:Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California, School of Pharmacy, 1985 Zonal Avenue, Los Angeles, CA 90033, USA.
Keywords:Adverse drug reactions, antidepressants, drug-induced liver injury, hepatotoxicity, liver enzymes, liver injury,
safety.
Abstract:Antidepressants are commonly prescribed and used in the management of depression, anxiety disorders, and
other psychiatric illnesses. Antidepressants used in therapeutic dosing ranges are associated with causing several adverse
drug reactions including hepatotoxicity. Paroxetine, fluoxetine, fluvoxamine, citalopram, mirtazapine and venlafaxine are
associated with reversible liver injury upon discontinuation of the agent. Patient cases of hepatotoxicity involving the use
of nefazodone, trazodone, duloxetine, bupropion, and sertraline are linked to causing death in its users. Due to the
idiosyncratic nature of hepatotoxicity, monitoring of liver function tests and immediate discontinuation upon abnormal lab
findings or signs and symptoms of liver dysfunction are crucial since most cases of hepatic damage are reversible when
detected early. Onset of antidepressant-associated hepatotoxicity varies from 5 days to 3 years. Antidepressant-induced
liver injury can occur in the absence of identifiable, underlying risk factors such as cirrhosis and hepatitis infection; only a
few cases of hepatic injury involve patients with chronic hepatitis infection. Some of these cases involve possible drug
interactions between antidepressants and concomitant agents that increase the risk for liver injury. Understanding druginduced
liver injury associated with antidepressants and the importance of safety monitoring is essential to optimize
outcomes for antidepressant treatment.
