Posted by yxibow on August 17, 2006, at 1:50:03
In reply to Cymbalta - More Trouble With This Compound, posted by ttee on August 15, 2006, at 22:37:15
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> 1: Clin Gastroenterol Hepatol. 2006 Jul;4(7):912-7. Epub 2006 Jun 22. Links
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> Case report: fulminant hepatic failure involving duloxetine hydrochloride.
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> · Hanje AJ,
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> · Pell LJ,
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> · Votolato NA,
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> · Frankel WL,
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> · Kirkpatrick RB.
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> Department of Internal Medicine, Division of Digestive Health, The Ohio State University, Columbus, Ohio 43210, USA. jim.hanje@osumc.edu
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> BACKGROUND AND AIMS: Duloxetine hydrochloride was approved by the Food and Drug Administration in August 2004 for the treatment of major depressive disorder and diabetic peripheral neuropathic pain. Initial product labeling contained a precaution regarding the risk for increases in liver function test results. Recently, postmarketing research has revealed episodes of cholestatic jaundice and increases in transaminase levels to greater than 20 times normal in patients with chronic liver disease. METHODS: In this case report, we describe a patient with non-Hodgkin's lymphoma in remission and depression treated with duloxetine and mirtazapine. RESULTS: Approximately 6 weeks after increasing her duloxetine dose from 30 to 60 mg daily, she became jaundiced and presented with fulminant hepatic failure. Liver function tests immediately before initiating duloxetine were not available, although the patient carried no prior history of chronic liver disease. A complete work-up for alternate causes failed to reveal another explanation for the patient's clinical presentation. A liver biopsy examination showed histologic changes of subacute injury and the patient's clinical course was consistent with drug-induced liver injury. Despite aggressive measures, the patient's condition deteriorated and the decision was made to withdraw care. CONCLUSIONS: This report shows a case of fulminant hepatic failure and death involving duloxetine use. Given recent reports of severe hepatotoxicity associated with the use of duloxetine in patients with pre-existing liver disease, further investigation into the safety of this compound is warranted.
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> PMID: 16797245 [PubMed - in process]
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One has to read case reports with a fine tooth comb. Thats what they are -- case reports, of one or several people. In fact all of what we talk about here on the medication side are our own case reports. Negative case reports are often discussed online more than positive reports, because if some medication is not causing side effects there are less reasons to complain or ask for advice.
I'm not saying that one shouldn't ignore these things. It is simple to get an ALT test for your liver functions, and I get tests regularly because I am on multiple medications (including Cymbalta.)
Also, the case report here mentions someone with a cancerous disease (already weakening the system) and not only on one antidepressant, but also on a second, Remeron. Most antidepressants and psychiatric medications pass through the P450 cytochrome system in the liver.
And it is also dare I say, prudent for doctors to practice CYA (cover your ***) medication in people with impaired liver function. You don't give nefazodone to someone who has complex cirrhosis.
While liver disorders are something to absolutely avoid obviously, there are signs oneself can see rather early on to avoid liver damage. It is one of the organs in the body that greatly repairs itself, and with supportive care, one can survive for quite some time on 5% to 10% of it. Jaundice shows up rather early on, with yellow bruising and eye color changes and partial liver transplants are much more common and routine, if there is such a word, now.
I guess what I'm saying is that all medications have side effects and there are choices to take or not take, and most go through the liver through a complex system that all doctors need to be aware of, the P450 cytochrome, with few exceptions such as the benzodiazepine Serax which largely goes through the kidneys.
poster:yxibow
thread:676910
URL: http://www.dr-bob.org/babble/20060810/msgs/677332.html