Xavier Cardona; Asunción Avila; Pere Castellanos
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Cardona X, Avila A, Castellanos P. Venlafaxine-Associated Hepatitis. Ann Intern Med. 2000;132:417. doi: 10.7326/0003-4819-132-5-200003070-00016
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Published: Ann Intern Med. 2000;132(5):417.
TO THE EDITOR:
We agree with Horsmans and colleagues, who suggest that liver function should be regularly monitored in patients receiving venlafaxine. We report another case of acute hepatic injury with a prominent element of cholestasis in a patient taking this drug.
On 15 April 1999, a 78-year-old man was admitted to our hospital with icteric acute hepatitis. His medical history revealed Parkinson disease that was being treated with levodopa and pergolide and a major depression episode that had been treated with electroconvulsive therapy 2 months before admission. On 6 March, he had begun receiving venlafaxine at an initial dosage of 37.5 mg/d; this was increased to 150 mg/d on 9 April. Abdominal ultrasonography showed no anatomic abnormalities. In sharp contrast to his previous normal liver chemistry analysis, his liver function at admission showed the following abnormalities: alanine aminotransferase level, 3.97 µkat/L (normal < 1.08 µkat/L); aspartate aminotransferase level, 4.36 µkat/L (normal < 0.62 µkat/L); γ-glutamyltransferase level, 12.17 µkat/L (normal < 1.42 µkat/L); alkaline phosphatase level, 11.33 µkat/L (normal < 2.27 µkat/L); total bilirubin level, 87 µmol/L (normal < 17.1 µmol/L); and direct bilirubin level, 86 µmol/L (normal < 5.5 µmol/L). Serologic tests for hepatitis A, B, and C yielded negative results.
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