Hepatotoxicity of Psychotropic Drugs

table 1. Hepatotoxicity Caused by Psychotropic Drugs

Drug	Type of Injury	Incidence	Latency	Probable Mechanism

Phenothiazines
Chlorproma-	CH	0.1%-1%	1-5 weeks	Hypersensitivity
zine		(ALT only 25%-50%)		idiosyncratic?
Butyrophenones
Haloperidol	CH	0.002%	4-5 weeks	Hypersensitivity
		(ALT only 16%)
Misc. neuroleptics
Clozapine	HC	rare	5 weeks	unclear
		(ALT only 37%)
Benzodiazepines
Diazepam	CH or HC	rare	days-months	Hypersensitivity
Chlordiazepoxide			2-6 weeks
Barbiturates
Phenobarbital	CH or HC	rare	1-8 weeks	Hypersensitivity
MAO inhibitors
Phenelzine	HC	rare	weeks	unclear
Tricyclic antidepressant
Amitriptyline	CH or HC	0.5%-1%	8 weeks	Hypersensitivity
Imipramine		(ALT only 10%)		1-3 weeks
Desipramine			1-3 weeks
Amineptine	HC	rare	2-3 months	Hypersensitivity
Other antidepressants
Trazodone	HC or CH	rare	2-20 weeks	unclear
Nefazodone	HC	rare	14-28 weeks	unclear
Acetylcholinesterase inhibitors
Tacrine	HC	ALT > 3-fold 20% ALT > 20-fold 2%		up to 12 weeks idiosyncratic
SSRI Fluoxetine
Fluoxetine	HC	rare	4 weeks	unclear
Drugs of abuse
Cocaine	HC	unknown	hours to days	ischemic vs. toxic metabolite
Ecstasy	HC	unknown	hours to weeks	unclear

NOTE. Rare = one or few isolated reports. Hypersensitivity based on presence of clinical features. Abbreviations: CH, cholestatic; HC, hepatocellular.