Reactions 726 - 7 Nov 1998

Maprotiline/opipramol

Hepatitis: case reportA 61-year-old man developed acute hepatitis during 2

months’ treatment with maprotiline and opipramol for severedepression.

The patient was initially treated with opipramol [‘Insidon’]150 mg/day for 2 months, with no adverse effects. His regimenwas then changed to opipramol 100 mg/day and maprotiline[‘Ludiomil’] 75 mg/day. Over the next 2 months he began tofeel increasingly tired, his sclera were jaundiced and his liverfunction tests were found to be abnormal. His serum AST, ALTand γ-glutamyl transferase levels peaked at 436, 857 and 658U/L, respectively, 1 day after opipramol and maprotiline werediscontinued.

A percutaneous needle biopsy of the man’s liver showedprominent periportal fibrosis, florid hepatitis with activation ofKupffer cells and siderosis.

The man’s liver function normalised over the next 2 monthsand his fatigue and jaundice resolved. A recurrence of hisdepression was treated with mirtazapine with noreappearance of hepatitis.

Author comment: Although hepatitis has been seen withopipramol alone and maprotiline alone, ‘this is the firstpublished case of severe but reversible hepatotoxicity withclinical signs of liver damage, serum liver enzyme elevation andhistologic evidence of hepatitis due to a therapy withtetracycline (maprotiline) and tricyclic (opipramol)antidepressants’.Braun JS, et al. Hepatitis caused by antidepressive therapy with maprotiline andopipramol. Pharmacopsychiatry 31: 152-155, Jul 1998 - Germany 800718324

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Reactions 7 Nov 1998 No. 7260114-9954/10/0726-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved