Imipramine

Hepatitis A 33-year-old female (54kg) with psychotic depression developed abnormal liver function following administration of oral imipramine ( 300mg) and thiothixene ( I Omg) for 26 days. Oral chlorpromazine ( 50mg qid) and amitriptyline ( 1 OOmg) had been given over the preceding 3 months. Two months prior to starting imipramine liver function was normal. Oral diazepam ( IOmg qid) and imipramine ( 75rng qid) had been given for 6 days prior to starting single dose imipramine and thiothixene. SGPT (130SIU/L), SGOT(346IUfU, and alkaline phosphatase ( 3641 U / L) were all elevated after 26 days of single dose imipramine but returned to near normal limits 14 days after stopping the drug. Thiothixene was not discontinued. Liver biopsy was not obtained. 300mg imipramine orally was considered to be a large dose for the patient's body weight despite the finding of therapeutic levels of serum imipramine (I08ng/mll and its metabolites, II hours following the last dcr:;e of the drug. ' ... toxic peak feliefs remain a possibifity (and] ... farge single daily dosage might deliver toxic amoUniS of drug to the liver via the portal system even i{systemic plasma concentrations remain norma/'. R. Mooltovitz aJ. J ""rnal of Clinical Psychiatry 4], 165 I Apr 1982}

0157-7271/82/0625-0005/0$01.00/0 © ADIS Press Reactions 25 Jun 1982 5