LETTER
Phenelzine-Induced Fulminant Hepatic Failure
Esther Gomez-Gil, MD;
Joan M. Salmeron, MD; and
Antoni Mas, MD
1 April 1996 | Volume 124 Issue 7 | Pages 692-693
TO THE EDITOR:
During the last year, two of our patients who had received phenelzine (a monoamine oxidase inhibitor commonly used to treat depression and other psychiatric and nonpsychiatric disorders) for 4 months (22.5 mg and 60 mg twice daily, respectively) had emergency orthotopic liver transplantation because of fulminant hepatic failure [1]. Phenelzine-induced fulminant hepatic failure was diagnosed after adequate biochemical, serologic, immunologic, hematologic, and histologic studies were done to rule out other known causes of liver damage. These two patients fit the pattern previously reported for hydrazine derivative—induced hepatotoxic injury: delayed toxic effect, no evidence of hypersensitivity-mediated injury, and histologic features of predominantly hepatocellular (rather than cholestatic) damage [2, 3].
Severe phenelzine-induced hepatitis has been reported rarely [4, 5]. To our knowledge, we report the first two cases of fulminant hepatic failure successfully treated by orthotopic liver transplantation in which other causes of acute liver damage were ruled out. The mechanism by which a hydrazine derivative such as phenelzine leads to hepatic injury appears to be idiosyncratic. Advanced age, simultaneous enzymatic induction by alcohol or other drugs, and coincident viral infection may play roles in the development of this clinical picture [2]. The potential relation with the rapid acetylator phenotype remains controversial [2, 4].
These cases suggest that phenelzine should be considered a potential cause of fulminant hepatic failure. Because early recognition of liver damage and withdrawal of phenylzine is the only way to prevent such hepatic failure, liver function tests should be done regularly in all patients receiving phenelzine, at least during the first 6 months of therapy.
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Author and Article Information
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Hospital Clinic Provincial; Barcelona, Spain
1. Castells A, Salmeron JM, Navasa M, et al. Liver transplantation for acute liver failure: analysis of applicability. Gastroenterology. 1993; 105:532-8.
2. Zimmerman HJ, Ishak KG. The hepatic injury of monoamine oxidase inhibitors. J Clin Psychopharmacol. 1987; 7:211-3.
3. Zimmerman HJ, Maddrey WC. Toxic and drug-induced hepatitis. In: Schiff L, Schiff ER, eds. Diseases of the Liver. Philadelphia: JB Lippincott; 1993:707-83.
4. Bonkovsky HL, Blauchette PL, Schned AR. Severe liver injury due to phenelzine with unique hepatocellular disposition of extracellular material. Am J Med. 1986; 80:689-92.
5. Cook GC, Sherock S. Jaundice and its relation to therapeutic agents. Lancet. 1965; 1:175-9.
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