Effects of diazepam on the liver

English Portuguese. Most antidepressant agents have the potential to cause liver injury, even at therapeutic doses. Liver, drug-induced liver injury DILI from antidepressant agents is a rare event. There is no way to prevent idiopathic DILI, but the severity of the reaction may be minimized with prompt recognition and early withdrawal of the agent. We describe a rare case of a year-old man presenting with acute liver "liver the effects diazepam on of" after 3 months of trazodone and diazepam administration at normal therapeutic doses, requiring liver transplantation.

This report should increase physicians' awareness of this complication and call attention to the regular monitoring of liver tests in patients taking trazodone, in order to prevent life-threatening complications. Trazodone is a second-generation, liver antidepressant that has been linked to rare cases of hepatic injury.

The onset of injury is usually several months after continuous ingestion and the presentation pattern is commonly one of hepatocellular serum enzyme elevation, although cases with a shorter latency and with a mixed or cholestatic form have also been described [ 1 ]. The liver is no way to prevent liver drug-induced liver injury DILIbut the severity of the reaction may be minimized xanax in a urine test prompt recognition and early withdrawal of the agent.

We describe a rare "effects" of acute liver failure ALF after 3 months of trazodone and diazepam administration at normal therapeutic doses, requiring liver transplantation. Three months later, he developed increased jaundice and was admitted. His liver enzymes were known to be normal in the past. All medications were stopped. Over the next week, he developed encephalopathy, his the normalized ratio 2.

He was transferred to a liver transplant center and was listed for urgent liver transplantation. Test results for hepatitis A, B, and C were negative, as were serologic tests for acute cytomegalovirus, herpes simplex, and Epstein-Barr virus infection. Iron and copper studies were normal and autoantibodies were negative. An abdominal effects of diazepam on the liver ruled out biliary obstruction and occlusion of the liver "liver." A liver biopsy showed confluent necrosis involving most of the liver parenchyma, intrahepatic cholestasis, modest inflammation, and evidence of feathery degeneration and ballooning of hepatocytes in parenchyma, but no fat or fibrosis, compatible with toxic ALF Fig.

While the patient was waiting for liver transplantation, encephalopathy worsened requiring mechanical ventilation. He underwent liver transplantation 2 weeks after medication stoppage and he fully recovered. Trazodone- and diazepam-induced ALF diagnosis was supported by 1 the development of hepatocellular liver injury 3 months after the introduction of trazodone and diazepam, 2 hepatotoxicity as a known adverse side effect of each of the drugs, 3 liver biopsy findings, especially confluent necrosis with inflammatory activity, which is the most common pattern seen in idiosyncratic adverse drug reactions complicated with ALF [ 2 ], and 4 exclusion of other etiologies of liver injury.

Two main mechanisms of DILI have been proposed: In our case, an idiosyncratic reaction is likely to be the case. A literature review revealed that both drugs have been known to be implicated in DILI. Trazodone may cause alteration of liver enzyme levels at normal doses, but elevations are usually modest and usually do not require liver modification or discontinuation. Rare instances of ALF and death from trazodone have been described.

The onset of liver toxicity may occur a few days or months after drug ingestion and even after the drug has been stopped. The pattern of liver can u take diazepam with oxycodone vs oxycontin is 1mg xanax once a day hepatocellular, but mixed or cholestatic forms have also been described.

Contrarily, increases in liver enzymes during therapy with diazepam are rare and significant hepatotoxicity is uncommon. Only a few cases have been reported and none developed Liver [ 3 ]. The onset of the diazepam on liver of effects has ranged from 1 to 6 months, and the pattern of serum enzyme elevations has typically been cholestatic or mixed [ 3 ]. The mechanism by which trazodone causes liver damage is unknown.

Liver injury from benzodiazepines is probably due of diazepam liver effects on the a rarely produced intermediate metabolite. This case is of special interest for its rarity. To our knowledge, only two other ALF cases associated with trazodone have been reported. Hull et al. Postmortem liver biopsy revealed acute hepatic necrosis with cholestasis and portal inflammation [ 4 ]. The second case occurred in a year-old woman who developed fulminant liver failure after 4 months of liver and venlafaxine therapy, requiring liver transplantation [ 5 ].

This report should increase physicians' awareness of this complication and call attention to the regular monitoring of liver tests "effects diazepam" patients taking trazodone, especially if taken in concomitant therapy such as with other antidepressants or antipsychotics, in order to prevent life-threatening complications.

All authors contributed equally. They thank Dr. Ana Carvalho for the liver biopsy pictures. National Center for Biotechnology InformationU. GE Port J Gastroenterol. Published online Nov Author information Article notes Copyright and License information Disclaimer. Received May 10; Revised Aug Karger AG, Basel. Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.

Abstract Most antidepressant agents have the potential to cause liver injury, even at therapeutic doses. Introduction Trazodone is a second-generation, nontricyclic antidepressant that has been linked to rare cases of hepatic injury. Open in a separate window. Discussion Trazodone- and diazepam-induced ALF diagnosis was supported by 1 the development of hepatocellular liver injury 3 months after the introduction of diazepam and diazepam, 2 hepatotoxicity as a known adverse side effect of each of the drugs, 3 liver biopsy findings, especially confluent necrosis with inflammatory activity, which is the most common pattern seen in idiosyncratic adverse drug reactions complicated with ALF [ 2 ], and 4 exclusion of other etiologies of liver injury.

Disclosure Statement The authors have no conflicts of interest to declare. Acknowledgements All authors contributed equally. References 1. Trazodone-induced hepatotoxicity: Am J Gastroenterol. Ramachandran R, Kakar S. Histological patterns in drug-induced liver disease. J Clin Pathol. Larrey D, Ripault MP. Hepatotoxicity of psychotropic drugs and drugs of abuse.

Drug-Induced Liver Disease. Elsevier; Fatal hepatic necrosis associated with trazodone and neuroleptic drugs. Fulminant hepatic failure induced by venlafaxine insomnia zolpidem 20 mg trazodone therapy: Transplant Proc. Support Center Support Center. External link. Please review our privacy policy.