DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20174390

Venlafaxine induced hepatotoxicity in a carcinoma of breast survivor with co-morbid depression

Rajnish Raj, Nisha Bhagat

Abstract


Drug Induced Liver Injury (DILI) is one of the leading causes of liver damage worldwide and raises concerns about its prescription in lieu of the limited drug options available for the depression. Venlafaxine (VEN) is an antidepressant with dual neurotransmitter receptor modulations i.e., serotonin and norepinephrine reuptake inhibitor (SNRI) and having an additional benefit in management of vasomotor symptoms especially in menopausal patients where hormone replacement therapy (HRT) is contraindicated. VEN induced hepatotoxicity have been reported to occur in less than 1% of patients. Until now, less than 11 cases of VEN-related liver injuries have been reported in literature. We hereby, report a rare case of VEN induced liver injury in a 40-year-old breast cancer survivor with co-morbid depression.


Keywords


Drug induced liver injury, Depression, Hot flashes, Venlafaxine

Full Text:

PDF

References


Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, LaVasseur BI, Barton DL, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet. 2000;356:2059-63.

Holliday SM, Benfield P. Venlafaxine: a review of its pharmacology and therapeutic potential in depression. Drugs. 1995;49:280-94.

Klamerus KJ, Moloney K, Rudolph RL, Sisenwine SF, Jusko WJ, Chiang ST. Introduction of a composite parameter to the pharmacokinetics of venlafaxine and its active O‚Äźdesmethyl metabolite. The Journal of Clinical Pharmacology. 1992 Aug 1;32(8):716-24.

Otton SV, Ball SE, Cheung SW, Inaba T, Rudolph RL, Sellers EM. Venlafaxine oxidation in vitro is catalysed by CYP2D6. Clin Pharmacol. 1996;41:149-56.

Rudolph RL, Derivan AT. The safety and tolerability of venlafaxine hydrochloride: Analysis of the clinical trials database. J Clin Psychopharmacol. 1996;16:54S-9S.

Verma S, Kaplowitz N. Diagnosis, management, and prevention of drug-induced liver injury. Gut. 2009;58:1555-64.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th Edn) (DSM-5). Arlington VA: American Psychiatric Association; 2013:123-154.

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.

Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50-5.

Beneke M, Rasmus W. Clinical global impressions (ECDEU): some critical comments. Pharmacopsychiatry. 1992;25:171-6.

Naranjo CA, Busto U, Sellers EM, Sander P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239-45.

Aithal GP, Watkins PB, Andrade RJ, Larrey D, Molokhia M, Takikawa H, et al. Case definition and phenotype standardization in drug-induced liver injury. Clin Pharmacol Ther. 2011;89:806-15.

Bordeleau L, Pritchard KI, Loprinzi CL, Ennis M, Jugovic O, Warr D, et al. Multicenter, randomized, cross-over clinical trial of venlafaxine versus gabapentin for the management of hot flashes in breast cancer survivors. J Clin Oncol. 2010;28:5147-52.

Sencan I, Sahin I, Ozcetin A. Low-dose venlafaxine-associated liver toxicity in chronic hepatitis. Ann Pharmacother. 2004;38(2):352-3.

Phillips BB, Digmann RR, Beck MG. Hepatitis associated with low-dose venlafaxine for postmenopausal vasomotor symptoms. Ann Pharmacother. 2006;40(2):323-7.

Cardona X, Avila A, Castellanos P. Venlafaxine-associated hepatitis. Ann Intern Med. 2000;132(5):417.

Detry O, Delwaide J, De Roover A, Hans MF, Delbouille MH, Monard J, et al. Fulminant hepatic failure induced by venlafaxine and trazodone therapy: A case report. Transplant Proc. 2009;41(8):3435-6.

Stadlmann S, Portmann S, Tschopp S, Terracciano LM. Venlafaxine-induced cholestatic hepatitis: case report and review of literature. Am J Surg Pathol. 2012;36(11):1724-8.

Freeman EW1, Guthrie KA, Caan B, Sternfeld B, Cohen LS, Joffe H, et al. Efficacy of Escitalopram for Hot Flashes in Healthy Menopausal Women: A Randomized Controlled Trial. JAMA: J Am Med Assoc. 2011;305(3):267-74.