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Related Experiment Videos

Nortriptyline-induced fulminant hepatic failure

C Berkelhammer1, N Kher, C Berry

  • 1Department of Medicine, Christ Hospital and Medical Center, Oak Lawn, Illinois 60453.

Journal of Clinical Gastroenterology
|January 1, 1995
PubMed
Summary

Nortriptyline, a common antidepressant, can cause severe liver damage. This case highlights the need to identify and stop this drug if liver failure symptoms appear.

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Area of Science:

  • Hepatology
  • Clinical Pharmacology
  • Toxicology

Background:

  • Tricyclic antidepressants (TCAs) are widely prescribed for depression.
  • Drug-induced liver injury (DILI) is a significant clinical concern.
  • Nortriptyline is a commonly used TCA with a known, though infrequent, risk profile.

Observation:

  • A postmenopausal woman presented with fulminant hepatic failure after 64 days of nortriptyline use.
  • Clinical presentation lacked typical signs of hypersensitivity, such as fever, rash, or eosinophilia.
  • Liver biopsy revealed predominant zone 3 necrosis with bridging, suggestive of a metabolic insult.

Findings:

  • This case represents the first reported instance of nortriptyline-induced fulminant hepatic failure.
  • The clinical and histological features support an idiosyncratic metabolic reaction rather than a hypersensitivity response.

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  • A significant latent period between drug initiation and liver failure onset was observed.

    • Implications:

    • Early recognition of nortriptyline as a potential cause of acute liver failure is crucial for timely intervention.
    • Discontinuation of the offending agent is paramount in managing drug-induced liver injury.
    • This case emphasizes the importance of considering less common adverse drug reactions in clinical practice.