title: Fulminant chemical hepatitis possibly associated with donepezil and sertraline therapy.
abstract: OBJECTIVE
  To describe a case of fulminant hepatitis possibly related to concomitant donepezil and seratriline therapy.
  
  
  METHODS
  An 83-year-old woman treated in a dementia care facility and later in a tertiary medical center.
  Discontinuation of donepezil and sertraline therapy with subsequent improvement evidenced by liver biopsy and liver function tests.
  
  
  RESULTS
  An older woman with Alzheimer's disease was admitted to a dementia care facility because of aggressive behavior. Treatment with sertraline was initiated in February 1998. Sertraline doses were increased gradually to 200 mg daily by May 1998, and some improvement in behavior was seen. Concomitant therapy with donepezil 5 mg qhs was initiated June 26, 1998. Ten days later, confusion and jaundice were noted. Total bilirubin was 5.6 mg/dL, GGTP was 1,208 IU/L, and alkaline phosphatase was 369 IU/L. Computed tomography revealed cholelithiasis without ductal dilation. Liver, spleen, and pancreas seemed normal. Donepezil and sertraline were discontinued. The patient was admitted to our institution and treated for dehydration. A liver biopsy revealed scattered portal eosinophils and prominent cholestasis consistent with acute chemical hepatitis. The GGTP and total bilirubin of this patient peaked at 2,235 IU/L and 22.6 mg/dL, respectively. The patient improved, and her liver function tests normalized over the next 2 months.
authors.affiliation: University of Pittsburgh Medical Center, Pennsylvania, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Verrico
authors.forename: D A
authors.initials: DA
authors.lastname: Nace
authors.forename: A L
authors.initials: AL
authors.lastname: Towers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy*; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D002779:Cholestasis / Q000139:chemically induced; D000077265:Donepezil; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007189:Indans / Q000009:adverse effects*; D017114:Liver Failure, Acute / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D008111:Liver Function Tests; D018697:Nootropic Agents / Q000009:adverse effects*; D010880:Piperidines / Q000009:adverse effects*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D020280:Sertraline / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000469:Alkaline Phosphatase; D001663:Bilirubin; D000077265:Donepezil; D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; D005723:gamma-Glutamyltransferase