Liver Injury From Antidepressants Underestimated
Scientific literature has underestimated liver toxicity from antidepressants, researchers reported in the December 20 online American Journal of Psychiatry.
Drug-induced liver injury from antidepressants is rare, but the damage to patients may be permanent and sometimes even life-threatening. “The available data show that all antidepressants are associated with a risk of hepatotoxicity,” said Cosmin Sebastian Voican, MD, PhD, and colleagues in their recently published study. Elderly patients and those with polypharmacy are especially at risk.
In their search of the literature, the investigators analyzed 378 articles and selected 158 for review, of which 88 were case reports, 38 were original papers, and 32 were reviews.
Results indicated that 0.5% to 1% of patients treated with second-generation antidepressants and up to 3% of those treated with monoamine oxidase (MAO) inhibitors or tricyclic and tetracyclic antidepressants experienced asymptomatic mild abnormal liver function. However, the authors noted that “evidence is insufficient for rigorous conclusions to be drawn about the prevalence and severity of antidepressant-induced liver injury.”
Based on available data, drug-induced liver toxicity occurs most often in patients taking MAO inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine.
Hepatotoxicity risk appears to be lower for patients receiving citalopram, escitalopram, paroxetine, and fluvoxamine.
For the most part, liver injury linked with antidepressants occurs between several days and six months after treatment commences. “Liver damage is in most cases idiosyncratic and unpredictable, and it is generally unrelated to drug dosage,” the researchers said.
Still, the study authors recommend prescribing the minimum effective dosages of antidepressants. To avoid possible drug-drug interactions, clinicians are advised to avoid coprescriptions.
Other recommendations include advising patients of the possibility of liver abnormalities and counseling them that alcohol consumption could increase their risk.
“Drug-induced liver toxicity is difficult to prevent, and consequently its early detection is a major goal,” wrote Dr. Voican and colleagues. “Antidepressants suspected to have a higher potential for hepatotoxicity should be used with caution in elderly patients, in patients with coprescriptions, and in patients with substantial alcohol use, illicit substance use, or evidence of chronic liver disease.”
In addition, “pretherapeutic screening and regular assessment of hepatic enzymes while under treatment may be useful.” If liver injury is detected, “prompt discontinuation of the drug responsible is essential,” they concluded.
—Lauren LeBano
References
