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Amitriptyline-induced fulminant hepatitis.

G Danan, J Bernuau, X Moullot

    Digestion
    |January 1, 1984
    PubMed
    Summary
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    Amitriptyline can cause severe liver injury, including hepatitis and necrosis, in susceptible individuals. Prompt drug withdrawal led to the patient's complete recovery, highlighting the importance of monitoring for adverse drug reactions.

    Area of Science:

    • Hepatology
    • Clinical Pharmacology
    • Toxicology

    Background:

    • Tricyclic antidepressants, such as amitriptyline, are widely prescribed for various conditions.
    • Drug-induced liver injury (DILI) is a significant concern in clinical practice.
    • Identifying specific drug culprits is crucial for patient management.

    Observation:

    • A patient experienced recurrent episodes of fever and jaundice following amitriptyline administration.
    • The second episode presented with severe hepatitis, characterized by hepatic encephalopathy, ascites, coagulopathy, and massive hepatic necrosis.

    Findings:

    • Amitriptyline was identified as the causative agent for severe hepatotoxicity in this case.
    • Cessation of amitriptyline resulted in a slow but complete clinical recovery.

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  • This case underscores the potential for idiosyncratic liver reactions to amitriptyline.

    • Implications:

    • Clinicians should maintain a high index of suspicion for DILI when patients present with unexplained liver dysfunction.
    • Awareness of amitriptyline's hepatotoxic potential is essential for safe prescribing practices.
    • Further research into the mechanisms of idiosyncratic DILI may improve patient outcomes.