Desipramine

Hepatitis Two suspected cases of desipramine­induced hepatotoxicity are described. Case I: A 37-year-old woman, who had undergone a caesarian section 5 months previ(lu~ly .. wa~ hospitalised after a 4-month episode of depression which had not responded (0 treatment. Over the next 3 weeks, treatment included 3 1M injections of haloperidol, followed by oral haloperidol 2-lOmg daily, benztropine 1-2mg daily and diphenhydramine SO­IOOmg daily as required. Desipramine hydrochloride was started on day 6 (25mg bid) increased to 50mg tid by day 12, and stopped for 2 days on day 17 due to tremulousness and diaphoresis. Haloperidol was stopped on day 33. Liver enzymes, which had been normal on days 13 and 20. were abnormally elevated on days 27 and 35. Desipramine dosage was reduced to 50mg daily on day 50. and then stopped on day 53. Levels of hepatic enzymes fell immediately and were normal by day 71. There was no recurrence of hepatic dysfunction during later treatments with trazodone or electroconvulsi ve therapy. Case 1: A 20-year-old female student. with a history of drug abuse and 2 previous psychotic episodes, was hospitalised after a I-week period of bizarre behaviour. She had taken no psychotic I]ledications in the preceding 18 months. Treatment over the next 7 weeks included oral thiothixene 5· ISmg daily. lithium 1200-1800mg daily, and flurazepam 15-30mg daily. Desipramine hydrochloride 25mg tid was begun on day 51, and increased to 125 mg/day by day 53. Hepatic enzymes (which had been normal on day 29) were abnormally high on day 57. The patient was physically well. except for lethargy. Desipramine was stopped on day 58, and thereafter the hepatic enzymes improved dramatically and were normal by day 64. Although it is difficult to establish with certainty, desipramine is considered responsible for the observed hepatitis which is probably due to drug hypersensitivity. Price, L.R et at: Journal of Clinical Psychopharmacology 3: 243 (Aug 1983)

4 Reactions 4 Nov 1983 0157-7271/83/1104-0004/0$01.0010 © ADIS Press