Associates' Presentations
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Acute hepatitis secondary to Prozac therapy.

Qiang Cai, M.D. (Associate), Michelle Bensen, M.D., Todd Talbot, D.O., Grace Devadas, M.D., Howard Swanson, M.D., John Olson, M.D., John Kirchner, M.D., Marshfield Clinic/St. Joseph's Hospital, Marshfield, Wisconsin

Hepatotoxicity is one of the known adverse effects of fluoxetine (Prozac) (Cooper GL, 1988). It usually presents as elevation of liver enzymes without clinical symptoms. Prozac induced hepatitis is not a well known side effect. To our knowledge, there are only three cases of Prozac related acute hepatitis published to date. Whether it is a truly rare phenomena or it has not been well recognized is unknown. Since Prozac is a commonly prescribed medicine we report two cases of acute hepatitis secondary to Prozac treatment in order to alert others to this possible relationship.

Our two patients were middle-age and presented with acute abdominal pain, jaundice, elevation of liver transaminases, total bilirubin and alkaline phosphatase. Both had taken Prozac for several months before the above presentation. Extensive laboratory testing to include viral hepatitis serologies, iron and autoimmune assays were normal or negative. Abdominal ultrasound and ERCP failed to find gallstones in either patient. With discontinuation of Prozac, symptoms improved slowly. One patient's liver function tests became normal about six months after discontinuation of Prozac. The other one still has abnormal liver function tests, since Prozac was discontinued only one month ago. Liver biopsy and Prozac-rechallenge were not performed in these two cases.

Of the five known cases four presented with painful jaundice. Each had taken Prozac for several months (1.5-6 months) prior to presentation. Improvement of liver function tests occurred at least one month after discontinuation of Prozac (4 out of 5 patients). Suspicion and early discontinuation of Prozac is recommended as long term effects on the liver are unknown.

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