SUN-282 Sertraline-Induced Dyslipidemia and Liver Toxicity in a 17-Year-Old Adolescent

Abstract

Background: SSRI’s are very common first line drugs used for treatment of anxiety and depression in adults and children. Different drugs in this group have been reported in adults to be associated with increased weight, cholesterol, triglyceride (TG), insulin level and fasting blood glucose. Sertraline-induced liver toxicity has been described clinically and in vitro. Some studies found Fluoxetine to be the safest SSRI in terms of metabolic syndrome with reduction of weight, cholesterol, TG, fasting blood glucose and hemoglobin A1c. SSRI’s side effects have not been examined thoroughly in the pediatric population. Clinical case: 17 year old Caucasian autistic male teen was referred for initial endocrine evaluation with concern about fatty liver, increased liver enzymes, and increased triglyceride. He was started on Sertraline about 6 months prior to presentation for behavioral issues. He was previously on Aripiprazole and Fluoxetine for few years. Lipid panel showed total cholesterol of 186 mg/dl, TG 245 mg/dl, LDL cholesterol 106 mg/dl, and HDL cholesterol 31 mg/dl. Aspartate Aminotransferase (AST) was 50 U/L and Alanine Aminotransferase (ALT) was 111 U/L. Liver US showed fatty infiltration. Detailed work up for liver disease was negative. He had normal hemoglobin A1c of 5.1%, fasting insulin level of 4 mcIU/ml and TSH of 2.4 mcIU/ml. No major weight change was reported. BMI on presentation was normal at 24.42 kg/m² (78%ile based on CDC 2-20 Years BMI-for-age data). Sertraline-related side effects were suspected giving previous normal lipid panel and liver enzymes prior to starting this medication, and recommendation was made to stop it. He was switched back to Fluoxetine. Labs studies improved quickly within few weeks. Studies after 6 month showed total cholesterol of 141 mg/dl, TG 100 mg/dl, LDL cholesterol 87 mg/dl, HDL cholesterol 34 mg/dl, Aspartate Aminotransferase (AST) 19 U/L and Alanine Aminotransferase (ALT) 21 U/L. Conclusion: SSRIs are increasingly prescribed in the pediatric population, and studies are needed to understand their possible metabolic side effects. This is important giving the increased prevalence of obesity and metabolic syndrome in children and adolescents. Clinicians treating with Sertraline should be aware of its possible metabolic side effects and hepatic toxicity. Laboratory studies should be conducted periodically while taking this medication.