Acute Liver Failure to Fluoxetine Therapy

Fluoxetine is a commonly prescribed antidepressant. The hepatic failure reported secondary to this particular drug is very rare i.e. 0.5% of the patients who are taking this drug for long term therapy. The routine monitoring is not advised for someone on maintenance therapy. The exact mechanism is still unknown. We reported a case of hepatic failure in a 35 year old patient who was started on this drug for her persistent depression. The presenting complaint was jaundice with a cholestatic manifestations. The workup was unremarkable, other than liver enzymes dysfunction (ALT 1129 U/L, AST 1892 U/L). The hepatitis panel and imaging was negative. Ultimately biopsy was done which showed portal, periportal and lobular hepatitis. The working diagnosis of Drug-induced liver injury was made and patient showed improvement in her condition in 2-4 weeks. The patient was also followed at outpatient clinic and the liver enzymes were normalized.

Keywords: drug-induced liver injury, hepatic failure, SSRI.