Lofepramine Elevated liver enzymes: 3 case reports

Case 1 A 90-year-old woman with a left hemiparesIs and normal liver function was receiving bendroflumethlazlde 10mg. and atenolol 100mg Lofepramlne 70mg Increased to 210mg daily was given for depression and after 3 weeks AST U/L. AL Twas 271 U/L. gamma­glutamyl transferase was 722 U/L. alkaline phosphatase was 809 U/ L and bilirubin was 18 ,ugmol/L All values returned to normal on discontinuing lofepramlne

Case 2 On admission with poor mobility and depression but normal liver function . a 75-year-old man received lofepramlne 70mg Increased to 140mg dally after 1 week After 2 weeks AST was 61 U/L. AL Twas 65 U/L. gamma-glutamyl transferase was 256 U/L. alkaline phosphatase was 757 U/ L and bilirubin was 22 ,umol/L Normal liver function was noted 4 months after lofepramine withdrawal.

Case 3: A 90-year-old woman with Alzheimer's disease received lofepramine 140 mg/ day for depression_ Within 3 days. alkaline phosphatase was 322 U/L and after 1 week It rose to 595 U/ L Gamma glutamyl transferase was 122 U/L. AST was 114 U/L. AL Twas 116 U/L and bilirubin was normal Five days after stopping lofepramlne all transaminase values were normal and within 6 weeks . gamma-glutamyl transferase and alkaline phosphatase were normal.

'The temporal relation of deranged biochemistry with lofepramine treatment and its withdrawal strongly suggests a reaction to the drug_ '

MacPhee GJA Roberls MA McKean CE Bnllsh Medical Journal 295 1001 17 Oct 1987

0157- 7271 / 88/ 0116-0007/ 0S01 00/ 0 © ADIS Press REACTIONS · 16 January 1988 7