Wabont G, Ferret L, Houdre N, Lepied A, Bene J, Cousein E. Escitalopram-induced hepatitis: A case report. World J Clin Cases 2022; 10(8): 2468-2473 [PMID: 35434055 DOI: 10.12998/wjcc.v10.i8.2468]
Corresponding Author of This Article
Guillaume Wabont, PharmD, Pharmacist, Statistician, Department of Pharmacy, Valenciennes Hospital, Avenue Desandrouin, Valenciennes 59300, France. wabont.guillaume@gmail.com
Research Domain of This Article
Pharmacology & Pharmacy
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 16, 2022; 10(8): 2468-2473 Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2468
Escitalopram-induced hepatitis: A case report
Guillaume Wabont, Laurie Ferret, Nicolas Houdre, Antoine Lepied, Johana Bene, Etienne Cousein
Guillaume Wabont, Laurie Ferret, Etienne Cousein, Department of Pharmacy, Valenciennes Hospital, Valenciennes 59300, France
Nicolas Houdre, Department of Emergency Medicine, Valenciennes Hospital, Valenciennes 59300, France
Antoine Lepied, Department of Psychiatry, Valenciennes Hospital, Valenciennes 59300, France
Johana Bene, Department of Pharmacology, Lille University Hospital, Lille 59000, France
Author contributions: Wabont G wrote the manuscript; all authors contributed equally to this work and have read and approved the final manuscript.
Informed consent statement: The study participant provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors followed the CARE checklist guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guillaume Wabont, PharmD, Pharmacist, Statistician, Department of Pharmacy, Valenciennes Hospital, Avenue Desandrouin, Valenciennes 59300, France. wabont.guillaume@gmail.com
Received: August 11, 2021 Peer-review started: August 11, 2021 First decision: September 2, 2021 Revised: September 23, 2021 Accepted: February 9, 2022 Article in press: February 9, 2022 Published online: March 16, 2022 Processing time: 211 Days and 10.2 Hours
Abstract
BACKGROUND
The antidepressant escitalopram is widely prescribed for the treatment of depression. It is generally well-tolerated, and cholestasis is not mentioned in its summary of product characteristics (SmPC). We present a case of cholestatic and cytolysis liver injury due to escitalopram and a VigiBase® study.
CASE SUMMARY
A 68-year-old man was admitted to our emergency unit due to clinical jaundice associated with hepatitis, pruritus and dark urine. We tested the patient for the most common etiologies of jaundice, including hemolysis, viral hepatitis, cirrhosis, carcinoma, cholangitis, cholelithiasis and intrahepatic or extrahepatic obstruction. The etiological study was negative, and an adverse drug reaction was the sole possible explanation. The patient was receiving treatment with escitalopram. Two days after its withdrawal, pruritus was resolved. Ten days after withdrawal, clinical jaundice disappeared. It took a month and three weeks after withdrawal for the patient to have normalized liver function tests. To our knowledge, this is the first reported case of cholestasis where treatment with escitalopram was the only possible cause, with a highly probable causality. In addition, we determined whether escitalopram is associated with hepatotoxicity and cholestasis by performing a disproportionality analysis. All cases of hepatobiliary disorders induced by escitalopram and reported in the World Health Organization pharmacovigilance database (VigiBase®) were analyzed to characterize this toxicity. We found that patients treated with escitalopram had an increased risk of hepatitis [odds ratio (OR) = 1.938(1.186-3.166)] and cholestasis [OR = 1.866(1.279-2.724)] [OR (95% confidence interval)]. The median duration between the introduction of escitalopram and the occurrence of acute hepatitis and/or cholestasis was ten days +/- seven days.
CONCLUSION
Although extremely rare, this case report, the review of the literature and the pharmacovigilance update confirm that escitalopram can cause drug-induced hepatotoxicity and cholestasis, generally within a week after initiation. Thus, escitalopram should be withdrawn immediately if an iatrogenic cause cannot be excluded. If its responsibility is ascertained, escitalopram should be consequently contraindicated. In addition, serotoninergic antidepressants in patients with non-severe depression are ineffective and harmful. Finally, the SmPC of escitalopram should be updated to alert for this risk and give clear clinical guidelines.
Core Tip: The antidepressant escitalopram is widely prescribed for the treatment of depression. The article consists of a unique clinical case, a review of the literature and a pharmacovigilance analysis. This is the first clinical case of escitalopram as the only possible drug causing hepatitis and cholestasis. This is also the first pharmacovigilance analysis conducted to qualify and quantify the risk of hepatitis and cholestasis when using escitalopram.
