Park Susie H, Ishino Risa
Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California, School of Pharmacy, 1985 Zonal Avenue, Los Angeles, CA 90033, USA.
Curr Drug Saf. 2013 Jul;8(3):207-23. doi: 10.2174/1574886311308030011.
Antidepressants are commonly prescribed and used in the management of depression, anxiety disorders, and other psychiatric illnesses. Antidepressants used in therapeutic dosing ranges are associated with causing several adverse drug reactions including hepatotoxicity. Paroxetine, fluoxetine, fluvoxamine, citalopram, mirtazapine and venlafaxine are associated with reversible liver injury upon discontinuation of the agent. Patient cases of hepatotoxicity involving the use of nefazodone, trazodone, duloxetine, bupropion, and sertraline are linked to causing death in its users. Due to the idiosyncratic nature of hepatotoxicity, monitoring of liver function tests and immediate discontinuation upon abnormal lab findings or signs and symptoms of liver dysfunction are crucial since most cases of hepatic damage are reversible when detected early. Onset of antidepressant-associated hepatotoxicity varies from 5 days to 3 years. Antidepressant-induced liver injury can occur in the absence of identifiable, underlying risk factors such as cirrhosis and hepatitis infection; only a few cases of hepatic injury involve patients with chronic hepatitis infection. Some of these cases involve possible drug interactions between antidepressants and concomitant agents that increase the risk for liver injury. Understanding druginduced liver injury associated with antidepressants and the importance of safety monitoring is essential to optimize outcomes for antidepressant treatment.
抗抑郁药常用于治疗抑郁症、焦虑症及其他精神疾病。治疗剂量范围内使用的抗抑郁药会引发多种药物不良反应，包括肝毒性。帕罗西汀、氟西汀、氟伏沙明、西酞普兰、米氮平和文拉法辛在停药后会出现可逆性肝损伤。涉及使用奈法唑酮、曲唑酮、度洛西汀、安非他酮和舍曲林的肝毒性患者病例与使用者死亡有关。由于肝毒性具有特异质性，监测肝功能检查并在实验室检查结果异常或出现肝功能障碍的体征和症状时立即停药至关重要，因为大多数肝损伤病例若早期发现是可逆的。抗抑郁药相关肝毒性的发作时间从5天到3年不等。抗抑郁药引起的肝损伤可在没有肝硬化和肝炎感染等可识别的潜在风险因素的情况下发生；仅有少数肝损伤病例涉及慢性肝炎感染患者。其中一些病例涉及抗抑郁药与伴随药物之间可能的药物相互作用，从而增加肝损伤风险。了解与抗抑郁药相关的药物性肝损伤以及安全监测的重要性对于优化抗抑郁治疗效果至关重要。
