Cross hepatotoxicity between tricyclic antidepressants and phenothiazines.

OBJECTIVE

To describe a case of cross hepatotoxicity between tricyclic antidepressants and phenothiazines.

PATIENT: A woman who developed three episodes of drug-induced hepatitis within 3 years as a result of successive treatment with two tricyclic antidepressants, trimipramine and desipramine, and one neuroleptic derivative, cyamemazine.

INTERVENTIONS: The drugs were withdrawn after the patient experienced liver dysfunction, although bromazepam was later administered with no side effects.

RESULTS

After three episodes of drug-induced hepatitis the patient's serum aspartate aminotransferase and alanine aminotransferase levels returned to normal when the tricyclic antidepressants and cyamemazine were withdrawn.

CONCLUSIONS

Trimipramine, desipramine and cyamemazine are related by their chemical structures which include a tricyclic ring. This suggests that this chemical moiety might be involved in the hepatotoxicity of tricyclic antidepressants and phenothiazine derivatives.