Venlafaxine-induced Cholestatic Hepatitis

Abstract

Venlafaxine is a widely used antidepressant with relatively low occurrence of adverse side effects. Increasing evidence suggests that venlafaxine may cause severe liver damage. Until now, 10 cases of venlafaxine-related liver injuries have been reported. We describe a case of a 39-year-old woman who developed cholestatic hepatitis after intake of venlafaxine. The patient had taken low-dose venlafaxine (75 mg/d) for 2.5 years. Three months before admission to the hospital, the venlafaxine dosage had been increased to 300 mg/d because of severe depression. Laboratory findings revealed elevated serum transaminases (aspartate aminotransferase 1033 U/L; alanine aminotransferase 2063 U/L), alkaline phosphatase (274 U/L), γ-glutamyltransferase (284 U/L), and serum bilirubin (4.6 mg/dL). Liver biopsy showed cholestatic hepatitis predominantly involving zone 3 of hepatic acini and a mixed portal inflammatory infiltrate along with eosinophils. Symptoms rapidly resolved after cessation of venlafaxine and administration of corticosteroid. The present paper describes detailed clinicohistopathologic characteristics of venlafaxine-associated cholestatic hepatitis and provides a comprehensive summary of prior case reports.