Liver Injury Induced by the Interaction Between Fluoxetine and Celecoxib: A Case Report and the Literature Review

Abstract

Introduction: Fluoxetine is used commonly as an antidepressant and celecoxib is widely used for pain relief and reducing inflammation in various chronic conditions. Both of them can cause liver injury, but it is a rare adverse reaction of their interactions. Here we report a case of liver injury possibly induced by fluoxetine and celecoxib in a female patient. Case Presentation: A 55-year-old woman who was given fluoxetine for three months and celecoxib for seven days was transferred to the Department of Emergency, the first affiliated hospital of Jilin University, Changchun, China, on March 2019, with icterus on the skin, dark brown urine and pain in the upper abdomen. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) levels were elevated. According to follow-up examination, liver injury and cholecystitis were diagnosed. After discontinuing the two drugs and starting symptomatic treatment, her ALT and AST levels returned to normal. Conclusions: The mechanism of liver injury induced by fluoxetine and celecoxib remains unclear. Inhibitors and substrates of CYP2D6, CYP2C9, CYP3A4, and CYP2C19 might participate in this situation. The interaction between fluoxetine and celecoxib, as well as other inhibitors and substrates with similar metabolic pathways, are noteworthy.