RSS Feeds
Phenelzine-Induced Fulminant Hepatic Failure
- Esther Gomez-Gil, MD;
- Joan M. Salmeron, MD; and
- Antoni Mas, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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.
Esther Gomez-Gil, MD
Joan M. Salmeron, MD
Antoni Mas, MD
Hospital Clinic Provincial
Barcelona, Spain
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
