Lucena M Isabel, Carvajal Alfonso, Andrade Raúl J, Velasco Alfonso
Instituto de Farmacoepidemiología de la Universidad de Valladolid, Spain.
Expert Opin Drug Saf. 2003 May;2(3):249-62. doi: 10.1517/14740338.2.3.249.
Depression is a chronic, severe and increasingly prevalent illness associated with substantial morbidity, mortality and healthcare costs. Antidepressant drugs, the cornerstone of depression treatment, are not devoid of adverse effects, including hepatotoxicity. To review the risk of liver toxicity related to major antidepressants, the authors have followed structural criteria focusing on the underlying mechanism presumably involved and the role of particular chemical structures. The clinicopathological expression goes from transient increases in liver enzymes to fulminant liver failure. Classical antidepressants such as monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants (TCAs) seem to have the highest potential to induce liver damage compared with the newer drugs such as selective serotonin re-uptake inhibitors (SSRIs). The potential for severe hepatotoxicity associated with nefazodone is stressed. Guidelines for therapy and prevention of antidepressant-induced hepatotoxicity are also discussed.
抑郁症是一种慢性、严重且日益普遍的疾病，与大量的发病率、死亡率及医疗费用相关。抗抑郁药物作为抑郁症治疗的基石，并非没有不良反应，其中包括肝毒性。为了评估与主要抗抑郁药物相关的肝毒性风险，作者遵循了结构标准，重点关注可能涉及的潜在机制以及特定化学结构的作用。临床病理表现从肝酶短暂升高到暴发性肝衰竭不等。与新型药物如选择性5-羟色胺再摄取抑制剂（SSRI）相比，经典抗抑郁药如单胺氧化酶抑制剂（MAOI）或三环类抗抑郁药（TCA）似乎具有最高的肝损伤诱导潜力。文中强调了与奈法唑酮相关的严重肝毒性可能性。还讨论了抗抑郁药诱导肝毒性的治疗和预防指南。
