Sertraline-induced liver injury

A 66-year-old female patient received oral sertraline (initial dose 25 mg once daily, gradually increased to 100 mg once daily on day 10), zopiclone (7.5 mg once per night), lorazepam (0.5 mg thrice daily), and amlodipine (2.5 mg once daily) following the doctor′s advice due to recurrent depressive disorder, sleep disorder, and hypertension. Before administration, the patient′s serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyl transpeptidase (γ-GT) were 21 U/L, 16 U/L and 50 U/L, respectively. On day 16 after the medication, the patient′s serum levels of AST, ALT, and γ-GT were 114 U/L, 134 U/L, and 192 U/L, respectively, but the treatment protocol was not adjusted. On day 21 after the medication, her serum levels of AST, ALT, and γ-GT turned to be 178 U/L, 242 U/L, and 362 U/L, respectively. Then hepatoprotective drugs were given, sertraline was discontinued by gradual reduction (oral escitalopram 5 mg once daily was added when sertraline was reduced to 25 mg once daily, but escitalopram was changed to oral mirtazapine 15 mg at bedtime finally due to the patient′s leg discomfort), and the other drugs were continued. The liver function of the patient gradually improved and her serum levels of AST, ALT, and γ-GT were 35 U/L, 36 U/L, and 108 U/L, respectively about 50 days after sertraline withdrawal. Key words: Sertraline; Drug-related side effects and adverse reactions; Liver diseases