Content area
Full Text
KEY WORDS: sertraline; Zoloft; SSRI; hepatotoxicity; hepatitis.
Sertraline is a selective serotonin reuptake inhibitor (SSRI) approved by the Food and Drug Administration in 1991 as first-line therapy of depression; sertraline is as effective in treatment of depression as amitriptyline (2) and fluoxetine (3). Additionally, sertraline is used to treat panic (DSM IV 300.01), (4-6) and obsessive-compulsive (DSM IV 300.3) disorders (7-9). Therapeutic response to sertraline occurs with oral doses ranging from 50 to 200 mg once daily. In 1999, sertralinewas the second most commonly prescribed SSRI, withworldwide sales exceeding US$2 billion annually (24). As of February 2000, over 115 million prescriptions for sertraline had been written in 80 countries under various brand names (25). Sertraline is chemically unrelated to other SSRIs. It also is chemically unrelated to tricyclic antidepressants (TCA), and other antidepressant medications. It acts, as do other members of its class, through inhibition of presynaptic serotonin reuptake, while having only weak effects on norepinephrine and dopamine reuptake (1).
Patients taking sertraline have reported experiencing few adverse effects. A minority of treated individuals develop nausea (26-30%), diarrhea (18-24%), insomnia (16-28%) or sexual dysfunction (7-19%). Hepatotoxicity caused by sertraline is rare; in premarketing studies (1), asymptomatic serum aminotransferase level elevations occurred in 0.8% of study patients. Increases in enzyme levels developed in the first one to nine weeks of treatment and promptly resolved after discontinuation of the medication. Rare cases of hyperbilirubinemia and even liver failure and death due to sertraline have been reported to the manufacturer. In these instances, however, the causal role of sertraline was not proven in a manner consistent with usually accepted standards, as the patients described were taking other potentially hepatotoxic drugs (11-13).
We describe a patient who developed markedly elevated serum aminotransferase levels and nonspecific symptoms while being treated with sertraline; her symptoms and liver test abnormalities resolved after discontinuation of therapy. This case is significant because it is the only one of which we are aware in which the diagnosis of sertraline hepatotoxicity was confirmed when inadvertent rechallenge with the medication resulted in recurrent hepatitis.
CASE REPORT
A 23-year-old African-American woman was referred for evaluation of hepatitis. She had a history of depression treated with sertraline and frequent headaches treated with acetaminophen. She was well until...