Trimipramine* Cholestatic jaundice and first report of acute renal failure

Examination of a drowsy, confused 75-year-old woman showed she was jaundiced and mildly dehydrated with 480 white cells/mm3 , no red blood cells and < 1% eosinophils in the urine. A blood screen showed haemoglobin 12.8 gjdl, and white blood cell count 14.4 x 109jL with 93% neutrophils and 0% eosinophils. The patient had no relevant ~ medical history and normal kidneys, pancreas, spleen) bile ducts and abdominal aorta and did not have hepatomegaly or signs and symptoms of chronic liver disease.

Three weeks before admission, the patient was prescribed trimipramine which was increased, over 2 weeks to a dosage of 60 mgjday. However, following the appearance of anticholinergic side effects the trimipramine dosage was reduced to 40 mg/day.

Approximately 18 days after trimipramine withdrawal, the acute renal failure (which had been treated with dialysis) and jaundice had resolved. Leighton JD. Walker RJ. Lynn KL. New Zealand Medical Journal 99. 248. 9 Apr 1986

10 Reactions® 10 May 1986 0157-7271/86/1026-0010/0$01.00/0 © ADIS Press