Acute liver injury secondary to sertraline

Abstract

Sertraline is widely prescribed to treat depression and anxiety disorders. However, hepatitis secondary to its use is a rare entity. We report the case of a 26-year-old woman in her 20th week of pregnancy presented with nausea, vomiting, malaise and dark urine. This occurred 6 months after sertraline 50 mg daily was started for the treatment of depression. Three weeks prior to her presentation, the dose of sertraline was increased to 100 mg daily. The patient's liver biochemical profile demonstrated increased transaminases. The biopsy of the liver showed lobular hepatitis, with a mild prominence of eosinophils, suggestive of a drug-induced or toxin-induced aetiology. Extensive biochemical work-up failed to show any other pathology to account for her hepatitis. Liver function tests normalised after cessation of sertraline, indicating a probable association between sertraline use and acute hepatocellular injury in our patient.

Antidepressant-Induced Liver Injury: A Review for Clinicians

“…Antidepressant-induced liver injury is generally considered to be dose independent. However, cases of hepatic toxicity following antidepressant dosage escalation have been reported for duloxetine, nefazodone, mianserin, and sertraline (30,38,43,44) (Table 2); in one case report, reduction of the daily dose was followed by reversal of mianserin-associated liver injury (43) ( Table 2). In clinical trials of agomelatine, aminotransferase values .33ULN were observed in 1.4% of patients treated with 25 mg/day and 2.5% of those treated with 50 mg/day, compared with 0.6% of the placebo group (147,151).…”

Sertraline Induced Acute Hepatitis: A Case Report

“…Autoimmune (autoantibodies) and immune allergic features (rash, fever, and eosinophilia) are uncommon. Acute liver failure due to sertraline has been described but very rarely [4] [6].…”

“…Christopher F describe that in rare instances of acute clinically apparent episodes of liver injury with marked liver enzyme elevations with or without jaundice been reported in patients on sertraline [4]. Croft H found that sertraline cause sexual dysfunction [3].…”

“…A review of the literature revealed eleven prior reports of sertraline induced hepatotoxicity presenting with a predominately hepatocellular injury pattern or mixed obstructive and hepatocellular picture. Reported symptoms ranged from asymptomatic elevation of transaminases to fulminant hepatitis [4]- [7]. In these case reports, the liver injury pattern was predominately hepatocellular.…”

“…Sertraline (ser'tra leen) is a selective serotonin reuptake inhibitor (SSRI) that acts by blocking the reuptake of serotonin in CNS synaptic clefts, thus increasing serotonin levels in the brain which is associated with its psychiatric effects. Sertraline was approved for use in the United States in 1991, and it remains in wide use, with almost 40 million prescriptions being filled yearly [4]. Indications for sertraline include major depression, obsessive-compulsive disorder, panic disorder, and major anxiety disorders including social anxiety, post-trauma stress and generalized anxiety disorder [2].…”